玻璃体后脱离临床和超微结构诊断

Clinical and ultrastructure diagnosis of posterior vitreous detachment

目的 通过临床、B超和扫描电镜检查玻璃体后脱离 (posterior vitreous detachm ent,PVD)情况 ,评价各种检查手段诊断 PVD的价值。方法 16只新西兰白兔随机分为 A、B、C三组各 6、6、4只兔 ,均以右眼为实验眼 ,左眼为对照。A组实验眼玻璃体腔内注射纤溶酶 0 .1m l 1U联合透明质酸酶 2 0 U,B组注射 0 .1m l纤溶酶 1U ,C组注射透明质酸酶 2 0 U ,所有对照眼玻璃体腔内注射 0 .1m l BSS液。术后 7天内裂隙灯前置镜、直接检眼镜、B超观察 PVD,术后 7天摘除眼球扫描电镜检查 PVD。结果 A组实验眼临床诊断完全性 PVD6 6 .7% (4 / 6 ) ,B超诊断完全性 PVD87.5 % (5 / 6 ) ,扫描电镜确诊完全性 PVD10 0 % (6 / 6 )。临床和 B超诊断之间及它们分别与扫描电镜诊断PVD的非参数 Z检验无明显差异 (分别 P =0 .180 ,P =0 .317,P =0 .15 7)。 B组实验眼临床检查无 PVD(0 / 6 )。 B超仅发现一例部分性 PVD(1/ 6 ) ,扫描电镜确诊部分性 PVD87.5 % (5 / 6 ) ,一例完全性 PVD。临床和 B超诊断的非参数 Z检验无明显差异 (P =0 .317) ,它们分别与扫描电镜诊断部分性 PVD的非参数 Z检验差异显著 (分别 P =0 .0 2 0 ,P =0 .0 34 )。C组临床、B超及扫描电镜诊断均无 PVD。结论 临床结合 B超检查对于诊断伴有玻璃体液化的

Objective Assessing three methods in the diagnosis of posterior vitreous detachment(PVD):(1)clinical examinations including sliplamp biomicroscopy adding+90D aspheric lens and direct ophthalmoscopy;(2)B-ultrasonic examination;(3)scanning electron microscopy.Methods 16 New Zealand rabbits were assigned to three groups(6,6,4 respectively).In group 1,1U plasmin combined with 20U hyaluronidase(0.1ml diluted in BSS) injected into the vitreous of the right eye.In group 2,plasmin 1 U alone.In group 3,hyaluronidase 20U alone.All the left eyes received 0.1ml BSS as a control.Clinical examination and B-ultrasonic examination were performed in the following 7 days after operation.All the rabbits were executed,the eyeballs were enucleated and performed scanning electron microscopy.Results In group 1,the diagnosis of complete PVD by clinical B-Ultrasonic and scanning electron microscopic examination was 66.7%(4/6)?87.5%(5/6)?100%(6/6),respectively.The nonparameter test was no obvious difference among them(P=0.180,P=0.317,P=0.157 respectively).In group 2,no PVD was discovered by clinical diagnosis,only 1 partial PVD was found by B-ultrasound,the scanning election microscopy diagnosis partial PVD was 87.5%(5/6),1 eye was complete PVD.The nonparameter test was no obvious difference between clinical and B-ultrasonic examination(P=0.317),both of them contrast to scanning election microscopy,the nonparameter test was obviously different(P=0.020,P=0.034).In group 3,these three methods were not discovered PVD at all.Conclusions Clinical observations combined with B-ultrasonic examination are safe,convenient,economic and reliable methods to diagnose PVD with liquefaction and syneresis of vitreous.Scanning electron microscopy can accurately distinguish the ultrastructure of vitreoretinal interface,which is the most reliable diagnosis method of PVD.