超声生物显微镜在晶状体悬韧带观察中的临床价值及意义

The accuracy and clinical significance of ultrasound biomicroscopy observing zonule situation

背景在临床上晶状体悬韧带的状态对于决定白内障的手术方式非常重要。超声生物显微镜（UBM）是术前观察晶状体悬韧带状态的重要方法。目的探讨UBM观察白内障患者晶状体悬韧带情况的准确性及临床应用价值。方法采用系列病例观察研究方法。于2015年1—6月在天津市眼科医院纳入拟行白内障摘出术且晶状体悬韧带情况不明的白内障患者130例130眼，包括白内障合并原发性闭角型青光眼（PACG）患者59例59眼和外伤性白内障患者71例71眼。所有术眼术前均行UBM检查，记录晶状体悬韧带异常的情况和范围，与术中探查的悬韧带情况进行对比，比较2种检查方法显示的悬韧带异常结果的一致性和差异。结果UBM检查可见外伤性白内障患者睫状体前旋及晶状体与睫状体间成一定距离，悬韧带的回声清晰。白内障合并PACG患者UBM图像可显示眼前节结构的典型PACG解剖形态，晶状体赤道部与睫状体接触，悬韧带回声欠清晰。UBM检查与术中探查的悬韧带异常情况一致（Kappa系数=0．952），2种检测显示的悬韧带异常眼数分布差异无统计学意义（P=0．250）。2种检查均有晶状体悬韧带异常的75眼中1眼的悬韧带异常位置不能比较，占所有受检眼的0．77％；UBM检查所示悬韧带异常范围与手术记录完全一致者8眼，占全部受检眼的6．15％。2种检查晶状体悬韧带异常相差1个钟点范围者35眼，占全部受检眼的26．92％，相差2个钟点范围者27眼，占20．77％，相差3个钟点范围者4眼，占3．08％。2种检查均显示悬韧带异常的74眼中，UBM检查悬韧带异常方向与手术探查结果平均相差（1．36~1．29）个钟点，外伤性白内障的28眼平均相差（1．14±1．10）个钟点，合并PACG的36眼平均相差（1．64±1．48）个钟点。结论UBM可准确观察和定位晶状体悬韧带的异常，其对外伤性白内障的观察效果优于白内障合并PACG者，在对白内障手术方式的选择及术中可能出现并发症的风险预见方面均有重要的临床价值。

Background The situation of zonule is very important for determining the cataract surgery. Ultrasound biomicroscopy （UBM） is an important method to observe the situation of zonule before cataract surgery. Objective This study was to evaluate the accuracy and clinical significance of observing the zonule of cataract patients by UBM. Methods A series eases-observational study was performed. One hundred and thirty eyes of 130 cataract patients who were to receive extracapsular cataract enucleation were enrolled in Tianjin Eye Hospital from January to June 2015 ,including 59 eyes with cataract associated with primary angle-closure glaucoma （PACG） and 71 eyes with traumatic cataract. UBM examination was carried out before surgery, and the abnormalities of zonule were recorded and compared between UBM and surgery findings. This study was approved by the Ethic Committee of Tianjin Eye Hospital and informed consent was obtained from all subjects. Results A large space between lens and cilfiary was exhibited and the echo of zonule was clear on the UBM image in the eyes with traumatic cataract. The typical anatomic findings of the anterior eye segment were displayed,and lens equator came into contact with cilliary on the UBM image,and the echo of zonule was blurry in the eyes with cataract associated with PACG. The eye number of abnormal zonule was consistent between UBM and surgery findings （ Kappa = 0. 952） ,and no significant difference in the eye number of abnormal zonule between UBM and surgery findings （ P = 0. 250）. In 75 zonule abnormal eyes diagnosed by both UBM and surgery findings, zonule abnormal range could not be compared in 1 eye （1/130, 0.77% ）,and exactly consistent in 8 eyes （8/130,6. 15% ） between the two methods. The difference of zonule abnormal range between the two methods was 1 clock in 35 eyes （35/130,26.92%） ,and 2 clock in 27 eyes （27/130, 20.77% ）,3 clock in 4 eyes （4/130,3.08%）. In 74 zonule abnormal eyes,the mean difference of zonule abnormal meridian between the two methods was （1.36±1.29） clock, an those in 28 traumatic cataract eyes and 36 cataract with PACG eyes were （1. 14±1. 10） clock and （1.64±1.48） clock,respectively. Conclusions UBM is able to observe zonule accurately,the observation effectiveness of UBM for traumatic cataract is better than that of cataract combined with PACG. These results are of clinical valueable for surgical strategy of cataract and prediction of surgical complications.