隐匿性后巩膜裂伤的B超诊断

目的探讨眼表无伤口而临床可疑后巩膜裂伤患者进行眼部B超扫描的意义。方法对临床可疑后巩膜裂伤36例（36只眼）进行常规B超检查，观察玻璃体腔及球后影像学变化。结果B超显示玻璃体明显积血浑浊者36只眼，占100％。合并出血性脉络膜脱离者29只眼，占80．56％。合并视网膜脱离者13只眼，占36．11％，8眼B超诊断后巩膜裂伤，表现为后部眼球壁弧度异常，或眼球壁回声不连续，眼球后相应部位可见大小不等的低回声眶内出血暗区。可疑部位均在中周部眼球壁。B超诊断后巩膜裂伤8眼经手术或病理证实均存在巩膜裂伤。结论对于重度眼部钝击伤，角膜及结膜无明显裂伤，但球结膜下大片出血灶，尤其是伴低眼压者，应常规行B超检查以排除后巩膜裂伤，以免贻误最佳手术时间。

Diagnosis of occult posterior scleral rupture with B-scan ocular ultrasonography

Objective To assess the value of the B-scan ocular ultrasonography in patients with no ocular surface wounds and suggestive of posterior scleral rupture. Methods Thirty-six eyes of 36 patients suggestive of posterior scleral rupture were examined with B-scan to observe the images of posterior segment of eyeball and retrobulbar contents. Results In 36 cases, the major radiographic signs included vitreous hemorrhage（ 36 eyes, 100% ） , hemorrhagic ehoroidal detachment （ 29 eyes, 80.56% ） , retinal detachment （ 13 eyes,36.11% ）. The images of 8 eyes with occult posterior scleral rupture diagnosed by B-scan ocular ultrasonography showed the changes of globe contour, interruption of occular ring, or the uneven low echo area in middle peripheral eyeball. The occult posterior scleral ruptures in these 8 eyes were confirmed by surgeries or pathological examinations. Conclusion For patients diagnosed as severe ocular contusion, who present with large subconjunctival hemorrhage, no wounds in cornea or selera, especially with low intraoeular pres- sure, B-scan ocular uhrasonography is necessary to detect occult posterior scleral rupture to avoid delaying the optimal surgical timing.