眼B超诊断早期视网膜裂孔

目的 探讨利用眼B超技术早期发现视网膜裂孔的临床价值.方法 收集2008年9月至2009年5月期间采用全方位纵向扫描B超探查首诊发现的可疑视网膜干性裂孔68只眼,经三面镜散瞳眼底检查进一步明确诊断.分析B超判断早期视网膜裂孔的正确性,及其图像特征.确诊为裂孔者行激光封孔术,术后一月随访裂孔封闭情况.结果 B超可疑视网膜裂孔 68只眼中,经眼底检查确诊视网膜裂孔44只眼,阳性率66%.其中有突发性视糊、闪光主诉者24只眼(55%),近视屈光度≥-6D者14只眼(32%).裂孔均为马蹄形,大多位于赤道部之前(63只眼,占93%),颞上象限多见(23只眼,占50%).B超表现为周边部球壁前中粗短弧形或短带状回声,带宽类似视网膜厚度或略粗,游离端多见玻璃体后脱离的细带状回声与之牵引.非裂孔24只眼(35%),病变处可见积血机化、变性区或玻璃体混浊黏连.所有裂孔均即刻行激光封孔术,2例因裂孔过于周边和视网膜下积液转行巩膜冷冻外加压手术.术后一月复查,所有术眼裂孔封闭良好,视网膜平伏.结论 全方位纵向扫描眼B超探查,有助于早期发现周边部视网膜裂孔,对其及时激光治疗和预防孔源性视网膜脱离具有重要价值.

Ultrasonography in early detection of retinal tear

Objective To explore the clinical value of B-scan application in early detection of retinal tear. Methods Of 68 eyes ranged from Sep 2008 to May 2009 suspected as dry retinal tear by full range longitudinal B-scan were examined by Goldman three-mirror fundus examination adter pupil dilatation for further diagnosis. The accuracy of B scan in early detection of the retinal tears, and describe the image characteristic was evaluated. The patients confirmed retinal tears underwent laser coagulation, the tears were observed by one month follow-up. Results All 44 out of 68 eyes which were suspected as retinal tears by B-scan were confirmed the diagnosis by fundus examination, the positive rate was 66%. Within these patients, 24 cases (55%)complained for sudden blur vision or flash, 14 eyes (32%) were myopia with the refractory degree -6 D. All the tears were horseshoe-shaped, mostly located in front of the equator (63 eyes, 93%), and often occurred in the superior temporal quadrant (23 eyes, 50%). B-scan showed a short curve or filate echogenic line with a moderate thickness similar to the retinal or slightly thicker in front of peripheral wall of eyeballs. The proximal free end was mostly tracted by posterior vitreous detachment. Among 24 (35%) cases which were ruled out for tears, vitreous hemorrhage with proliferation, degeneration, and vitreous opacity adhesion were found. The tears were closed successfully after laser coagulation as soon as the diagnosis were confirmed, except that 2 peripheral tears companied with sub-retinal fluid were ineffective by laser therapy and then changed to scleral cryotherapy and buckling surgery. At 1 month follow-up, the tears were well encircled by pigments, and no retinal detachment occurred. Conclusions The full range longitudinal B-scan technology is helpful for early detection and treatment of peripheral retinal tears, and is valuable for the prevention of rhegmatogenous retinal detachment.