青光眼是世界首位不可逆性致盲性眼病,降眼压是唯一被证实有效的干预措施。手术是降低眼压的主要途径,近年来创伤更小、术后炎症反应更轻、并发症更少的微创青光眼手术逐渐在临床得到应用。超声睫状体成形术(ultrasound cycloplasty, UCP)是一种新型微创青光眼治疗技术。本文综述了国内外现有研究,表明UCP在治疗各种类型青光眼中均表现出良好的降眼压效果,但不同类型青光眼疗效存在一定差异。UCP可减少术后局部抗青光眼药物的使用数量,同时显示出较少的并发症和较轻的术后反应。与其他睫状体分泌功能减弱性手术相比,该手术在缓解难治性青光眼患者因高眼压导致的局部疼痛方面尤为有效。青光眼类型、超声探头型号匹配及治疗扇区数量是影响疗效的主要因素,其适应证的准确把握及手术参数设计的优化将进一步提高其治疗效果。本文归纳了UCP治疗青光眼的作用原理、手术操作与术后用药、适应证与禁忌证、有效性、安全性及其疗效的影响因素,以期为其临床应用和研究提供参考依据。
Glaucoma is the leading cause of irreversible blindness worldwide. Lowering intraocular pressure (IOP) is the only proven intervention to effectively prevent visual field deterioration and slow the progression of glaucoma. Surgery plays a critical role in reducing IOP, with traditional glaucoma surgeries focusing primarily on classic filtration procedures. In recent years, minimally invasive glaucoma surgeries (MIGS), characterized by less trauma, milder postoperative inflammation, and fewer complications, have been increasingly applied and continuously refined in clinical practice. Ultrasound cycloplasty (UCP) is a novel, minimally invasive technique for glaucoma treatment. This article reviews existing research both domestically and internationally, showing that UCP demonstrates good IOP-lowering effects in various types of glaucoma, though its efficacy varies across different glaucoma types. UCP reduces the need for postoperative anti-glaucoma medications, while also exhibiting fewer complications and milder postoperative reactions. Compared with other ciliary body function-reducing surgeries, UCP is particularly effective in alleviating local pain caused by elevated IOP in patients with refractory glaucoma. The type of Glaucoma, matching of the ultrasound probe model, and the number of treatment sectors are key factors influencing UCP efficacy. Accurate selection of indications and optimization of surgical parameters will further enhance its therapeutic outcomes. This article summarizes the mechanisms, surgical procedures, postoperative medication, indications and contraindications, efficacy, safety, and factors influencing UCP outcomes in glaucoma treatment, aiming to provide a reference for its clinical application and research.
临床上囊袋张力环(capsular tension ring,CTR)与睫状体接触导致的反复持续性高眼压较为少见,本文报告一例改良型CTR植入术后反复持续性高眼压的病例,行“巩膜悬吊线松解术”后高眼压状态有效缓解,考虑可能与巩膜固定缝线过紧,造成改良型CTR局部与睫状体相接触,刺激睫状体分泌过量房水有关。
Recurrent intraocular hypertension caused by contact between capsular tension ring (CTR) and ciliary body is rare clinically. We report a case of recurrent intraocular hy pertension after modified CTR implantation. The IOP returned to normal levels when released the scleral suture. We speculated that the ciliary process irritated by MCTR might increase aqueous humor secretion because of a tight scleral suture.
