标准化A超联合B超诊断脉络膜血管瘤和脉络膜黑色素瘤

目的：探讨标准化A超和B超联合诊断脉络膜血管瘤和脉络膜黑色素瘤的价值。方法：使用标准化A超联合B超诊断5例脉络膜血管瘤和4例脉络膜黑色素瘤。结果：脉络膜血管瘤标准化A超表现为病变内反射波较高，结构规则，声衰减不明显，B超示眼后极部孤立性占位病变，内回声强而均匀。脉络膜黑色素瘤标准化A超表现为病变内反射较低，声衰减明显，B起示眼内半圆形或蘑菇形实性隆起，可见脉络膜凹陷现象。结论：标准化A超对脉络膜血管瘤和脉络膜黑色素瘤可提供如病变内部结构、内反射、声衰减等诊断信息，B超对病变的形状、定位更有价值。标准化A超鉴别肿瘤的性质要优于B超，并具有可重复性和可比较性的优点。标准化A超联合B超可对脉络膜血管瘤和脉络膜黑色素瘤的诊断起到较好效果。     

高频超声对眼内膜状回声的定量分析

目的 探讨高频超声A/B超眼内膜状物的定量分析的价值.方法 用法国BVI公司生产的A/B超,B超直观显示膜状回声的声像图,A超同时对应的显示其波峰高度,对860例(880只眼)眼内膜状物进行超声检查分析,实时精确记录各种膜状回声完整出现时的最弱增益值,膜状回声消失时增益值及球壁回声消失时增益数值.主要观察指标:膜状回声的位置同定点、强度、形态、厚度、运动、后运动、与周围组织的关系、膜状回声消失增益值及球壁回声消失增益差值.结果 5种眼内病变均有各自的超声声像学特点及回声的强弱.视网膜脱离的影像诊断数206只眼,符合率达99.5%;玻璃体后脱离的影像诊断数332只眼,符合率达97.1%;玻璃体机化的影像诊断数178只眼,符合率达95.2%;玻璃体积血并机化的影像诊断数100只眼,符合率达98.1%.脉络膜脱离的影像诊断数41只眼,符合率达97.4%.通过比较,视网膜脱离、玻璃体后脱离、玻璃体机化及玻璃体积血并机化、脉络膜脱离5种疾病的膜状回声消失与球壁回声消失时回声增益差值,各组间均有统计学意义结果差异显著(P<0.05) .结论 高频超声的A/B超对视网膜脱离、玻璃体后脱离、玻璃体机化及玻璃体积血并机化、脉络膜脱离5种病变的定量分析有重要意义.定量分析这些膜状回声,有利于鉴别诊断眼后段病变,为眼后段疾病诊晰提供了依据,声像图为治疗方式的选择提供参考.     

应用B超诊断脉络膜骨瘤的分析

目的 了解脉络膜骨瘤的B超声像特征，以助于临床诊断。方法 眼科专用A，B型超声诊断仪对5例患者进行眼部扫描，发现典型病变，留图打印。结果 5例患者B超均显示近税乳头附近可见孤立的、低隆起度的、条形强回声斑，其后方声影明显，提示脉络膜骨瘤，后经眼底荧光血管造影检查或CT检查得到证实。结论 B超检查安全、无痛苦、可重复，经济，快速易行。脉络膜骨瘤有典型的声像特征，可作为诊断脉络膜骨瘤的首选检壹方法。     

