【作者】 王小强；

【导师】 汤欣；

【作者基本信息】 天津医科大学 ， 眼科学（专业学位）， 2014， 博士

【摘要】 目的：探讨眼前节光学相干断层扫描(AS-OCT)与眼超声生物显微镜(UBM)在诊断睫状体脱离中的临床应用价值,为丰富及优化临床检查选择提供依据。评价一种新的改良睫状体缝合复位术与传统的睫状体缝合复位术治疗外伤性睫状体脱离的临床效果,为优化手术方案提供依据。检测外伤性睫状体脱离患者睫状体上腔渗液中interleukin-6(IL-6)、tumor necrosis factor-alpha(TNF-α)的含量,探讨其在睫状体脱离发生发展中的作用,为临床治疗促使睫状体脱离复位提供思路。方法：1临床病例对照研究。外伤性睫状体脱离病人30例入组,每个病例均采用房角镜、UBM和AS-OCT三项检查,其中任意一项检查发现睫状体脱离即可确诊。比较UBM和AS-OCT诊断睫状体脱离的阳性率,应用SPSS配对χ2检验进行统计分析,探讨其不同机制及优劣。2临床随机对照研究。行手术治疗的外伤性睫状体分离患者23例,随机分为2组。传统组11例,改良组12例,传统组行传统睫状体脱离缝合复位术,改良组行改良的睫状体缝合复位术。比较两组术后睫状体复位情况、眼压及视力,进行统计分析,评价疗效。注意两组临床资料的匹配情况。统计方法采用SPSS16.0统计软件,术前术后两组睫状体脱离情况的比较采用四格表资料的确切概率法(Fisher’s exact test),术前术后两组眼压、视力对比采用配对资料t检验。两组间术后睫状体复位情况、眼压、视力比较分别四格表资料的确切概率法(Fisher’s exact test)和独立样本t检验。3实验研究。于天津市眼科医院住院行手术治疗并成功取得检测样本的外伤性睫状体脱离患者12例,取其睫状体上腔渗液作为实验组,取其自身血清作为对照组,应用酶联免疫吸附试验法检测两组的interleukin-6(IL-6)、tumor necrosis factor-alpha(TNF-α)含量,应用SPSS统计软件计量资料配对t检验进行统计学分析。结果：1房角镜组、UBM组、AS-OCT组三组检查睫状体脱离阳性率分别为63.33%、100%、60%,其中UBM检查组与房角镜组、AS-OCT组相比差异均具有统计学意义(P值分别为0.001、0.000,均<0.05),而房角镜组与AS-OCT组比较差异无统计学意义(P值=1.000,>0.05)。2传统睫状体缝合复位组中11例有10例一次手术复位成功,改良睫状体缝合复位组中12例全部一次手术复位成功,两组术前术后比较差异均有统计学意义(P<0.05),两组复位率分别为90.9%(10/11)、100%(12/12),两组间复位率比较差异无统计学意义(P>0.05)。两组术后眼压较术前均有明显回升,差异均有统计学意义。传统睫状体缝合复位组及改良睫状体缝合复位组术前平均眼压分别为6.45±1.58mmHg、6.78±1.43mmHg,术后两组平均眼压均有回升,分别达到了13.35±2.08mmHg、14.57±2.96mmHg,两组术前术后差异比较具有统计学意义(传统组t=-12.34,P<0.01；改良组t=-11.85,P<0.01),但两组间术后2周眼压值比较差异无统计学意义(t=-1.17,P>0.05)。传统睫状体缝合复位组及改良睫状体缝合复位组术前视力分别为0.25±0.21、0.29±0.23,术后2周分别为0.42±0.26、0.45±0.21,其中视力>0.3者分别达到了63.6%、66.6%,与术前比较差异具有统计学意义(传统组t=-5.27,P<0.01；改良组t=-5.89,P<0.01)。两组间术后2周视力比较差异无统计学意义(P>0.05)。3本组睫状体脱离患者IL-6的含量在睫状体上腔渗液和自体血清中分别为70.25±58.64pg/ml、6.29±1.25pg/ml,TNF-α的含量在睫状体上腔渗液和自体血清中分别为18.59±5.75pg/ml、8.93±1.82pg/ml。睫状体脱离患者的睫状体上腔渗液中IL-6、TNF-α的含量均高于自体血清中IL-6、TNF-α的含量,差异均有统计学意义(P<0.05)。结论：眼前节OCT与UBM比较并无明显诊断优势,但其为非接触式检查,为睫状体脱离提供了新的检查手段,尤其是对于一些不适于房角镜和UBM等需行接触式检查的患者及对检查过程中舒适度要求比较高的患者；传统的睫状体缝合复位术和改良的睫状体缝合复位术均能有效复位睫状体,眼压、视力等指标均有改善,取得了良好的效果,但改良术式较传统术式操作相对简化,费时更少,应用范围更宽,效果确切。外伤性睫状体脱离患者睫状体上腔渗液中IL-6与TNF-α的含量均高于自身血清中的含量,提示两者可能参与了睫状体上腔渗液形成发展的过程,在其中发挥了作用,为防治睫状体脱离提供了新的思路和切入点。更多还原

