| Objective:To evaluate the effect of anterior segment optical coherence tomography (AS-OCT) and intraocular ultrasound biomicroscopy (UBM) in the diagnosis of traumatic cyclodialysis in order to optimize the clinical examination and to evaluate the clinical effects of an improved cyclopexy and the traditional cyclopexy in the treatment for traumatic cyclodialysis for optimizing surgical options. To detect interleukin-6(IL-6), tumor necrosisfactor-alpha (TNF-a) level in ciliary body cavity exudate of patients with traumatic cyclodialysis, and explore its role in the development of detachment of ciliary body, provide ideas for prevention and treatment of cyclodialysis.Methods:1Clinical case-control study.30patients of traumatic cyclodialysis were enrolled. Each case was used gonioscopy, UBM and AS-OCT to confirm the ciliary body detachment. Positive rate of UBM and AS-OCT in the diagnosis of traumatic cyclodialysis was compaired using paired χ2, test of SPSS.2A randomized controlled clinical study.23patients receiving operation for traumatic cyclodialysis were randomly divided into2groups. The traditional group was11cases, the improved group was12cases. Recording their restoration of ciliary body, preoperative and postoperative intraocular pressure and visual acuity. SPSS statistical software was used for statistical analysis.312patients with traumatic ciliary body detachment underwent surgical operation were enrolled in this study and samples were successfully obtained. The ciliary body cavity effusion is as the experimental group and the autologous serum as the control group. IL-6and TNF-a were analysed using ELISA assay in two groups, using SPSS statistical software paired t test for statistical analysis.Results:1The positive rate of ciliary body detachment of gonioscopy group, UBM group and AS-OCT group was respectively63.33%,100%,60%. The differences were statistically significant (P=0.001,P=0.0000respectively, P<0.05)between the UBM group and the gonioscopy group, the UBM group and AS-OCT group, but there was no statistical significance between the gonioscopy group and the AS-OCT group (P value=1.000,>0.05).290.9%(10/11) patients in the traditional group and100%(12/12) patients in the improved group successfully reset the ciliary body after operation, which has significant difference in statistical significance compared with that of preoperative(P <0.05),but there was no statistical significance between the. two groups postoperatively (P>0.05). The mean preoperative IOP was6.45±1.58mmHg in the traditional group and6.78±1.43mmHg in the improved group.which reached13.35±2.08mmHg and14.57±2.96mmHg respectively on average2weeks after operation.The difference in both the two groups has statistical significance(traditional group:t=-12.74,P<0.01; improved group:t=-11.85,P<0.01). but there was no statistical significance between the two groups postoperatively (t=-1.17,P>0.05). Visual acuity was increased from0.25±0.21in the traditional group and0.29±0.23in the improved group preoperatively to0.42±0.26and0.45±0.21respectively after operation, in which the vision>0.3reached63.6%and66.6%respectively and the difference has statistical significance(traditional group:t=-5.27, P<0.01; improved group:t=-5.89,P<0.01). There was no statistical significance between the two groups postoperatively (P>0.05).3The content of IL-6was70.25±58.64pg/ml in the experimental group,6.29±1.25pg/ml in the control group. The content of TNF-a was18.59±5.75pg/ml,8.93±1.82pg/ml respectively. The content of IL-6and TNF-a in ciliary body cavity effusion was higher than that of in serum,and the difference had statistical significance on average2weeks after operation.The difference in both the two groups has statistical significance (P<0.05)Conclusions:Anterior segment OCT has no obvious advantage compared with UBM, but it provides a new means of inspection for the detachment of ciliary body, especially for some patients not suitable for gonioscopy and UBM and those demanding for better comfort in the examination. Both the traditional direct cyclopexy and the improved cyclopexy can effectively reset ciliary body with intraocular pressure and visual acuity improved, but the latter is relatively simplified, time saving and it is hopefully getting more applications in more cases. IL-6and TNF-a levels in ciliary body cavity effusion were higher than that in serum, suggesting that they may be involved in the formation and/or development of the effusion,which provide new ideas for prevention and treatment of cyclodialysis. |
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