常规超声联合超声造影鉴别诊断脉络膜转移癌和脉络膜血管瘤

目的:分析脉络膜转移癌和脉络膜血管瘤的常规超声和超声造影(CEUS)特点,探讨常规超声联合CEUS在脉络膜转移癌和脉络膜血管瘤鉴别诊断中的临床应用价值。方法:回顾性分析2010-05/2016-01于沈阳市第四人民医院诊治的脉络膜转移癌患者17例17眼和脉络膜血管瘤患者35例35眼的常规超声和CEUS资料,常规超声观察肿瘤的二维和彩色多普勒特点,CEUS观察肿瘤的造影剂灌注强度和变化情况,并分析CEUS动态资料获得TI曲线和CEUS参数。结果:常规超声检查显示,脉络膜转移癌较脉络膜血管瘤回声偏低、欠均匀,隆起度较均匀一致,表面呈波浪状,其诊断脉络膜转移癌、脉络膜血管瘤的正确率分别为59%(10/17)、68%(24/35)。CEUS检查显示,脉络膜转移癌TI曲线类型多呈快进快出模式(14/17),脉络膜血管瘤TI曲线类型多呈快进慢出模式(31/35);脉络膜转移癌峰值强度(IMAX)、上升时间(RT)均低于脉络膜血管瘤(P<0.05)。常规超声联合CEUS诊断脉络膜转移癌、脉络膜血管瘤的正确率分别为82%(14/17)、88%(31/35)。结论:常规超声联合CEUS可为脉络膜转...     

眼内肿瘤的彩色超声多普勒诊断分析

目的研究眼内肿瘤的彩色超声多普勒诊断特征，为鉴别诊断提供依据。方法应用彩色超声多普勒诊断仪对９２例（１０５只眼）眼内肿瘤进行检查，观察各种肿瘤的血流特征，并测定病变内血管的血流参数。用ＳＡＳ软件对测定结果进行统计学分析。结果视网膜母细胞瘤、脉络膜黑色素瘤、脉络膜血管瘤、视盘血管瘤、脉络膜转移癌，Ｃｏａｔｓ病及原始玻璃体增生症（ｐｅｒｓｉｓｔｅｎｔｈｙｐｅｒｐｌａｓｔｉｃｐｒｉ－ｍａｒｙｖｉｔｒｅｏｕｓ，ＰＨＰＶ）的病变上均可发现血流信号；而脉络膜骨瘤和视乳头黑色素细胞瘤的病变内无血流信号。脉络膜黑色素瘤的视网膜中央动脉和脉络膜血管瘤的眼动脉、视网膜中央动脉及睫状后短动脉的血流参数均较正常值下降（Ｐ＜０．０５）；而脉络膜黑色素瘤与脉络膜血管瘤比较，睫状后短动脉的血流速度，前者明显高于后者（Ｐ＜０．０５）。结论彩色超声多普勒对眼内肿瘤的诊断及鉴别诊断有重要价值。     

脉络膜肿瘤的超声诊断——附43例探查报告

本文报告 A、B 超声探查脉络膜肿瘤43例,包括黑色素瘤31例,转移癌9例,血管瘤3例。所有病例均在超声图上有阳性发现。本文结合肿瘤组织学特征介绍和讨论了脉络膜黑色素瘤、转移癌和血管瘤的超声图形和声学特点、诊断、鉴别诊断以及值得注意的问题。     

超声检查和眼底血管造影在葡萄膜转移癌诊断中的价值

目的 探讨超声和荧光素眼底血管造影检查在葡萄膜转移癌诊断中的价值。方法 对9例(9只眼)葡萄膜转移癌病例的超声和荧光素眼底血管造影的检查结果进行同顾性分析,其中8例脉络膜转移癌,1例虹膜转移癌。结果 脉络膜转移癌者A超扫描为中-高强度反射且波峰不规则;B超检查为眼球后极部或视盘周围呈扁平状隆起的内回声不均病灶并伴有病灶周围渗出性视网膜脱离;眼底血管造影早期表现为无脉络膜背景荧光的暗区,而后逐渐显现斑点状高荧光,晚期荧光融合增强呈斑驳样。虹膜转移癌者超声生物显微镜检查可见虹膜实质层的广泛增厚隆起,边缘较整齐,内回声较均匀呈中等强度。结论 超声和荧光素眼底血管造影检查在葡萄膜转移癌诊断中具有重要的临床应用价值,尤其对于不典型病例,与其他脉络膜占位性病变难区分的时候,应注意其眼底典型的表现以及影像学的特点,减少误诊、漏诊。     

