超声生物显微镜在改良二氧化碳激光辅助深层巩膜切除术后长期随诊中的应用  

Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO_(2) Laser-assisted Sclerectomy Surgery

作　　者：张扬[1] 周崎[1] 张顺华[1] 李略[1] 卞爱玲[1] 刘丽英[1] 姜茹欣[1] 程钢炜[1] ZHANG Yang;ZHOU Qi;ZHANG Shunhua;LI Lüe;BIAN Ailing;LIU Liying;JIANG Ruxin;CHENG Gangwei(Department of Ophthalmology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院眼科,北京100730

出　　处：《中国医学科学院学报》2021年第5期749-754,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的观察超声生物显微镜(UBM)在改良二氧化碳激光辅助深层巩膜切除术(CLASS)治疗原发性开角型青光眼术后两年随诊中的作用。方法采用病例系列研究方法。对28例(28只眼)药物治疗眼压失控的原发性开角型青光眼患者实施术前虹膜激光预处理的改良CLASS手术,记录术前及术后2年内随访的最佳矫正视力、眼压、裂隙灯检查、视野、房角镜检查结果,术后1、3、12、24个月行UBM检查。结果患者术前平均眼压为(30.61±10.59)mmHg(1 mmHg=0.133 kPa),术后1、3、6、12、24个月的平均眼压分别为(15.15±5.87)、(12.56±3.24)、(13.15±2.73)、(13.75±2.55)、(13.75±2.46)mmHg,术后各时间点眼压均明显低于术前(P均<0.001)。术后12、24个月手术绝对成功率和相对成功率分别为60.71%、89.29%和53.57%、85.71%。成功CLASS术后UBM呈现海豚头征。术后1个月小梁狄氏膜窗厚度为(0.13±0.03)mm,与术后12(r=-0.278,P=0.144)、24个月(r=0.026,P=0.895)眼压无显著相关性;巩膜池面积缩小范围超过50%的病例在术后12个月有1只眼(3.57%),在术后24个月有3只眼(10.71%);术后巩膜池的大小与术后眼压无显著相关性。术后12、24个月分别有16(57.14%)、25只眼(89.28%)为非功能性滤过泡。术后24个月有2只眼(7.14%)发生严重周边虹膜前黏连,需手术干预。结论UBM在改良CLASS术后随诊中可有效地观察巩膜池、房角及滤过泡的形态,早期提示并发症的发生;UBM监测下巩膜池的存在为保障CLASS手术的成功发挥重要作用。Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO_(2) laser-assisted sclerectomy surgery(CLASS).Methods This was a case series study.A combination of modified CLASS and preoperative laser iris management was administered to 28 eyes.Visual acuity,intraocular pressure(IOP),and slit-lamp examinations,visual field testing,and gonioscopy were carried out at baseline and until 24 months postoperatively.UBM examination was performed at 1,3,12 and 24 months postoperatively.Results Compared with the mean preoperative IOP[(30.61±10.59)mmHg],the IOP at each time point after operation was significantly lowered[(15.15±5.87),(12.56±3.24),(13.15±2.73),(13.75±2.55)and(13.75±2.46)mmHg at 1,3,6,12 and 24 months,respectively;all P<0.001].Complete success rates and qualified success rates at 12 months and 24 months were 60.71%,89.29%and 53.57%,85.71%,respectively.UBM images can present“dolphin head sign”after successful CLASS.The thickness of trabeculo-Descemet’s window was(0.13±0.03)mm,which had no significant correlation with postoperative IOP at 12(r=-0.278,P=0.144)and 24 months(r=0.026,P=0.895).UBM examination revealed a severe scleral lake diminution(a change>50%)in 1 eye(3.57%)at 12 months and 3 eyes(10.71%)at 24 months.There was no statistical significance detected between the size of the scleral lake and IOP after CLASS.Non-founctional blebs were found in 16 eyes(57.14%)at 12 months and 25 eyes(89.28%)at 24 months.Two eyes(7.14%)demonstrated severe peripheral anterior synechiae at 24 months,requiring surgical intervention.Conclusions UBM can effectively observe the morphology of the scleral lake,anterior chamber angle and filtering blebs in post-operative follow-up after modified CLASS,and give early warning of complications.It plays an important role in ensuring the success of CLASS.

关 键 词：超声生物显微镜 青光眼 巩膜切除术 二氧化碳激光辅助 改良 

分 类 号：R775.2[医药卫生—眼科]