Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Ophthalmology. 2011 Nov;118(11):2166-71. doi: 10.1016/j.ophtha.2011.03.040. Epub 2011 Jul 20.
To analyze the morphologic features of acute hydrops and treatment success using ultrasound biomicroscopy (UBM).
Prospective interventional case series.
Fourteen patients (14 eyes) affected by keratoconus with acute corneal hydrops.
Patients with acute hydrops were treated with intracameral injection of 0.15 ml of 14% perfluoropropane (C₃F₈) gas.
The parameters evaluated on UBM included the location and length of the Descemet's membrane (DM) tear and corneal thickness at the central corneal thickness at the area overlying the DM tear (CT₀), corneal thickness 2.5 mm from the central point (CT₂.₅), and peripheral corneal thickness 2.0 mm from the scleral spur toward the corneal side (CT(P)). The ratio of CT₂.₅ to CT₀ was calculated to obtain the hydrops resolving index (HyRI).
The DM tear was visualized with UBM in all cases and slit-lamp microscopy in 9 of 14 eyes. The mean length of DM tears at presentation was 1.74 ± 0.77 μm. Patients with zone 3 corneal edema had a longer DM tear compared with patients with zone 2 corneal edema (1.27 ± 0.55 vs 2.02 ± 0.79 μm, respectively, P = 0.09). Significant positive correlations were seen between DM tear length and CT₂.₅ and CT(p) (r = 0.790, P = 0.020 and r = 0.766, P = 0.027, respectively). An intracameral gas bubble was seen abutting the edges of the tear in all cases. At the 6-week follow-up, the apposition of the DM and the overlying stroma occurred in all eyes, and resolution of epithelial edema and intrastromal cysts were seen in 11 of 13 cases (84.6%) and 12 of 13 cases (92.3%). The mean values of CT₀, CT₂.₅, and CT(p) at presentation were 2359.69 ± 582.26 μm, 1911.15 ± 502.60 μm, and 1156.46 ± 275.77 μm, respectively, which decreased to 398.15 ± 31.65 μm (P = 0.0), 453.46 ± 68.45 μm (P = 0.0), and 638.00 ± 62.17 μm (P = 0.0), respectively. The mean HyRI showed a significant increase from 0.80 ± 0.05 at the time of presentation to 1.13 ± 0.12 (P = 0.03) at 3 months follow-up.
Ultrasound biomicroscopy is a useful tool for quantitative and qualitative study of the morphologic features of acute hydrops.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
使用超声生物显微镜（UBM）分析急性水肿的形态特征和治疗效果。
前瞻性干预性病例系列。
14 名（14 只眼）患有圆锥角膜并伴有急性角膜水肿的患者。
对急性水肿患者行房水内注射 0.15ml14%全氟丙烷（C₃F₈）气体。
UBM 评估的参数包括角膜后弹力层（Descemet 膜，DM）撕裂的位置和长度以及 DM 撕裂上方中央角膜厚度（CT₀）、距中央点 2.5mm 处角膜厚度（CT₂.₅）和距角膜缘 2.0mm 处周边角膜厚度（CT(P)）。计算 CT₂.₅与 CT₀的比值以获得水肿缓解指数（HyRI）。
所有病例均通过 UBM 观察到 DM 撕裂，其中 9 只眼通过裂隙灯显微镜观察到。DM 撕裂的平均长度为 1.74±0.77μm。与角膜水肿 2 区患者相比，角膜水肿 3 区患者的 DM 撕裂更长（分别为 1.27±0.55μm 和 2.02±0.79μm，P=0.09）。DM 撕裂长度与 CT₂.₅和 CT(p)呈显著正相关（r=0.790，P=0.020 和 r=0.766，P=0.027）。所有病例中均可见房水内气泡紧贴撕裂缘。在 6 周随访时，所有眼的 DM 与上方的基质层均贴合，13 只眼中有 11 只（84.6%）和 13 只眼中有 12 只（92.3%）可见上皮水肿和基质内囊泡消退。就诊时 CT₀、CT₂.₅和 CT(p)的平均值分别为 2359.69±582.26μm、1911.15±502.60μm和 1156.46±275.77μm，分别降至 398.15±31.65μm（P=0.0）、453.46±68.45μm（P=0.0）和 638.00±62.17μm（P=0.0）。HyRI 的平均值从就诊时的 0.80±0.05显著增加至 3 个月随访时的 1.13±0.12（P=0.03）。
超声生物显微镜是研究急性水肿形态特征的一种有用的定量和定性工具。
作者在本文讨论的任何材料中均无专有或商业利益。