脉络膜上腔出血的超声显像

为了解脉络膜上腔出血（脉络膜暴发性出血）的Ｂ超图像特征,对手术或外伤等所致的疑为脉络膜上腔出血病例应用Ｂ超检查进行诊断。使用眼科专用超声诊断仪,探头频率为１０兆赫。对眼内各个方位使用正常灵敏度进行探测。结果：４９例４５眼超声显像特征：显示向玻璃体腔暗区突起的边界清晰、光滑的半球形强回声区。光点的密与疏代表出血量的多少,出血范围的大小表现为一个至多个半球形或六个半球形强回声区。结论：应用Ｂ超检查可以明确脉络膜上腔出血的诊断,并随访治疗的效果。     

彩色多普勒在脉络膜脱离型视网膜脱离的临床应用

目的 评价B型超声及彩色多谱勒血流成像(CDH)对脉络膜脱离型视网膜脱离的诊断价值.方法 16例脉络膜脱离型视网膜脱离患者,分别行常规B超并叠加CDH诊断,结合临床治疗及手术反馈信息,证实超声诊断准确性.结果 经手术验证,B超结合CDFI诊断脉络膜脱离型视网膜脱离符合率96.85%,B超及CDFI影像具有特征性表现.结论 应用B超结合CDFI,显著提高了对脉络膜脱离犁视网膜脱离的诊断准确性,并较精细的显示内眼情况.     

年龄相关性黄斑变性的彩色多普勒超声影像特征

目的探讨年龄相关性黄斑变性(AMD)患者的彩色多普勒血流成像(CDFI)超声影像特征。方法应用CDFI超声诊断仪检测98例AMD患者,观察、分析其CDFI影像特征,并与脉络膜黑色素瘤、脉络膜转移癌、脉络膜黑色素细胞瘤、黄斑水肿等疾病相鉴别。结果干性AMD患者的CDFI影像特征：多数患者经CDFI超声检测无特殊发现,部分患者CDFI影像中可见黄斑区球壁回声局限隆起,但隆起高度一般不超过1．5mm,病变内可见边界清晰的点状强回声,基底部血流信号较丰富。湿性AMD患者的CDFI影像特征：黄斑区呈现半球形或不规则形实性病变,边界清晰,但不规则,内回声均匀为中强回声,无脉络膜凹陷;病变的基底部可探及较丰富的血流信号,表面可探及点状、带状血流信号,病变内部无异常血流信号。应用CDFI诊断干性和湿性AMD患者,关键在于黄斑区病变的形态、边界、内部回声、玻璃体内有无同时合并玻璃体混浊(积血)等。依据AMD患者的CDFI影像特征和血流形态,可与脉络膜黑色素瘤、脉络膜转移癌、脉络膜黑色素细胞瘤、黄斑水肿等疾病相鉴别。结论应用CDFI检测AMD患者的方法简便、诊断准确,值得临床推广应用。（中华眼科杂志,2005．41：300—304）     

A study on axis length measurement of high myopia with cataract]

PURPOSE: To study the accuracy of axis length measurement on high myopia with cataract. METHODS: A/B scan ultrasonography and IOL-master were used to measure the ocular axial length in 168 high myopic eyes with cataract of 103 cases. B-scan ultrasonography was used to examine posterior scleral staphyloma. Refractive results were recorded during the follow-up after operation to evaluate the accuracy of measurement. RESULTS: The rate of posterior scleral staphyloma was 76.19%. The average postoperative error of refractive of all eyes was between -1.0 D and +1.0 D. CONCLUSION: Accurate data of axis length can be obtained by combining results of A-scan, B-scan ultrasonography and IOL-master for high myopia with cataract, especially for patients with posterior scleral staphyloma.     

