颞侧角膜缘切口的选择及其解剖学基础

Selection and anatomic basis of incision of temporal limbus corneae

目的 :探讨颞侧角膜缘的应用解剖特点 ,为颞侧角膜缘切口提供应用解剖学基础。方法 :采用成人尸体眼球 10只在体式显微镜下观察角膜缘的层次结构特点 ,并测量角膜缘的宽和厚以及前房角主要结构间的距离。另外选取 4 0例青光眼术后眼压失控患者采取颞侧切口和上方常规切口二次手术 ,比较不同切口入路患者的术后视力及眼压 ,以确定颞侧角膜缘切口的治疗效果。结果 :尸体测量颞侧角膜缘内界宽为 (0 .6 2± 0 .0 5 ) mm,厚为(0 .73± 0 .0 4 ) mm。 Schlemm管前缘与巩膜突和后弹力层止端的距离分别是 (0 .4 4± 0 .0 2 ) mm和 (0 .2 4±0 .0 3) m m。青光眼患者上方切口组和颞侧切口组术后视力差异无显著性 (P>0 .0 5 ) ,眼压颞侧角膜缘切口低于上方切口 (P<0 .0 5 )。结论 :颞侧角膜缘切口适用于第二次青光眼及并发性白内障手术。

Objective To research the applied anatomic characteristics of temporal limbus corneae and provide applied anatomic basis for incision of temporal limbus corneae. Methods The hierarchical structures of limbus corneae of 10 adult cadaveric eyeballs were observed under stereomicroscopy. The width and thickness of the temporal limbus corneae, the distance between main structures of the anterior chamber angle were measured. In addition, the comparison of 40 cases of uncontrolled intraocular pressure cases after the operation of glaucoma was used to prove the therapeutic efficacy of the incisions of temporal limbus corneae. Results By measuring the cadavers, the width of the temporal limbus corneae was (0.62±0.05)mm,the thickness was (0.73±0.04)mm. The distance between anterior border of the Schlemm′s duct and scleral process was (0.44±0.02)mm, the distance between anterior border of the Schlemm′s duct and the Schwalbe′s line was (0.24±0.03)mm. There was no obvious difference of sight between the incision of superior limbus corneae and the incision of temporal limbus corneae. The intraocular pressure of the incision of temporal limbus corneae was lowered than that of the incision of superior limbus corneae (P<0.05). Conclusion The incisions of temporal limbus corneae is applicable for the second operation of glaucoma and complicated cataract.