青光眼是一组以病理性眼压升高为主要危险因素的,以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术,其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成,并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛,早期主要用于各类难治性青光眼患者,特别是晚期及绝对期患者,研究者发现其除降眼压外,还能够显著缓解该类患者的局部疼痛。近年来,UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中,也表现出了良好的降眼压效果,同时显示出较少的并发症和较轻的术后反应,并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异,且为达最佳治疗效果,其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法,测算精度并不适用于国人,然而精准度更高的模型法,其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量,但术后用药策略的调整仍可能导致眼压波动。综上,针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等,仍有待开展相关临床研究,以期为其临床应用提供更加可靠的依据。
青光眼是一组以病理性眼压升高为主要危险因素的,以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术,其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成,并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛,早期主要用于各类难治性青光眼患者,特别是晚期及绝对期患者,研究者发现其除降眼压外,还能够显著缓解该类患者的局部疼痛。近年来,UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中,也表现出了良好的降眼压效果,同时显示出较少的并发症和较轻的术后反应,并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异,且为达最佳治疗效果,其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法,测算精度并不适用于国人,然而精准度更高的模型法,其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量,但术后用药策略的调整仍可能导致眼压波动。综上,针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等,仍有待开展相关临床研究,以期为其临床应用提供更加可靠的依据。
超声睫状体成形术(ultrasound cyclo-plasty,UCP),是一种新型的睫状体治疗手术,目前已应用于治疗不同类型的青光眼。UCP通过微型高强度聚焦超声(high-intensity focused ultrasounds,HIFU)设备,高度选择性作用于睫状体,实现温和可控、稳定的降眼压(intraocular pressure,IOP)效果。相较于传统的睫状体破坏手术,UCP具有操作简单、耗时短、可重复性高及安全性高的特点。该文从UCP的由来、结构特点、作用机制、疗效、特点及安全性对UCP治疗不同类型青光眼的研究进展进行综述。
Ultrasound cyclo-plasty (UCP) is a novel technique for ciliary body surgery, which has been applied to treat different types of glaucoma. UCP works on the cilary body highly and selectively with the micro high-intensity focused ultrasounds (HIFU) to achieve a mild, controllable, and stable intraocular pressure(IOP) effect. Compared with the traditional ciliary body destruction surgery, UCP is simple operation, efficiency, high repeatability, and high safety.This article reviews the research progress in the UCP treating various types of glaucoma, from its origin, structural characteristics, mechanism, efficacy, characteristics, and safety.
睫状体髓上皮瘤是一种源自神经上皮层的恶性肿瘤,易因其伪装特性而被漏诊和误诊。本文报道了1例3岁9个月的男性患儿,眼部表现似晶状体破裂,经部分肿物切除活检,病理诊断为睫状体恶性髓上皮瘤。
Medulloepithelioma of the ciliary body is a kind of malignant tumor which arises from neuroepithelium. It is easily misdiagnosed or miss diagnosed due to its masquerade feature in the clinical practice. We report a boy with a tumor in his right eye at age of 3 years and 9 months presented first with lens rupture. Diagnosis of malignant medulloepithelioma of ciliary body was made pathologically by biopsy of the partial tumor.
青光眼睫状体炎综合征(Posner-Schlossman syndrome,PSS)表现为单眼反复发作性非肉芽肿性前葡萄膜炎,伴有眼压升高,可发展为慢性继发性青光眼,最终导致视神经损伤。尽管PSS总体预后良好,但仍有部分患者因反复眼压骤升造成视神经损伤持续进展,甚至导致失明。目前,PSS的确切病因尚不明确,治疗方式以控制炎症及眼压为主。本文将从病因及治疗两方面阐述PSS的研究现状,以期为PSS相关基础研究及临床诊治提供思路及参考。
Posner-Schlossman syndrome (PSS), also called glaucomatocyclitic crisis, is characterized by recurrent non-granulomatous anterior uveitis, accompanied by elevated intraocular pressure. It is able to develop into chronic secondary glaucoma and eventually lead to optic nerve injury. Although the overall prognosis of PSS is favourable, there are still some patients whose optic nerve injury continues to progress and even lead to blindness due to recurrent attacks of ocular hypertension. At present, the exact cause of PSS is not clear, and the treatment is mainly to control inflammation and intraocular pressure. This article will elaborate the research status of PSS from two aspects of etiology and treatment to provide ideas and reference for the basic research clinical diagnosis and treatment of PSS.
报道1例睫状体无色素上皮腺瘤(adenoma of nonpigmented ciliary epithelium,ANPCE)并进行相关文献复习。患者主要症状为左眼视力逐渐下降3个月,视物不清半个月。经眼部检查及左眼超声生物显微镜(ultrasound biomicroscopy,UBM)检查显示左眼虹膜周边隆起,边界清晰。予虹膜睫状体肿物切除术并行常规病理检查:光镜下肿瘤组织由分化好的上皮细胞组成,排列成腺泡状及条索状,细胞间可见红染无结构的基底膜样物;免疫组织化学表达:S-100(+)、Vimentin(+)、EMA(+)、CKpan(+)、Melan-A(+);最终病理诊断ANPCE。手术后截至随访日期,术后3个月无疾病进展。
A case of adenoma of nonpigmented ciliary epithelium (ANPCE) was reported and relevant literatures were reviewed. The left eye visual acuity of the patient gradually decreased for 3 months, and half a month was blurred vision. The vision examination and ultrasound biomicroscopy (UBM) from the left eye examination revealed a bulge in the peripheral iris in the left eye, with the boundaries are clear. The left eye was treated with ciliary mass resections and routine pathological examination: microscopy showed that the tumor tissue consists of well-differentiated epithelial cells, the tumor cells were arranged in tubes and cords, between the cells were seen red-stained unstructured basement membrane; immunohistochemistry showed: S-100 (+), Vimentin (+), EMA (+), CKpan (+), Melan-A (+); the final pathological diagnosis was ANPCE. There was no progression of the disease during the 3 months following the surgery on the follow-up date.