高度近视白内障患者眼轴测量方法的探讨

目的:探讨高度近视白内障患者眼轴测量方法,提高检查的准确性。方法:对103例(168只眼)高度近视合并白内障患者,用A/B超测量仪(法国光太公司生产的A/B超测量仪和加拿大OTI公司生产的A/B超测量仪)和光学相干生物测量仪(德国生产的IOLMASTER)多种仪器对比测量。结合B超了解后巩膜葡萄肿的位置,对后巩膜葡萄肿位于黄斑区者,调整对准葡萄肿位置诱导出现标准波形进行测量。对后巩膜葡萄肿位于黄斑区之外者,避开葡萄肿位置,诱导出现标准波形。用多种仪器对照测量,对照标准波形(图1)取三次标准波形的均值作为眼轴数据计算人工晶状体度数,并对患者手术后屈光度进行分析。结果:本组患者的后巩膜葡萄肿发生率为76.19%。患者术后复查,平均绝对屈光误差≤±1D为100%。结论:对高度近视白内障患者,特别有后巩膜葡萄肿患者,采取A、B超结合测量,多种仪器对照测量,观察获取标准波形的均值等综合方法获取准确的眼轴数据。     

Posterior uveal melanomas in aphakic and pseudophakic eyes

Of 650 eyes with posterior uveal melanomas that were accessioned at the Armed Forces Institute of Pathology from 1975 to 1983, 28 were aphakic and eight were pseudophakic. In ten of these 36 cases, the cataract had been unilateral. Only two patients had been examined with preoperative A-scan ultrasonography to obtain the axial length of the eye. None of the patients had been examined for possible intraocular tumors by either A- or B-scan ultrasonography. We believe that in many of these cases the tumor was large enough to have been detected at the time of cataract surgery. Thus, if the lens is too opaque for the fundus to be viewed, B-scan ultrasonography should be used before cataract extraction.     

Echographic features of tilted optic disk

Unusual echographic features of the optic nerve were observed in four cases of tilted disk syndrome. A-scan ultrasonography revealed an increase in the dural diameter of the optic nerve (average, 8.5 microseconds), and B-scan ultrasonography showed an accentuation and doubling of optic nerve outline, which is a feature of optic neuropathy. The probable cause for these echographic features is the abnormal configuration of the nerve.     

Dynamic register in ocular ultrasonography: Combining A- and B-scan techniques

We present the results obtained after studying two groups of patients with dynamic register techniques, using A-scan, standardised A-scan following Ossoinig's procedure and B-scan. One group comprised 50 patients with retinal detachment and proliferative vitreoretinopathy while the other consisted of 15 patients with choroidal melanoma. In the group of patients with retinal detachment and proliferative vitreoretinopathy 90% of cases demonstrated waves with 100% amplitude on A-scan when the ultrasound beam was directed perpendicularly over the detached retina. Likewise in these same 90% of cases we observed a small split in the wave peak during the aftermovements. Conversely on B-scan 80% of these patients with retinal detachment and proliferative retinopathy showed retinal mobility. In the group of patients with choroidal melanoma rapid spontaneous movements were detected in the internal echoes on A-scan and standardised A-scan. Moreover in 3 of the 15 cases (those of greatest size) movement could also be detected on B-scan.     

B-scan ultrasonic evaluation of a dilated superior ophthalmic vein in orbital and retro-orbital arteriovenous anomalies

All patients between 1977 and 1982 who presented with unilateral exophthalmos were evaluated with contact B-scan ultrasonography. Of these, eight patients were diagnosed as having retro-orbital or orbital arteriovenous anomalies (two carotidcavernous sinus fistulas, four dural arteriovenous malformations, and two orbital arteriovenous malformations). On B-scan ultrasound, all of these patients demonstrated a dilated superior ophthalmic vein. None of the other patients with unilateral proptosis demonstrated this finding. With recent advances in treatment of these conditions, early diagnosis becomes increasingly important. Contact B-scan ultrasonography (which is widely available, convenient, and expedient) can be used for early diagnosis of arteriovenous anomalies in the orbit and cavernous sinus areas. Other ultrasonic techniques such as A-scan, standardized A-scan, or immersion B-scan, are equally reliable in the recognition of a dilated superior orbital vein. In the authors' opinion, however, these are less convenient, more time consuming, and require more expertise for similar results.     

