{"id":9010,"date":"2019-08-20T10:15:08","date_gmt":"2019-08-20T10:15:08","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=9010"},"modified":"2019-08-20T10:15:08","modified_gmt":"2019-08-20T10:15:08","slug":"9010-2","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/9010-2\/","title":{"rendered":"Biomicroscopia ultrasonica in diagnosticul patologiei segmentului anterior ocular"},"content":{"rendered":"
\"\"
Dr. Oana POSTOLACHE, Medic Primar Oftalmolog Clinica Oftalmologic\u0103 Gauss, Bac\u0103<\/em>u<\/figcaption><\/figure>\n

\n

\u00a0\u00a0\u00a0\u00a0 Biomicroscopia ultrasonic\u0103 (UBM) este o metod\u0103 noninvaziv\u0103 care utilizeaz\u0103 frecven\u021ba ultrasonic\u0103 (25-60 MHz) pentru evaluarea cantitativ\u0103 \u0219i calitativ\u0103 a structurilor segmentului anterior ocular.<\/p>\n

\u00a0\u00a0\u00a0\u00a0 Avantaje ale UBM:<\/p>\n

    \n
  1. Vizualizarea structurilor segmentului anterior ocular cu penetran\u021b\u0103 de 16 mm \u0219i rezolu\u021bie de 35 microni \u00een timp real.<\/li>\n
  2. Examinarea at\u00e2t calitativa c\u00e2t \u0219i cantitativ\u0103 a structurilor segmentului anterior ocular, independent\u0103 de starea mediilor optice.<\/li>\n<\/ol>\n

    \u00a0\u00a0\u00a0\u00a0 UBM vizualizeaz\u0103: cornea, camera anterioar\u0103, cristalin \u0219i zonula, complexul iridociliar (iris, corp ciliar, unghiul camerular), camera posterioar\u0103, periferia vitrosului \u0219i a retinei.<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Tehnica UBM se realizeaz\u0103 cu un transductor de 40-60 MHz. Se realizeaz\u0103 o fereastr\u0103 de diagnostic de 15×16 mm, cu unghi de scanare de 30 de grade \u0219i rezolu\u021bie de 15-35 microni. Pacientul st\u0103 \u00een pozi\u021bie de supina\u021bie cu anestezie topic\u0103. Se pozi\u021bioneaz\u0103 o „scoic\u0103” (suport de plastic de forma de trunchi de con, care se sprijin\u0103 pe suprafa\u021ba globului ocular) care se umple cu solu\u021bie salin\u0103, se pozi\u021bioneaz\u0103 sonda \u00een scoic\u0103 \u0219i se ob\u021bine pe monitor o imagine \u00een timp real.<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Scan\u0103ri UBM: axial\u0103, longitudinal\u0103 \u0219i transvers\u0103.<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Scanarea axiala realizeaz\u0103 o imagine panoramic\u0103 a segmentului anterior. Pacientul prive\u0219te drept \u00eenainte, sonda este plasata perpendicular pe cornee, central. Prin aceasta scanare se evalueaz\u0103 corneea (grosime, transparent\u0103), camera anterioar\u0103 (ad\u00e2ncime, umoare apoasa), iris (pozi\u021bie, structura), cristalin (transparent\u0103, pozitie), pozi\u021bionarea lentilei intraoculare.<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Scanarea longitudinal\u0103 (meridional\u0103) se realizeaz\u0103 cu sonda perpendiculara pe limb, cu marker-ul spre pupila, func\u021bie de meridianul orar. Aceasta evalueaz\u0103 ad\u00e2ncimea camerei anterioare, iris (grosime, convexitate, inser\u021bie), corp ciliar (grosime, structura), cristalin (zonula, capsula), hapticile lentilei intraoculare, periferia vitrosului si a retinei.<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Scanarea transversa se realizeaz\u0103 cu sonda paralela cu limbul peste irisul central la meridianul orar de interes. UBM evalueaz\u0103 irisul (grosime, convexitate, structura) corp ciliar (grosime, structura, procese ciliare), para plana, periferia vitrosului si retina (ora serata).<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Parametri ecografici ai structurilor segmentului anterior ocular la pacien\u021bii normali (inserare tabel)<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 UBM \u00ee\u0219i g\u0103se\u0219te utilitatea \u00een: glaucom, chirurgia cataractei \u0219i chirurgia refractiv\u0103, oncologie, patologia traumatic\u0103.<\/p>\n

