前节相干光断层扫描技术在角膜外伤中的应用研究

Use of anterior segment optical coherence tomography in corneal injuries

目的评估前节相干光断层扫描技术(AS-OCT)在角膜外伤诊疗中的应用价值。方法回顾性分析85例(91只眼)各类角膜外伤:穿通伤56只眼,钝挫伤18只眼,角膜异物10只眼,化学伤7只眼。所有患者在诊疗过程中除常规裂隙灯显微镜等检查外,均以AS-OCT观察了角膜形态结构,部分患者进行了角膜厚度测量。结果所有病例均获得清晰AS-OCT角膜图像,8只眼角膜穿通伤病例清创缝合术后患眼发现严重角膜伤口内口对合不佳,3只眼LASIK术后眼球钝挫伤发现角膜层间积液,对于透明/半透明角膜异物病例,AS-OCT可显示异物在角膜内具体位置。但对于金属异物,在AS-OCT检查所获图像中异物后的部分呈现为无反射区,故而无法判断异物深度。AS-OCT可清晰显示急性期角膜化学伤患者角膜水肿情况并可进行厚度测量。1只眼因陈旧性化学伤导致的角膜白斑,裂隙灯显微镜下无法窥见眼内结构,AS-OCT显示前房、虹膜结构基本正常。结论 AS-OCT可清晰显示外伤后角膜的形态结构,对于角膜外伤的诊断和疗效评估具有很好的应用价值。

Objective Evaluate the value of anterior segment optical coherence tomography（AS-OCT） for diagnosis and monitoring treatment results in corneal injury cases.Methods We examined 91 eyes of 85 patients with different types of corneal injuries： penetrating injury（56 eyes）,contusion（18 eyes）,foreign body（10 eyes）,and chemical burn（7 eyes）.AS-OCT examination was performed at the initial visit,directly after injury,and repeated as treatment progressed.In some cases,corneal pachymetry was evaluated.Results In penetrating eyes,AS-OCT clearly demonstrated the microstructure of the corneal wound after primary repair and revealed 8 cases of incorrect closure of the corneal wound,which were not be detected by slit-lamp examination due to the presence of corneal oedema.In three cases of contusion in post-LASIK eyes,only corneal interface hyper reflection was noticed during slit-lamp examination,whereas AS-OCT revealed interface fluid.AS-OCT was helpful in establishing the localization and size of the transparent/translucent foreign bodies in cornea,while was useless for dense metallic foreign bodies.In patients with acute corneal chemical burns,AS-OCT was valuable for monitoring resolution of the corneal oedema after treatment.AS-OCT was also useful in assessment of the anterior chamber even in presence of corneal opacification after chemical burn.Conclusion AS-OCT can clearly demonstrate the structure of cornea after injuries.It is very useful in dealing with corneal injuries,for early diagnosis and for monitoring treatment progress.