Diode laser photocoagulation of choroidal hemangioma

Background: The argon laser photocoagulation has recently become the treatment of choice in choroidal hemangioma. We evaluated the efficacy of the near infrared wavelength diode laser in the treatment of such tumours. This wavelength is not highly absorbed by the retinal pigment epithelium and penetrates deep into the choroid. Methods: Two cases of choroidal haemangioma with a serous detachment of the neural retina were diagnosed with ophthalmoscopy, fluorescein and indocyanine green angiography, A-scan and B-scan ultrasonography and treated with a surface photocoagulation with a diode laser. The efficacy of photocoagulation was evaluated three, six, twelve and fifteen months after laser treatment. Results: The resorption of the subretinal fluid and a reduction in thickness of the tumour followed laser photocoagulation. Conclusions: Diode lasers might be effective in the treatment of choroidal haemangioma.     

Accuracy of axial length measurements from immersion B-scan ultrasonography in highly myopic eyes

AIM:To evaluate the accuracy of axial length (AL) measurements obtained from immersion B-scan ultrasonography (immersion B-scan) for intraocular lens (IOL) power calculation in patients with high myopia and cataracts.METHODS:Immersion B-scan, contact A-scan ultrasonography (contact A-scan), and the IOLMaster were used to preoperatively measure the AL in 102 eyes from 102 patients who underwent phacoemulsification and IOL implantation. Patients were divided into two groups according to the AL:one containing patients with 22 mm≤AL<26 mm(group A) and the other containing patients with AL≥26 mm (group B). The mean error (ME) was calculated from the difference between the AL measurement methods predicted refractive error and the actual postoperative refractive error.RESULTS:In group A, ALs measured by immersion B-scan (23.48±1.15) didn’t differ significantly from those measured by the IOLMaster (23.52±1.17) or from those by contact A-scan (23.38±1.20). In the same group, the standard deviation (SD) of the mean error (ME) of immersion B-scan (-0.090±0.397 D) didn’t differ significantly from those of IOLMaster (-0.095±0.411 D) and contact A-scan (-0.099±0.425 D). In group B, ALs measured by immersion B-scan (27.97±2.21 mm) didn’t differ significantly from those of the IOLMaster (27.86±2.18 mm), but longer than those measured by Contact A-scan (27.75±2.23 mm, P=0.009). In the same group, the standard deviation (SD) of the mean error (ME) of immersion B-scan (-0.635±0.157 D) didn’t differ significantly from those of the IOLMaster (-0.679±0.359 D), but differed significantly from those of contact A-scan (-0.953±1.713 D, P=0.028).CONCLUSION:Immersion B-scan exhibits measurement accuracy comparable to that of the IOLMaster, and is thus a good alternative in measuring AL in eyes with high myopia when the IOLMaster can’t be used, and it is more accurate than the contact A-scan.     

Interobserver and intraobserver variability of measurements of uveal melanomas using standardised echography

AIMS: To report on the intraindividual and interindividual variability of tumour size (height and base diameter) measurements using standardised echography in a masked prospective study. METHODS: 20 consecutive eyes of 20 patients were examined on four different visits by three experienced examiners using standardised echography. As common in standardised echography, tumour height was evaluated with A-scan technique, while transverse and longitudinal base diameter were calculated with B-scan. RESULTS: Tumour height measurements using A-scan were more accurate than base diameter measurements using B-scan. The standard deviation for tumour height over all visits/measurements was 0.18 mm (A-scan), 0.79 mm for transverse, and 0.69 mm for longitudinal base diameters (B-scan). The interclass correlation coefficient (ICC) was much higher for tumour height measurements with A-scan (0.7735 for three examiners on one visit) than for transverse (0.6563) or longitudinal (0.4522) base diameter measurements with B-scan techniques. CONCLUSIONS: A-scan techniques for tumour height measurements provide very reproducible results with little intraindividual and interobserver variability. As B-scan techniques for tumour base evaluation are less accurate they should be used for topographic and morphological examinations.