【作者】 朱睿玲；

【导师】 曾军；

【作者基本信息】 中南大学 ， 眼科学， 2009， 硕士

【摘要】 目的观察玻璃体切割联合硅油填充术眼的超声生物显微镜影像特征,并探讨其在硅油填充术后的临床应用价值。方法对硅油填充术后（＞3月）的154例（154只眼）患者进行超声生物显微镜检查并进行图像分析:（1）记录玻璃体切割联合硅油填充术眼的硅油乳化、分布及组织浸染情况;（2）记录玻璃体切割联合硅油填充术眼的眼前节增殖情况;（3）记录玻璃体切割联合硅油填充术后慢性低眼压组眼前段组织结构变化。结果1、154只眼硅油填充术后25只眼发生高眼压。眼压升高出现在玻璃体切割硅油填充术后3～24个月,平均为10.7个月。其中4只眼发生于术后3个月内,10只眼发生于术后6个月内,16只眼发生于术后12个月内,25只眼发生于术后24个月内,随着眼内硅油填充时间的延长,高眼压的患病率呈上升趋势。2、154只眼硅油填充术后86只眼发现硅油乳化,其中23只眼在硅油填充＞3月后发生高眼压,占26.7%;无硅油乳化68只眼,其中2只眼发生高眼压,占2.9%,组间比较有显著性差异（X²=15.822,P＜0.05）。说明硅油乳化组的高眼压发生率高于无硅油乳化组。进一步比较硅油乳化眼与高眼压眼两者的相关性（r=0.321,P＜0.05）,有统计学意义,说明硅油乳化的发生和高眼压的发病率呈中度相关。3、154只眼硅油填充术后16只眼发生低眼压。眼压降低出现在玻璃体切割硅油填充术后1～6个月,平均为2.1个月。其中4只眼发生于术后1个月内,8只眼发生于术后1～2个月,2只眼发生于术后2～3个月,1只眼发生于术后3～6个月,1只眼发生于术后6～12个月。以术后2月为分界线,合并成两组,比较术后2月内及3～12月内低眼压的发生情况（X²=4.219,p＜0.05）,差异有统计学意义。说明低眼压常发生在术后2个月内。4、154只眼硅油填充术后17只眼发现前部增殖性玻璃体视网膜病变,发生率约为11%。其中轻度玻璃体前部增殖9只眼,视网膜环形收缩（aPVRC₄型）3只眼,视网膜前移位（aPVRC₅型）5只眼。5、低眼压组16只眼,发现睫状体脉络膜脱离14（14/16=88%）只眼,其中11只眼（11/16=69%）存在aPVR,增殖范围均＞90°。6、对硅油填充术后低眼压组眼前段结构进行测量,并进行患眼与对侧健眼的参数比较,结果显示:低眼压眼、对侧健眼各值间差异有显著性（中央前房深度、房角开放距离、小梁虹膜夹角t检验值分别为37.218,42.554,23.478,P＜0.05）。结论1、硅油填充术后高眼压的发生及严重程度与硅油存留时间成正向关系。对于出现硅油乳化的患者,尽早取出硅油是防止高眼压发生的有效措施。2、UBM在观察硅油填充术后玻璃体基底部及其附近组织结构的变化起重要作用,对硅油充填术后低眼压及aPVR患者再次手术术式、时机的选择有较大帮助。更多还原

【Abstract】 [Objectivel:To observe ultrasound biomicroscopy(UBM) image characteristics of eyes taken pars plana vitrectomy with Silicone Oil tamponade.To investigate clinical value of ultrasound biomicroscopy in the operation of Silicone Oil tamponade.[Methods]:154Cases(154eyes) silicone oil tamponaded eyes(＞3 months) were measured by UBM and the images were analyzed.Following conditions of the eyes taken pars plana vitrectomy with Silicone Oil tamponade were recorded:(1)emulsification,distribution and tissues tincture(2) proliferation of anterior eye segment;(3) tissue changes of the anterior eye segment of chronicity ocular hypotension.[Results]:1.Ocular hypertension happened to 25 eyes among the 154 silicone oil tamponaded eyes.Intraocular pressure advanced at 3-24 months after the pars plana vitrectomy with Silicone Oil tamponade.The average time was 10.7 months.Among the total,there was 4 eyes took place within 3 months,10 eyes happened within 6 months,16eyes took place within 12 months,and 25eyes happened within 24 months.The incidence rate of ocular hypertension rose with the time of silicone oil tamponade.2.Emulsification of silicone oil happened to 86 eyes among the 154 silicone oil tamponaded eyes.Ocular hypertension took place in 23 eyes among them after more than 3 months,it occupied 23%.Another 68 eyes free of emulsification,ocular hypertension happened to 2 eyes,it occupied 2.9%.There were significant difference between this two groups(X2=15.822,P＜0.05).3.Ocular hypotension happened in 16 eyes among the 154 silicone oil tamponaded eyes.Decrease of intraocular pressure appeared at 1-6 months after the surgery,the average time was 2.1 months.5 eyes among them within 1 month,8 eyes happened after 1-2 months,2 eyes happened after 2-3 months,1 eye happened after 3-6 months.The crest-time of ocular hypotension was within 2 months.4.anterior proliferative vitreoretinopathy(aPVR) happened to 17 eyes among the 154 silicone oil tamponaded eyes,it occupied 11%. Among them 9 eyes were slight anterior Vitreous Body proliferation,3 eyes were retinal circumduction(aPVRC4),5 eyes were anterior displacement(aPVRC5).5.There were 16 eyes of ocular hypotension,14 eyes among them happened ciliary choroidal detachment(14/16=88%).11 eyes among them had aPVR(11/16=69%),the proliferative scope was more than 90 degree. 6.Anterior segments of ocular hypotension after silicone oil tamponade were measured by UBM,The comparision was took between sick eye and opposite normal eye.The result was that there were significant difference between ocular hypotension eye and the opposite normal eye(t=37.218,42.554,23.478,P＜0.05)[Conclusions]:1.Occurrence and graveness of ocular hypertension after silicone oil tamponade had forward direction with the time of silicone oil persistence.Extraction of silicone oil as early as possible to the patients with silicone oil emulsification was effective step.2.UBM played an important part in observing changes of basilar part of vitreum and vicinal tissues.It was helpful to select way and time to reoperation to the patients of ocular hypotension after silicone oil tamponade and aPVR.更多还原