【Abstract】 Objective:To evaluate the effect of anterior segment optical coherence tomography (AS-OCT) and intraocular ultrasound biomicroscopy (UBM) in the diagnosis of traumatic cyclodialysis in order to optimize the clinical examination and to evaluate the clinical effects of an improved cyclopexy and the traditional cyclopexy in the treatment for traumatic cyclodialysis for optimizing surgical options. To detect interleukin-6(IL-6), tumor necrosisfactor-alpha (TNF-a) level in ciliary body cavity exudate of patients with traumatic cyclodialysis, and explore its role in the development of detachment of ciliary body, provide ideas for prevention and treatment of cyclodialysis.Methods:1Clinical case-control study.30patients of traumatic cyclodialysis were enrolled. Each case was used gonioscopy, UBM and AS-OCT to confirm the ciliary body detachment. Positive rate of UBM and AS-OCT in the diagnosis of traumatic cyclodialysis was compaired using paired χ2, test of SPSS.2A randomized controlled clinical study.23patients receiving operation for traumatic cyclodialysis were randomly divided into2groups. The traditional group was11cases, the improved group was12cases. Recording their restoration of ciliary body, preoperative and postoperative intraocular pressure and visual acuity. SPSS statistical software was used for statistical analysis.312patients with traumatic ciliary body detachment underwent surgical operation were enrolled in this study and samples were successfully obtained. The ciliary body cavity effusion is as the experimental group and the autologous serum as the control group. IL-6and TNF-a were analysed using ELISA assay in two groups, using SPSS statistical software paired t test for statistical analysis.Results:1The positive rate of ciliary body detachment of gonioscopy group, UBM group and AS-OCT group was respectively63.33%,100%,60%. The differences were statistically significant (P=0.001,P=0.0000respectively, P<0.05)between the UBM group and the gonioscopy group, the UBM group and AS-OCT group, but there was no statistical significance between the gonioscopy group and the AS-OCT group (P value=1.000,>0.05).290.9%(10/11) patients in the traditional group and100%(12/12) patients in the improved group successfully reset the ciliary body after operation, which has significant difference in statistical significance compared with that of preoperative(P <0.05),but there was no statistical significance between the. two groups postoperatively (P>0.05). The mean preoperative IOP was6.45±1.58mmHg in the traditional group and6.78±1.43mmHg in the improved group.which reached13.35±2.08mmHg and14.57±2.96mmHg respectively on average2weeks after operation.The difference in both the two groups has statistical significance(traditional group:t=-12.74,P<0.01; improved group:t=-11.85,P<0.01). but there was no statistical significance between the two groups postoperatively (t=-1.17,P>0.05). Visual acuity was increased from0.25±0.21in the traditional group and0.29±0.23in the improved group preoperatively to0.42±0.26and0.45±0.21respectively after operation, in which the vision>0.3reached63.6%and66.6%respectively and the difference has statistical significance(traditional group:t=-5.27, P<0.01; improved group:t=-5.89,P<0.01). There was no statistical significance between the two groups postoperatively (P>0.05).3The content of IL-6was70.25±58.64pg/ml in the experimental group,6.29±1.25pg/ml in the control group. The content of TNF-a was18.59±5.75pg/ml,8.93±1.82pg/ml respectively. The content of IL-6and TNF-a in ciliary body cavity effusion was higher than that of in serum,and the difference had statistical significance on average2weeks after operation.The difference in both the two groups has statistical significance (P<0.05)Conclusions:Anterior segment OCT has no obvious advantage compared with UBM, but it provides a new means of inspection for the detachment of ciliary body, especially for some patients not suitable for gonioscopy and UBM and those demanding for better comfort in the examination. Both the traditional direct cyclopexy and the improved cyclopexy can effectively reset ciliary body with intraocular pressure and visual acuity improved, but the latter is relatively simplified, time saving and it is hopefully getting more applications in more cases. IL-6and TNF-a levels in ciliary body cavity effusion were higher than that in serum, suggesting that they may be involved in the formation and/or development of the effusion,which provide new ideas for prevention and treatment of cyclodialysis.更多还原