超声生物显微镜对白内障患者术前晶状体悬韧带的观察研究

Study on Preoperative Observation of Cataract Patients' Zonules by Ultrasound Biomicroscopy

目的利用超声生物显微镜(UBM)观察白内障患者术前晶状体悬韧带的情况,研究悬韧带长度与眼轴长度的关系,以了解影响高度轴性近视囊袋稳定性的解剖病理基础,为降低手术风险及指导术后随访提供依据。方法收集2014年10月-2015年10月55例(55只眼)拟行白内障超声乳化手术的患者,根据其眼轴长度(AL)的不同将其分为非高度轴性近视组(A组,AL<26 mm,21只眼)、高度轴近视组(B组,26 mm≤AL<29 mm,14只眼),超高度轴性近视组(C组,AL≥29 mm,20只眼),术前行UBM检查,通过测量仰卧位后受检眼12、3、6、9点共4个钟点位晶状体悬韧带的长度,比较白内障术前不同眼轴组悬韧带长度是否有差异,以及悬韧带长度与眼轴长度的相关性。结果 3组患者的4个钟点位晶状体悬韧带长度比较差异无统计学意义(F=0.452,P=0.716)。A组悬韧带平均长度为(0.67±0.13)mm,B组悬韧带平均长度为(0.93±0.29)mm,C组悬韧带平均长度为(0.98±0.19)mm。A组悬韧带长度均小于B组和C组悬韧带长度差异有统计学意义(P<0.001);B组悬韧带长度大于C组悬韧带长度,但两组比较差异无统计学意义(P=0.331)。晶状体悬韧带长度与眼轴长度呈正相关(r=0.502)。结论 UBM提供了定量的方法观察晶状体悬韧带,在白内障术前评估中,较以往能更准确地评估悬韧带情况,可考虑在白内障术前纳入常规检查项目,尤其是伴高度近视的患者。

ObjectiveTo use ultrasound biomicroscope （UBM） to observe the zonules in patients before cataract surgery and study the relation between the length of zonules and axial length （AL）, so as to understand the underlying anatomical and pathological basis of factors influencing the stability of lens capsule in high axial myopic patients and provide objective theoretical references for surgical risk reduction and postoperative follow-up guidance. MethodsFifty-five patients （55 eyes） proposed to receive phacoemulsification between October 2014 and October 2015 were divided into group A （AL 〈 26 mm, n=21）, group B （26 mm≤AL 〈 29 mm, n=14）, and group C （AL≥29 mm, n=20） according to their AL.UBM examination was conducted preoperatively.Through measuring the length of zonules in supine position at 12, 3, 6, and 9 o＇clock respectively, we compared the difference of the length of zonules among those three groups, and explored the correlation between the length of zonules and axial length. ResultsThe average length of zonules in group A was （0.67±0.13） mm, while that in group B and group C was （0.93±0.29） and （0.98±0.19） mm, respectively.The length of zonules in group A was shorter than that in group B and Group C, and the differences were statistically significant （P 〈 0.001）;and that in group B was shorter than that in group C, but the difference was of no statistical significance （P=0.331）.In the correlation analysis between axial length and the average length of zonules, the length of zonules was positively correlated with the axial length （r=0.502）. ConclusionsUBM provides a quantitative method for observing zonules.In the assessment before cataract surgery, it is a more accurate method for evaluation of zonules, and probably has a certain value in pre-assessment of intra ocular lens dislocation after cataract surgery.