糖尿病视网膜病变光凝前后的超声生物显微镜检测

Quantitative analysis of early influence on anterior ocular segment of diabetic retinopathy by retinal photocoagulation

目的 探讨视网膜光凝术对糖尿病视网膜病变 (diabeticretinopathy ,DR)患者眼前段的早期影响。方法 应用超声生物显微镜观察和定量分析 36例 (36只眼 )DR患者视网膜光凝术前 ,术后第 3d和第 7d前房深度、前房角、睫状体及前段脉络膜的改变。结果 与术前比较 ,光凝术后第 3d患眼眼压平均升高 (0 933± 1 985 )mmHg(1mmHg =0 133kPa) (t =2 82 1,P <0 0 1) ;上、下、颞侧前房角变窄 (t =2 0 33～ 3 15 0 ,P <0 0 5 ) ,前房轻度变浅 (t =1 793,P >0 0 5 )。2 9只眼 (80 6 % )同时发生了睫状体和前段脉络膜脱离 ,3只眼发生了单纯的睫状体或前段脉络膜脱离。上方象限睫状体脱离高度 >其他象限 (F =7 44 ,P =0 0 0 0 )。1例患者睫状体和脉络膜脱离持续至术后第 14d ,其余患眼睫状体和脉络膜脱离于术后第 7d自行消退。睫状体和脉络膜脱离的高度与年龄呈显著正相关 ,而与空腹血糖、糖尿病病程及DR病程无明显相关关系。结论 视网膜光凝术可引起DR眼早期眼压升高、前房角变窄、睫状体和脉络膜脱离等眼前段改变 ,年龄是影响睫状体和脉络膜脱离严重程度的因素之一。

Objective To investigate early influence on anterior ocular segment of diabetic retinopathy (DR) by retinal photocoagulation. Methods Ultrosound biomicroscopy (UBM) was applied to obtain and analyze quantitatively the changes of anterior ocular segment, including the anterior chamber, anterior chamber angle, ciliary body and choroid before the retinal photocoagulation and on the 3rd and 7th day after the therapy in 36 eyes with DR. Results Significant elevating of intraocular pressure (IOP), narrowing of chamber angle and slight shallowing of anterior chamber were observed on the 3rd day after retinal photocoagulation. Ciliary detachment and choroidal detachment were observed simultaneously in 29 eyes (80 6%). Ciliary detachment or choroidal detachment occurred singly in 3 eyes (8 3%) on the 3rd day and most of them disappeared on the 7th day spontaneously The height of ciliochoroidal detachment in the superior quadrant is greater than that in other quadrants. The severity of ciliochoroidal detachment is negatively correlated to the age, not correlated to fast blood sugar, duration of diabetes and duration of DR. Conclusion Temporary ciliochoroidal detachment with changes of anterior chamber angle and IOP may be a common complication after retinal photocoagulation that should be designed properly.