房水引流物置入术后眼部超声图像评价

Ocular echographic evaluation of human aqueous drainage implant

目的通过眼部超声图像检查，确定青光眼房水引流物置入术后赤道部引流盘周围是否存在液体，测定其周围滤过泡的高度。方法４１例４１只眼行ＨＡＤ（ｈｕｎａｎａｑｕｅｏｕｓｄｒａｉｎａｇｅｉｍｐｌａｎｔ，ＨＡＤ）房水引流物置入术的顽固性青光眼，术后平均５．２个月，对４１只眼的引流盘进行眼部Ａ、Ｂ型超声图像检查。根据滤过泡的高度和液体在引流盘表面的位置，将滤过泡分为五级和两型以评价其功能。结果４１例中，３５例（８５％）有明显后部滤过泡，４例（１０％）后部滤过泡不确切，２例（５％）无明显后部滤过泡。滤过泡为０～Ⅳ级的百分比分别为１５％、１２％、２９％、３７％和７％。Ａ型占１１％，而Ｂ型占８９％。大的滤过泡通常伴有巩膜变平。滤过泡的高度与术后眼压控制水平无明显相关性。结论眼部超声图像检查可描述后部滤过泡的特征，对处理ＨＡＤ等有引流盘的房水引流物置入术的失败病例具有一定的指导意义。

Objective To determine after implantation of a glaucoma aqueous drainage device whether fluid is present around the equatorial plate and to measure the bleb size around the plate. Methods 41 plates in 41 patients (41 eyes) with refractory glaucoma who had undergone human aqueous drainage (HAD) implantation underwent standardized echography (both Aand Bscan examinations) after a mean postoperative followup period, 5.2 months. According to the bleb height and the fluid underlying and/or overlying the plate, the blebs were divided into five grades and two types to evaluate their functions. Results Of the 41 cases examined with echography, 35(85%) were associated with posterior blebs, 2(5%) had no associated posterior blebs, and the posterior bleb in 4(10%) cases was not certain. The percentage of the presence of filtering bleb around the plate was 15%, 12%, 29%, 37%, and 7% in Grade 0 to Ⅳ group, and 11% and 89% in type A and B, respectively. There was no significant correlation between the bleb size and the level of intraocular pressure control. Conclusion Standardized ocular echography is helpful in the postoperative management of failed cases who have undergone HAD implantation because it can demonstrate the presence or absence of blebs and characterize them. 