Hammer Mark E, Grizzard W Sanderson
Retina Associates of Florida, 602 S. Mac Dill Avenue, Tampa, FL 33609-4614, USA.
Retina. 2003 Feb;23(1):30-6. doi: 10.1097/00006982-200302000-00005.
To determine the clinical utility of the intraocular videoendoscope for evaluation of the ciliary body in eyes with hypotony and as a visualization tool for surgery of the ciliary body.
A gradient index of refraction rod endoscope was used to evaluate the ciliary body in 14 patients. Videotapes and charts were reviewed retrospectively to correlate the appearance of the ciliary body and to analyze the clinical findings and surgical results. Videoendoscopic surgery to remove fibrous tissue from the ciliary processes was performed in nine eyes.
The endoscope produced a clear detailed image of the ciliary body in a state that is undisturbed by scleral depression or other forms of mechanical distortion. In eyes without hypotony the normal ciliary processes are uniformly pigmented with a velvet-like surface at high magnification. White surface changes in the peak and crest of individual ciliary processes (white-caps) were seen in 11 of 14 patients with hypotony. At high magnification the white surface changes had a brush-like texture integral to the ciliary processes. Other findings in hypotony were fibrous covering of the ciliary body in 10 patients, loss of pigment epithelium in 5, traction elongation of the ciliary processes in 8, vascular loops in 4, pigmented sheets in 3, and areas of missing ciliary processes in 1. White caps were present in seven of the nine patients who had surgery for fibrous traction of the ciliary processes and hypotony and three patients with hypotony not due to other endoscopically visible abnormalities of the ciliary processes. Endoscopically visualized dissection of ciliary body in 9 patients resulted in normal or elevated tension immediately postoperatively in 7 (78%). At the most recent visit only three of the patients had normal tension, but for these nine patients the pressures were marginally, significantly (P = 0.08) higher compared to the preoperative pressures.
The evaluation and management of hypotony is enhanced by the use of intraocular videoendoscopy. Clinical findings of whitecaps and traction elongation of the ciliary processes were associated with ocular hypotony. The endoscope facilitated surgery for dissection and removal of fibrous tissue over the ciliary processes. Further studies are needed to better understand the pathophysiology of ocular hypotony.
确定眼内视频内窥镜在评估低眼压眼中睫状体方面的临床实用性，并作为睫状体手术的可视化工具。
使用渐变折射率棒状内窥镜评估14例患者的睫状体。回顾性分析录像带和图表，以关联睫状体的外观，并分析临床发现和手术结果。对9只眼进行了视频内窥镜手术，以去除睫状突上的纤维组织。
内窥镜在不受巩膜压迫或其他形式机械变形干扰的状态下，产生了清晰详细的睫状体图像。在非低眼压眼中，正常的睫状突在高倍放大下均匀着色，表面呈天鹅绒状。14例低眼压患者中有11例在单个睫状突的峰和嵴处出现白色表面改变（白帽）。在高倍放大下，白色表面改变具有与睫状突一体的刷状纹理。低眼压的其他表现包括10例患者的睫状体有纤维覆盖，5例色素上皮缺失，8例睫状突牵引伸长，4例血管环，3例色素沉着片，1例睫状突缺失区域。在因睫状突纤维牵引和低眼压而接受手术的9例患者中有7例以及3例非因其他内窥镜可见的睫状突异常导致的低眼压患者中存在白帽。9例患者进行内窥镜下睫状体解剖术后，7例（78%）术后眼压立即恢复正常或升高。在最近一次随访时，只有3例患者眼压正常，但这9例患者的眼压与术前相比略有升高，差异有统计学意义（P = 0.08）。
眼内视频内窥镜的使用增强了对低眼压的评估和管理。白帽和睫状突牵引伸长的临床发现与低眼压有关。内窥镜有助于进行睫状突上纤维组织的解剖和切除手术。需要进一步研究以更好地理解低眼压的病理生理学。
