中华眼科杂志 1998年第6期第0卷 论著
作者：庞秀琴 周军 王文伟 杨文利
单位：100730 首都医科大学附属北京同仁医院眼科
关键词：超声生物显微镜；睫状体脱离
【摘要】 目的 评价超声生物显微镜(ultrasound biomicroscope,UBM)在挫伤性睫状体脱离复位手术中的应用价值。方法 对33例经UBM检查证实为睫状体脱离的患者进行手术分析评价，并回顾总结单纯应用前房角镜检查施行睫状体复位83例的手术效果。结果 经UBM检查33例中,一次手术眼压恢复正常者31例,占94%;二次手术成功率100%。前房角镜检查83例,一次手术成功68例,占82%,二次手术成功率94%;三次手术成功率96%。结论 UBM检查对于前房角镜下不能看到的小而窄的睫状体脱离可提供精确的数据,对诊断、指导手术缝合范围及术后效果追踪观察等有重要的临床应用价值。减少了手术的次数及盲目性,提高了一次手术的成功率。
Application of ultrasound microscope for the reattachment surgery of detachment of ciliary body Pang Xiuqin, Zhou Jun, Wang Wenwei, et al. Department of Ophthalmology, Affiliated Tong Ren Hospital, Capital Medical University, Beijing 100730
【Abstract】 Objective To evaluate the advantages of ultrasound biomicroscope (UBM) used for the reattachment surgery of traumatic ciliary body detachment.Mehtods 33 cases diagnosed by UBM as ciliary body detachment were studied. The surgical results of these cases were analyzed and compared with that of 83 cases which were simply diagnosed by a gonioscope.Results 31 of the 33 cases regained the normal intraocular pressure (IOP) after once of operation (94%), and all cases achieved successful results after twice of operation (100%). Of the 83 cases examined only by gonioscopy, the rates of reaching normal IOP after the 1st, 2nd and 3rd operations were 82%, 94% and 96% respectively.Conclusions These results suggest that the UBM be useful for the tiny and narrow detachment of ciliary body which can not be seen by a gonioscope. UBM has important clinical value in diagnosis, guide to the range of suture and follow-up observation. With the use of UBM, the frequency of operation necessary for surgical success and blindness in action in the operation will be reduced, and the successful rate of once of operation will be increased significantly.
【Keywords】 Ultrasound biomicroscope Ciliary body
挫伤性睫状体脱离由于前房浅、眼压低、角膜皱褶等影响, 完全依靠前房角镜检查确定手术范围有一定困难。近几年国内引进的超声生物显微镜(ultrasound biomicroscope,UBM),是一种新型超声诊断仪器, 由于其分辨率高,可以清楚地显示眼前段组织结构,对于睫状体脱离的范围、离断口以及脉络膜上腔积液等均可在图像上一目了然,为手术复位拟定缝合范 围及手术的成功提供了可靠保证。现将我院116例经两种检查方法行睫状体复位术的手术效果进行分析,以评估UBM的临床应用价值。
资料与方法
1.对象:有眼部挫伤病史,结合临床检查,诊断为睫状体脱离者116例, 包括近年经UBM证实为睫状体脱离、结合房角镜检查的33例,以往单纯应用房角镜检查的83例。 所有患者均施行睫状体直接缝合复位术。男性92例,女性24例。年龄7～55岁,平均31.8岁。右眼55例, 左眼61例。病史10天至7年不等,其中伤后2个月以内手术者54例(46.6%),半年以上手术者25例(21.6%)。3例曾在外院行睫状体复位术,2例行氩离子激光,手术均失败。术前视力0.1以下者71例。眼压均低于正常,其中＜0.53 kPa(1 kPa=7.5 mmHg)79例。合并晶体半脱位、外伤性白内障、玻璃体混浊、脉络膜破裂等共40例。
2.方法:前房角镜检查的83例中,不能看到睫状体离断口者14例,手术则根据瞳孔尖端的时钟方位向两端扩大2个时限或先缝合上半周,术后若眼压不恢复,酌情再缝合下半周［1］。33例经UBM检查均可见离断口,手术范围在离断口两端各扩大0.5～1.5时限,间断缝合,针距1.0～1.5 mm。
[1] [2] 下一页 |
