Reddy Pappuru Rajeev R, Tyagi Mudit, Paulose Remya M, Dave Vivek P, Das Taraprasad, Chhablani Jay, Narayanan Raja, Saxena Rushil K, Balakrishnan Divya, Basu Sayan, Sangwan Virender S
Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
Am J Ophthalmol. 2017 Apr;176:9-14. doi: 10.1016/j.ajo.2016.12.018. Epub 2016 Dec 28.
Direct visualization of the posterior segment is not possible with conventional imaging techniques in eyes with corneal opacification. This study evaluated the efficacy of videoendoscopy in visualizing and hence prognosticating the visual outcomes in such eyes.
Prospective, noncomparative, consecutive interventional case series.
This study included 64 eyes of 64 patients with corneal opacification who underwent a diagnostic ophthalmic endoscopy procedure from March 2014 to May 2016. All eyes also underwent conventional B-scan ultrasonography as part of their comprehensive ocular examination. The findings that were noted during endoscopy included the optic disc characteristics, anatomic integrity of the retina, and condition of the retinal blood vessels. The principal outcome measure was the determination of whether the results of the videoendoscopy helped in establishment of or brought a change in the management plan; accordingly, they were classified as either "contributory" or "noncontributory."
The videoendoscopy findings were classified as contributory in 62 of 64 eyes. The remaining 2 eyes had vitreous hemorrhage; endoscopic vitrectomy was done in them to detect an inoperable retinal detachment in 1 eye. With the help of the stereoscopic picture of the fundus provided by the endoscope, a poor visual prognosis in 17 eyes with retinal detachment and 22 eyes with attached retina was determined. Additionally, in eyes that had an attached retina on ultrasound B-scan, the endoscope helped in detecting a glaucomatous disc in 10 of those eyes; 7 of them had glaucomatous optic atrophy. In 3 patients ultrasound did not detect a retinal detachment (false-negative). One eye with detached retina on ultrasound did not actually have a retinal detachment (false-positive). Thus ultrasound had a sensitivity of 88.4% and a specificity of 97.3% in detecting RD as compared with an endoscopic evaluation. Based on the endoscopic findings, 34 of 64 (53%) eyes were identified as having a better visual prognosis and underwent subsequent vision-restoring procedures. This included 10 (16%) patients who directly underwent a corneal procedure and 24 (37.5%) patients who had endoscopic vitreoretinal procedures initially before undergoing a corneal procedure. Endoscopy helped in identifying poor prognosis in 30 of 64 (46.8%) eyes; thus, further invasive procedures could be avoided. The endoscopy procedure in itself did not lead to any complications.
Diagnostic endoscopy provided invaluable supplemental information about the posterior segment in eyes with corneal opacification. This helped in better prognostication and in reserving corneal reconstructive procedures for eyes with a favorable visual prognosis.
对于角膜混浊的眼睛，传统成像技术无法直接观察到眼后段。本研究评估了视频内窥镜检查在观察此类眼睛并预测其视觉预后方面的效果。
前瞻性、非对比性、连续介入病例系列研究。
本研究纳入了2014年3月至2016年5月间接受诊断性眼科内窥镜检查的64例患者的64只角膜混浊眼睛。所有眼睛在全面眼部检查中均进行了传统的B超检查。内窥镜检查时记录的发现包括视盘特征、视网膜的解剖完整性以及视网膜血管状况。主要观察指标是确定视频内窥镜检查结果是否有助于制定或改变治疗计划；据此，将其分为“有帮助”或“无帮助”。
64只眼中有62只的视频内窥镜检查结果被分类为有帮助。其余2只眼睛有玻璃体积血；对其中1只进行了内窥镜玻璃体切除术以检测到不可手术的视网膜脱离。借助内窥镜提供的眼底立体图像，确定了17只视网膜脱离眼睛和22只视网膜未脱离眼睛的视觉预后较差。此外，在B超检查显示视网膜未脱离的眼睛中，内窥镜帮助检测出其中10只眼睛存在青光眼性视盘；其中7只患有青光眼性视神经萎缩。在3例患者中，超声未检测到视网膜脱离（假阴性）。1只超声显示视网膜脱离的眼睛实际上并没有视网膜脱离（假阳性）。因此，与内窥镜评估相比，超声检测视网膜脱离的敏感性为88.4%，特异性为97.3%。根据内窥镜检查结果，64只眼中有34只（53%）被确定具有较好的视觉预后，并接受了后续的视力恢复手术。这包括10例（16%）直接接受角膜手术的患者和24例（37.5%）最初接受内窥镜玻璃体视网膜手术然后再接受角膜手术的患者。内窥镜检查有助于确定64只眼中30只（46.8%）眼睛的预后较差；因此，可以避免进一步的侵入性手术。内窥镜检查本身未导致任何并发症出现。
诊断性内窥镜检查为角膜混浊眼睛的眼后段提供了宝贵的补充信息。这有助于更好地预测预后，并为视觉预后良好的眼睛保留角膜重建手术。