目的:评估右美托咪定复合舒芬太尼用于老年青光眼患者经巩膜二极管激光睫状体光凝术 (transscleral diode laser cyclophotocoagulation,TDLC)术后自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)的安全性和有效性。方法:选择行TDLC术老年青光眼患者80例,采用随机数字表法将患者分为SD组(n=40)和S组(n=40)。SD组术后PCIA采用舒芬太尼1.5μg/kg+右美托咪定1.5 μg/kg+托烷司琼4mg;S组采用舒芬太尼2μg/kg+托烷司琼4mg。将相应药物置入生理盐水配成100mL混合液加入电子镇痛泵,手术结束即刻行PCIA至术后24h。观察比较两组患者基本情况和手术情况,比较术前(T0)、术后即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)患者的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)、NRS疼痛评分、Ramsay镇静评分及非手术眼的眼内压(intraocular pressure,IOP),比较术后恶心呕吐、呼吸抑制、躁动等不良反应及使用其他辅助镇痛药物的情况。结果:两组患者基本情况和手术情况的差异无统计学意义。两组各时点DBP、非手术眼IOP及NRS评分差异无统计学意义。SD组T3、T4时点SBP,T2、T3、T4时点HR以及T2、T3时点Ramsay评分均低于S组,差异有统计学意义(P<0.05)。两组患者发生不良反应的总例数差异无统计学意义,但SD组恶心呕吐(1例)和烦躁(2例)发生率均低于S组(分别为6例和9例),差异有统计学意义(P<0.05)。两组患者呼吸抑制和眩晕嗜睡发生率以及使用其他辅助镇痛药物例数差别无统计学意义,SD组舒芬太尼使用量低于S组(P<0.05)。结论:采用右美托咪定1.5μg/kg复合舒芬太尼1.5μg/kg行PCIA时不影响非手术眼IOP,可安全有效地应用于老年青光眼患者TDLC术后镇痛。
Objective: To evaluate the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) after transscleral diode laser cyclophotocoagulation (TDLC) in elderly patients with glaucoma. Methods: Eighty elderly glaucoma patients undergoing TDLC were selected and randomly divided into a SD group (n=40) and a S group (n=40) by random number table method. In SD group (n=40), sufentanil 1.5 μg/kg, dexmedetomidine 1.5 μg/kg and tropisetron 4 mg were used for postoperative PCIA, and sufentanil 2 μg/kg and tropisetron 4 mg were used in S Group (n=40). The corresponding drugs in saline solution was added into 100 mL solution with electronic analgesia pump. PCIA was performed immediately after the operation until 24 h after the operation. The basic condition and operation situation of the two groups were observed and compared, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), NRS pain score, Ramsay sedation score and non-operation eye intraocular pressure (IOP) at preoperative (T0), after operation (T1), postoperative 6 h (T2), 12 h after operation (T3) and 24 h after operation (T4) were compared, and postoperative adverse reactions such as nausea and vomiting, respiratory depression, restlessness and use of other auxiliary analgesic drug were also compared. Results: There was no significant difference between two groups of patients’ basic and surgical conditions. There was no significant difference between two groups at each time point DBP, non-operation eye IOP and NRS score. SBP at T3 and T4, HR at T2, T3 and T4, and Ramsay score at T2 and T3 in SD group were lower than the S group, the difference was statistically significant. There was no significant difference in the total number of adverse reactions between two groups, but the incidence of nausea and vomiting and restlessness in group SD were lower than those in group respectively, the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the incidence of respiratory depression, dizziness, lethargy and the use of other auxiliary analgesics. The sufentanil usage in group SD was lower than that in group S (P<0.05). Conclusion: PCIA with dexmedetomidine 1.5 g/kg combined with sufentanil 1.5 g/kg does not affect the non-operation eye IOP. It can be safely and effectively applied to postoperative analgesia for elderly patients with glaucoma after TDLC