原发性开角型青光眼患者外路巩膜静脉窦精准定位方法  

Ab-externo precise localization of Schlemm’s canal in patients with primary open-angle glaucoma

作　　者：彭俊杰 刘姗姗 周玉娟 范晓军 王一涵 杨蕾 王继兵 PENG Junjie;LIU Shanshan;ZHOU Yujuan;FAN Xiaojun;WANG Yihan;YANG Lei;WANG Jibing(Weifang Medical University,Weifang 261053,Shandong Province,China;Weifang Eye Hospital,National Key Clinical Specialty of Ophthalmology,Weifang 261041,Shandong Province,China)

机构地区：[1]潍坊医学院,山东省潍坊市261053 [2]潍坊眼科医院(国家临床重点专科),山东省潍坊市261041

出　　处：《眼科新进展》2023年第9期732-735,共4页Recent Advances in Ophthalmology

摘　　要：目的探讨原发性开角型青光眼(POAG)患者外路巩膜静脉窦精准定位方法。方法选取2020年8月至2021年10月于潍坊眼科医院就诊,确诊为POAG需行外路巩膜静脉窦相关手术治疗的患者40例(40眼)。根据术中测量方法不同将患者随机分为两组,每组各20例(20眼)患者。高清图像组患者采用显微镜截取高清图像后划线测量;无菌图纸组患者采用测绘圆规标记于无菌图纸后完成显微镜下测量。采用角巩膜分光照明法标记巩膜床半透明与不透明组织交界线并将其作为基线,内窥镜光纤前房内透照可于巩膜床清晰透见巩膜静脉窦返流血带,定位巩膜静脉窦后完整切除其外侧壁进行相关指标的长度测量。术前采用IOL-Master记录患者白到白距离(WTW)、眼轴长度(AL),术中测量患者巩膜静脉窦宽度(SW)、基线到巩膜静脉窦后缘距离(d1)、球结膜反折线到巩膜静脉窦前缘距离(d2)、基线到球结膜反折线距离(d3);分析各指标间差异及相关性。结果高清图像组患者d2[(1.85±0.28)mm]和d3[(2.63±0.30)mm]均高于无菌图纸组[分别为(1.61±0.37)mm和(2.41±0.38)mm],差异均有统计学意义(均为P<0.05)。高清图像组和无菌图纸组患者WTW、d1与AL均呈正相关关系(均为P<0.05),d1、d2与d3亦均呈正相关关系(均为P<0.05),其余指标间均无明显相关性(均为P>0.05)。将40眼按照AL不同划分为3组:AL<23 mm为短眼轴组,23 mm≤AL<25 mm为中眼轴组,AL≥25 mm为长眼轴组。短、中、长眼轴组患者d1分别为(0.30±0.08)mm、(0.37±0.10)mm、(0.57±0.09)mm,组间差异有统计学意义(F=14.915,P<0.05);长眼轴组患者d1较短、中眼轴组更长(均为P<0.05)。结论采用内透照法可于深层巩膜床上清晰透见巩膜静脉窦返流血带从而实现术中对巩膜静脉窦的精准定位;d1与POAG患者AL呈正相关关系。Objective To investigate the ab-externo approach for the precise localization of the Schlemm’s canal(SC)in patients with primary open-angle glaucoma(POAG).Methods A total of 40 POAG patients(40 eyes)who underwent ab-externo SC-related surgeries in Weifang Eye Hospital from August 2020 to October 2021 were selected.According to the intraoperative measuring method,the patients were randomly divided into the high-definition(HD)image group and the sterile drawing group,with 20 patients(20 eyes)in each group.In the HD image group,HD images of the surgical area were captured by a microscope for measurement of the distance between loci.In the sterile drawing group,the loci were marked on the sterile drawing with a mapping compass under the microscope before measurement of their distance.The boundary line between the semitransparent and non-transparent tissues was marked by the sclerotic scatter and used as the base line(BL).A blood reflux band of SC was found on the scleral bed by the transillumination in the anterior chamber with the fiber optic endoscope.The outer wall of SC was removed completely during the operation for measuring related indexes,such as the width of SC(SW),the distance between the BL and the posterior edge of SC(d 1),the distance between the conjunctival insertion line(CIL)and the anterior edge of SC(d 2),and the distance between the BL and the CIL(d 3).The white-to-white(WTW)distance and axial length(AL)were measured with IOL-Master before surgery.Differences and correlations among these indexes were analyzed.Results d 2[(1.85±0.28)mm]and d 3[(2.63±0.30)mm]in the HD image group were higher than those[d 2:(1.61±0.37)mm and d 3:(2.41±0.38)mm]in the sterile drawing group,and the differences were statistically significant(both P<0.05).WTW and d 1 were positively correlated with AL(both P<0.05),d 1 and d 2 were positively correlated with d 3(both P<0.05)in both groups,while the rest indexes had no significant correlation(all P>0.05).The 40 eyes were divided into 3 groups according to AL:short AL g

关 键 词：巩膜静脉窦 外路巩膜静脉窦精准定位 角巩膜分光照明法 内透照法 原发性开角型青光眼 

分 类 号：R775[医药卫生—眼科]