摘要
目的:比较光谱域光学相干断层扫描(SD-OCT)和裂隙灯生物显微镜对闭合性眼球损伤患者眼前节病变的检测能力。方法:这是一项观察性横断面研究。2010-01/2015-07,在惠州市中心人民医院连续招募了16名闭合性眼球损伤患者。所有患者均行完整的眼科检查,包括视力评估、非接触眼压测量和裂隙灯生物显微镜检查。采用SD-OCT检查所有损伤眼的前段。两名患者双侧眼外伤,接受双侧SD-OCT检查。记录角膜、虹膜、前房和晶状体的OCT表现,并与裂隙灯生物显微镜检查结果进行比较。结果:所纳入的18眼均合并前房积血,且前房积血至少占前房容积的三分之一。16眼在裂隙灯生物显微镜和OCT检查中发现角膜水肿和角膜上皮损伤。OCT检查检出Descemet膜脱离(n=7),房角退缩(n=6),晶状体半脱位(n=3)和虹膜根部离断(n=3)。结论:SD-OCT能鉴别闭式眼球损伤的特征,而在裂隙灯生物显微镜下则看不到这些特征。在闭合性眼球损伤中,SD-OCT可能优于临床检查。
AIM: To compare the ability of spectral-domain optical coherence tom ography( SD-OCT) and slit lam p biom icroscopy to detect anterior segm ent findings inpatients with closed globe injury.METHODS: This is an observational,cross-sectional study. Sixteen patients with a closed globe injury were consecutively recruited from January 2010 to July 2015 in Huizhou M unicipal Central Hospital. All patients underwent com plete ophthalm ic exam ination,including assessm ent of visual acuity,m easurem ent of intraocular pressure using a noncontact tonom etry, and slit lam p biom icroscopy. SD-OCT was used to exam ine the anterior segm ents of all injured eyes. Tw o patients had bilateral ocular injuries and received bilateral SD-OCT exam inations. The OCT findings of the cornea, iris,anterior cham ber and lens were recorded and com pared with findings seen using slit lam p biom icroscopy.RESULTS: All 18 eyes were examined by SD-OCT had hyphem a occupying at least one-third of the anterior cham ber volum e. Sixteen eyes had corneal edem a and corneal abrasion detected on both slit lam p biom icroscopy and OCT exam ination. OCT exam ination was also able to detect Descem et's m em brane detachm ent( n = 7),angle recession( n = 6), lens subluxation( n = 3) and iridodialysis( n = 3).CONCLUSION: SD-OCT was able to identify features of closed globe injury that were otherwise not visible on slit lam p biom icroscopy. SD-OCT m ay have advantages over clinical exam ination in cases of closed globe injury.
引文
1 Kuhn F, Morris R, Witherspoon C. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 2002;15(2):139-143
2 Kong YC, Tang X, Kong BH, Jiang H, Chen Y. Six-year clinical study of firework-related eye injuries in North China. Postgrad Med J 2015;91(1071):26-29
3 Dreyer RR, Berrios EB. Traumatic hyphema. Int Ophthalmol Clin 1995;35(1):93-103
4 Ghafari AB, Siamian H, Aligolbandi K, Vahedi M. Hyphema caused by trauma. Med Arch 2013;67(5):354-356
5 Sayen A, Conart JB, Berrod JP. Posterior capsule rupture, iridodialysis, hyphema, and macular hole after blunt ocular trauma. J Fr Ophtalmol 2013;36(10):e187-e190
6 Walton W, von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol 2002;47(4):297-334
7 Cazabon S, Dabbs TR. Intralenticular metallic foreign body. J Cataract Refract Surg 2002;28(12):2233-2234
8 Gharaibeh A, Savage HI, Scherer RW, Goldberg MF, Lindsley K. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev 2013(12):CD005431
9 Erdurman FC, Ceylan OM, Hürmeri? V, Pellumbi A, Durukan AH, Sobac? G. Ocular injuries caused by metal caps of carbonated mineral water bottles. Ulus Travma Acil Cerrahi Derg 2013;19(3):256-260
10 Gad K, Singman EL, Nadgir RN, Yousem DM, Pillai JJ. CT in the evaluation of acute injuries of the anterior eye segment. Am J Roentgenol 2017;209(6):1353-1359
11 T?njum AM. Gonioscopy in traumatic hyphema. Acta Ophthalmol 1966;44(4):650-664
12 Alfonso A, Robert NW. Recurrent hyphema secondary to anterior chamber lens implant. Surv Ophthalmol 1997;41(5):414-416
13 Genovesi-Ebert F, Rizzo S, Chiellini S, Romani A, Gabbriellini G, Sartini MS, Nardi M. Ultrasound biomicroscopy in the assessment of penetrating or blunt anterior-chamber trauma. Ophthalmology 1998;212(Suppl 1):6-7
14 Rocha KM, Martins EN, Melo LA Jr, Moraes NS. Outpatient management of traumatic hyphema in children: prospective evaluation. J AAPOS 2004;8(4):357-361
15 Telle MR, Betbeze C. Hyphema: considerations in the small animal patient. Top Companion Anim Med 2015;30(3):97-106
16 Bricker-Anthony C, Hines-Beard J, D'Surney L, Rex TS. Erratum to: exacerbation of blast-induced ocular trauma by an immune response. J Neuroinflammation 2016;13(1):220
17 Dunkin JM, Crum AV, Swanger RS, Bokhari SA. Globe trauma. Semin Ultrasound CT MR 2011;32(1):51-56
18 Silverman RH. High-resolution ultrasound imaging of the eye-a review. Clin Experiment Ophthalmol 2009;37(1):54-67
19 Dessì G, Lahuerta EF, Puce FG, Mendoza LHR, Stefanini T, Rosenberg I, del Prato A, Perinetti M, Villa A. Role of B-scan ocular ultrasound as an adjuvant for the clinical assessment of eyeball diseases: a pictorial essay. J Ultrasound 2015;18(3):265-277
20 Milder E, Davis K. Ocular trauma and glaucoma. Int Ophthalmol Clin 2008;48(4):47-64
21 Keles S, Ondas O, Ekinci M, Sener MT, Erhan E, Sirinkan A, Akyol Salman I, Kocer I, Baykal O. Paintball-related ocular trauma: paintball or painball? Med Sci Monit 2014;20:564-568
