摘要
目的探讨眼前节相干光层析成像术(AS-OCT)与超声生物显微镜(UBM)在急性期圆锥角膜的影像学诊断价值,分析引起角膜水肿发生发展的因素,明确发病部位、厚度、范围等。方法回顾性病例研究。选取2016年5月至2020年8月在河北省眼科医院就诊的急性期圆锥角膜患者20例(20只眼),对其AS-OCT和UBM图像特征进行回顾性分析。结果急性期圆锥角膜的AS-OCT和UBM影像均表现为角膜后弹力层破裂,基质层水肿增厚,其内形成裂隙与前房沟通。AS-OCT影像显示角膜上皮完整,上皮下积液13例(13只眼);UBM影像显示角膜后弹力层界面分层17例(17只眼)。后弹力层裂孔小于2 mm者共11例(11只眼),其中深板层角膜移植术后1周矫正视力小于0.1者1例(1只眼),0.1~0.2者6例(6只眼),0.3~0.4者4例(4只眼)。后弹力层裂孔大于2 mm者9例(9只眼),其中7例(7只眼)深板层角膜移植术后1周矫正视力小于0.1,2例(2只眼)为0.2。20例(20只眼)均未发现角膜穿孔,在深板层角膜移植术后愈合阶段,会出现明显的基质层瘢痕,伴有角膜基质层增厚和角膜变平。结论在急性期圆锥角膜,AS-OCT可以显示完整的角膜上皮,上皮下积液;UBM可以显示角膜后弹力层界面分层。AS-OCT与UBM可以相互补充,提供精准的角膜影像学图像及参数测量,对病情的发展进行预测和评估,指导临床治疗。
Objective To analyze the diagnostic value of anterior segment optical coherent tomography(AS-OCT)and ultrasound biomicroscope(UBM)in acute keratoconus,to explore risk factors for corneal edema,to clarify the site,thickness and scope of lesion,and to provide reference for further clinical treatment.Methods A total of 20 patients(20 eyes)with acute keratoconus who were treated in Hebei Eye Hospital from May 2016 to August 2020 were selected.The characteristics of AS-OCT and UBM images were retrospectively analyzed.Results Both AS-OCT and UBM images of patients with acute keratoconus showed rupture of the Descemet's membrane,edema and thickening of the corneal matrix,with fissures communicated with the anterior chamber.AS-OCT images showed intact corneal epithelium and subcutaneous effusion in 13 eyes.UBM images showed laminated Descemet's membrane in 17 eyes.The Descemet's membrane fractures less than 2 mm were found in 11 patients(11 eyes),among whom the corrected vision at 1 week after deep lamellar keratoplasty was less than 0.1 in 1 patient(1 eye),0.1 to 0.2 in 6 patients(6 eyes),0.3 to 0.4 in 4 patients(4 eyes).The Descemet's membrane fractures larger than 2mm were found in 9 patients(9 eyes),among whom the corrected vision at 1 week after deep lamellar keratoplasty was less than 0.1 in 7 patients(7 eyes),and 0.2 in 2 patients(2 eyes).No corneal perforation was found in 20 patients(20 eyes).During the healing phase,scarring in the cornea matrix layer with matrix layer thickening and cornea flattening was observed.Conclusions In the acute stage of keratoconus,AS-OCT images may clearly display the intact corneal epithelium and the subcutaneous effusion.UBM images show the layering of the Descemet's membrane.AS-OCT and UBM may complement each other to provide accurate corneal images and parameter measurements,predict and evaluate the disease progression and provide useful guide for further clinical treatment.
作者
赵云
王建民
魏炜
郭金喜
许建锋
解铭
Zhao Yun;Wang Jianmin;Wei Wei;Guo Jinxi;Xu Jianfeng;Xie Ming(Eye Special Examination Department,Hebei Eye Hospital,Xingtai 054001,China;Department of Ophthalmology,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《临床眼科杂志》
2022年第1期29-32,共4页
Journal of Clinical Ophthalmology
关键词
眼前节相干光层析成像术
超声生物显微镜
圆锥角膜
角膜水肿
Anterior segment optical coherence tomography
Ultrasound biomicroscopy
Keratoconus
Corneal edema
