超声生物显微镜在术前评估先天性上睑下垂眼睑解剖结构中的应用

Ultrasound biomicroscopy in the preoperative assessment of eyelid anatomy in congenital ptosis

目的初步探究超声生物显微镜(UBM)作为先天性上睑下垂(CP)术前眼睑解剖结构评估工具的可行性,并分析患侧眼提上睑肌及腱膜的病理改变。方法前瞻性病例研究。选取10例单眼先天性上睑下垂的初诊患者入组,根据病情的严重程度分为中度组(5例)和重度组(5例)。利用UBM(SW-3200L,35MHz)对患者双侧上眼睑进行观察并成像。将患侧眼的UBM图像与其术中所见及术后病理相对照,进一步比较患侧眼提上睑肌(提肌)及腱膜的免疫组化结果并作初步定量分析。结果UBM能对包括眼轮匝肌、腱膜、睑板和提上睑肌-Müller肌复合体在内的眼睑结构清晰成像。术前UBM成像发现的腱膜变薄、腱膜后退及腱膜劈裂在术中观察得以印证;术前UBM成像发现的脂肪浸润在术中观察和术后病理中均得以证实。关于脂肪的浸润,中度组中,脂肪组织在腱膜中的浸润密度高于在提肌中(P<0.05),重度组中亦然(P<0.01);脂肪组织在重度组提肌中的浸润密度稍高于中度组提肌(P<0.05),而重度组腱膜中脂肪组织的浸润密度显著高于中度组腱膜(P<0.01)。关于胶原纤维的增生,中度组中,胶原纤维在提肌和腱膜中的增生没有明显统计学差异(P>0.05);重度组中,胶原纤维在腱膜中的增生相比于提肌显著增高(P<0.01);此外,重度组提肌中胶原纤维的增生程度稍高于中度组提肌(P<0.05),而重度组腱膜中胶原纤维的增生程度显著高于中度组腱膜(P<0.01)。结论UBM可作为先天性上睑下垂患者术前眼睑解剖结构评估的有效无创检查,重度患者腱膜的组织结构比提肌更为紊乱。

Objective To preliminarily investigate the possibility of using ultrasound biomicroscopy(UBM)as a preoperative tool to assess the anatomical structure of the eyelid in patients with congenital ptosis(CP),and to analyze the pathological changes in the levator palpebralis muscle and the levator aponeurosis of the affected eyes.Methods This prospective case study recruited 10 primary-care patients with unilateral congenital ptosis.Of them,5 were divided into the moderate group and 5 into the severe group according to the severity of the disease.The bilateral upper eyelids of all the patients were observed and imaged by UBM(SW-3200L)with the use of a 35MHz transducer.The UBM images of the affected eye were compared with their intra-operative visualisation and with the post-operative pathology.Then the histopathologic findings in the levator palpebralis muscle and the levator aponeurosis of affected eyes were further observed and statistically analyzed.Results UBM imaging could reveal detailed structures of upper eyelid including the orbicularis oculi muscle,the levator aponeurosis,tarsus and the levator-Müller muscle complex.Image findings of thinning,regression and splitting in the levator aponeurosis were verified by intraoperative observations.Fatty infiltration detected by UBM imaging was confirmed by intraoperative observation and postoperative pathology.Regarding fat infiltration,in the moderate group,the infiltration density of adipose tissue in the aponeurosis was higher than that in the levator muscle(P<0.05),and the same was true in the severe group(P<0.01);The infiltration density of adipose tissue in the severe group was slightly higher than that in the moderate group(P<0.05),while the infiltration density of adipose tissue in the severe group aponeurosis was significantly higher than that in the moderate group aponeurosis(P<0.01).Regarding the proliferation of collagen fibers,there was no significant statistical difference(P>0.05)in the proliferation of collagen fibers in the levator muscle and aponeurosis in the moderate group;In the severe group,the proliferation of collagen fibers in the aponeurosis was significantly increased compared to the levator muscle(P<0.01);In addition,the degree of collagen fiber proliferation in the severe group was slightly higher than that in the moderate group(P<0.05),while the degree of collagen fiber proliferation in the severe group's aponeurosis was significantly higher than that in the moderate group's aponeurosis(P<0.01).Conclusions UBM can be an effective non-invasive test for preoperative assessment of eyelid anatomy in patients with CP.The aponeurosis is characterized with a more disorganized structure than the levator muscle insevere CP patients.