眼科

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一种发生在老年人前部巩膜的局限性退行性改变

董喆,李彬,宋旭东,杨文利,顼晓琳,辛晨,刘含若,王宁利   

  1. 100730 首都医科大学附属北京同仁医院 北京同仁眼科中心 北京市眼科研究所 眼科学与视觉科学北京市重点实验室
  • 收稿日期:2018-01-08 出版日期:2018-03-25 发布日期:2018-03-24
  • 通讯作者: 王宁利,Email:wningli@vip.163.com

A special local sclera degeneration in old people

DONG Zhe,  LI Bin, SONG Xu-dong,   YANG Wen-li,  XU Xiao-lin,  XIN Chen, LIU Han-ruo,  WANG Ning-li   

  1. Beijing Tongren Eye Center,  Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science,  Beijing Tongren Hospital,  Capital Medical University,  Beijing 100730,  China
  • Received:2018-01-08 Online:2018-03-25 Published:2018-03-24
  • Contact: WANG Ning-li, Email: Wningli@vip.163.com

摘要:

目的 探讨老年人角膜缘外局部巩膜特殊退行性改变的临床特征。设计 回顾性病例系列。 研究对象 2016年5月至2017年12月北京同仁医院眼科白内障中心就诊的伴有局部巩膜外观异常的患者32例(51眼)。方法 回顾患者的裂隙灯检查记录、前节相干光断层扫描(OCT)、超声生物显微镜(UBM)、眼B超检查、IOL Master、病理检查资料。主要指标 局部巩膜病变位置、形态、大小、病理表现。结果 患者年龄61~86岁,平均(71.12±11.43)岁;男性10例(31.25%),女性22例(68.75%)。51眼局部巩膜异常均呈青灰色,边界清楚,约2 mm ×5 mm大小的类圆形改变。均位于角膜鼻侧睑裂区。裂隙灯下病变呈微囊样。前节OCT示病变部位巩膜层间呈类圆形中低反射。低反射区域上方边缘距巩膜外表面0.11~0.29 mm,下方边缘距巩膜内表面约0.31~0.48 mm。UBM示,病变部位表面巩膜回声均呈片状局限增强,内回声均匀一致,其下为规则的无回声区。眼B超检查均未见巩膜葡萄肿样改变。组织学检查巩膜病变呈蓝紫色无定形退行性改变。结论本文报告了一种角膜缘后局部巩膜板层的特殊退行性病变,该病变位于角膜鼻侧的睑裂区,呈青灰色、边界清楚、类圆形,发病机制不清。(眼科,2018, 27:95-98)

关键词: 巩膜, 退行性改变, 老年人

Abstract:

Objective To report a special local sclera degeneration located posterior to corneal limbus in old people. Design Retrospective case series. Participants 32 cases (51 eyes) of out-patients with cataract whose sclera showed local abnormal appearance from May 2016 to Dec 2017. Methods We reviewed the measurement of the eyes with slit-lamp,  anterior segment optical coherence tomography (OCT),  ultrasound biomicroscopy (UBM),and B scan. We also had the opportunity to perform pathological examination in one case. Main Outcome Measures The location,  the morphology,  the size of the lesion,  and the pathological findings. Results The age of these patients ranged from 61~86 years (mean 71.12±11.43 years). Among them,  10 cases were male (31.25%),  and 22 cases were female (68.75%). In all 51 eyes the lesion located in the nasal side posterior to corneal limbus of the fissurae palpebrae,  which appeared cinerous,  sharply-defined,  oval shape of about 2 mm ×5 mm,  with micro cyst appearance under slit-lamp microscopy. The abnormal area showed low echo and low reflection on OCT and UBM. The distance from the upper edge of the low echo area to the outer surface of sclera was 0.11~0.29 mm,  and the distance from the lower edge of the low echo area to the inner surface of sclera was 0.31~0.48 mm. No sclera stampyloma was detected with B scan. Histopathological examination showed that the lesion was a  blue-purple amorphous degenerative change. Conclusion We primarily reported a special local sclera degeneration located posterior to corneal limbus in old people. This kind of pathological change occurred in the nasal side of the fissurae palpebrae,  and appeared cinerous,  sharply defined,  oval shape. But its pathogenesis,  the relative factors,  and the clinical significance need to be further researched.(Ophthalmol CHN,  2018, 27:95-98)

Key words: scleral, degeneration, the aged