Zhou Nan, Yang Lihong, Xu Xiaolin, Wei Wenbin
Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2022 Jun 9;9:785444. doi: 10.3389/fmed.2022.785444. eCollection 2022.
In this study, we aimed to investigate clinical characteristics and histopathology and evaluate surgical outcomes of quadrantic lamellar-sclerectomy with sclerostomy for uveal effusion syndrome (UES).
Retrospective, cohort study.
Overall, 106 eyes of 66 patients diagnosed with UES were treated at the Beijing Tongren Hospital between January 1, 2001 and June 26, 2021.
Patients were examined by routine ophthalmologic examinations, fluorescein and indocyanine green angiography (FFA/ICGA); axial length determination; color Doppler ultrasound (CDU); ultrasound biomicroscopy (UBM), optical coherence tomography (OCT), and optical coherence tomographic angiography (SD/SS-OCTA). Quadrantic lamellar-sclerectomy with sclerostomy was performed at the equator in all patients and histopathological examination of the excised sclera was analyzed in all samples.
The reattachment of the choroid and retina with resolution of the serous fluid, best corrected visual acuity (BCVA), choroidal thickness, and recurrence of ciliochoroidal detachment were the main outcome measures.
Two subgroups were identified: (1) type 1 (nanophthalmic eye), wherein the eyeball was small (average axial length 15.83 ± 1.45 mm) with high hypermetropia (average 12.6 diopters) and (2) type 2 (non-nanophthalmic eye), wherein the eyeball size was normal (average axial length 23.45 ± 1.68 mm) with or without refractive error, combined with or without systemic symptoms. Histopathologically, types 1 and 2 demonstrated similarly abnormal sclera with the disorganization of collagen fiber bundles and deposits of proteoglycans in the matrix. Quadrantic lamellar-sclerectomy with sclerostomy was effective in both types 1 and 2, inducing post-operative resolution of the subretinal fluid accumulation and increasing the useful BCVA. The choroidal thickness was significantly different before and after surgery ( < 0.05). Approximately 98.1% of cases attained permanent reattachment within 6 months after one operation through this procedure. The single operation success rate was 96.2%, and success with one or two operations was 100%.
UES is caused by abnormalities of the sclera and increased resistance to transscleral fluid outflow, combined with increased choroidal thickness. Quadrantic lamellar-sclerectomy with sclerostomy is an effective treatment for UES that can rescue correct the useful visual acuity.
在本研究中，我们旨在调查葡萄膜渗漏综合征（UES）象限性板层巩膜切除术联合巩膜造口术的临床特征和组织病理学，并评估手术效果。
回顾性队列研究。
2001年1月1日至2021年6月26日期间，北京同仁医院共治疗了66例诊断为UES的患者的106只眼。
对患者进行常规眼科检查、荧光素和吲哚菁绿血管造影（FFA/ICGA）；眼轴长度测定；彩色多普勒超声（CDU）；超声生物显微镜检查（UBM）、光学相干断层扫描（OCT）和光学相干断层血管造影（SD/SS-OCTA）。所有患者均在赤道部进行象限性板层巩膜切除术联合巩膜造口术，并对所有切除的巩膜样本进行组织病理学检查。
脉络膜和视网膜复位、浆液性积液消退、最佳矫正视力（BCVA）、脉络膜厚度以及睫状体脉络膜脱离复发情况是主要观察指标。
确定了两个亚组：（1）1型（小眼球眼），眼球小（平均眼轴长度15.83±1.45mm），伴有高度远视（平均12.6屈光度）；（2）2型（非小眼球眼），眼球大小正常（平均眼轴长度23.45±1.68mm），有或无屈光不正，伴有或不伴有全身症状。组织病理学上，1型和2型均显示巩膜异常相似，胶原纤维束紊乱，基质中有蛋白聚糖沉积。象限性板层巩膜切除术联合巩膜造口术对1型和2型均有效，可使视网膜下液体积聚在术后消退，并提高有用的BCVA。手术前后脉络膜厚度有显著差异（<0.05）。通过该手术，约98.1%的病例在一次手术后6个月内实现永久性复位。单次手术成功率为96.2%，一次或两次手术成功的比例为100%。
UES是由巩膜异常、经巩膜液体流出阻力增加以及脉络膜厚度增加引起的。象限性板层巩膜切除术联合巩膜造口术是治疗UES的有效方法，可挽救并矫正有用视力。