    UBM \u00een glaucom<\/strong><\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Permite evaluarea leg\u0103turii anatomo topografice \u00eentre structurile camerei anterioare, \u0219i astfel \u00een\u021belegerea mecanismului de dezvoltate a glaucomului.<\/p>\n

    \u00a0\u00a0\u00a0\u00a0 Permite urm\u0103rirea pacientului dup\u0103 tratament: evaluarea modific\u0103rilor morfologice ale corpului ciliar, evaluarea topografiei unei c\u0103i noi de acces create pentru drenajul, umori apoase \u00een chirurgia glaucomului, localizarea dispozitivului de drenaj.<\/p>\n

      \n
    1. \u00cen glaucomul pigmentar (sindrom de dispersie pigmentar\u0103) mecanismul e dat de dispersia granulelor de pigment de pe fa\u021ba posterioar\u0103 a irisului. UBM permite evaluarea gradului de deschidere a camerei anterioare, configura\u021bia irisului (concav), bloc pupil\u0103 relativ, contactul irido zonular.<\/li>\n
    2. \u00cen glaucomul prin blocaj pupilar mecanismul e determinat de contactul irido cristalinian; rezisten\u021ba la scurgerea umori apoase din camera posterioar\u0103 \u00een camera anterioar\u0103 creeaz\u0103 un gradient presional \u00eentre cele dou\u0103 camere. UBM eviden\u021biaz\u0103 bombarda anterioar\u0103 a irisului, \u00eengustarea unghiului camerular, apozi\u021bionarea iris cristalin. Iridotomia periferic\u0103 laser elimin\u0103 diferen\u021ba presional\u0103 \u00eentre camera anterioar\u0103 \u0219i camera posterioar\u0103, elibereaz\u0103 convexitatea irisului \u0219i deschide unghiul camerular.<\/li>\n
    3. \u00cen glaucomul malign \u00eenchiderea unghiului e determinat\u0103 de diferen\u021ba de presiune \u00eentre vitros \u0219i compartimentul anterior. Umflarea \u0219i rota\u021bia anterioar\u0103 a corpului ciliar \u0219i a diafragmului iris cristalin poate determina deplasarea anterioar\u0103 a cristalinului.<\/li>\n
    4. \u00cen sindromul de iris \u00een platou mecanismul \u00eel reprezint\u0103 \u00eengustarea camerei anterioare datorit\u0103 inser\u021biei anterioare a corpului ciliar sau deplasarea corpului ciliar spre anterior. UBM eviden\u021biaz\u0103 \u00eengro\u0219area irisului, profil irian drept, procese ciliare deplasate anterior, \u00eenchiderea sulcusului ciliar, unghiul camerei anterioare \u00eengust.<\/li>\n
    5. \u00cen glaucomul pseudoexfoliativ mecanismul e determinat de ocluzia re\u021belei trabeculare cu material \u0219i pigment. UBM eviden\u021biaz\u0103 stadiile modific\u0103rilor, arii u\u0219or reflective \u00een vecin\u0103tatea marginii pupilare \u0219i suprafe\u021bei anterioare a cristalinului, lungimi variabile ale zonulei cu Lisa par\u021bial\u0103, deplasarea cristalinului cu laxitatea zonulei.<\/li>\n
    6. UBM evalueaz\u0103 eficient\u0103 iridotomiei laser \u00een tratamentul glaucomului. Iridotomia laser trebuie s\u0103 fie localizat\u0103 la periferia irisului \u0219i s\u0103 aib\u0103 un diametru mai mare de 0.2 mm.<\/li>\n
    7. UBM evalueaz\u0103 eficien\u021ba chirurgiei glaucomului: dac\u0103 bula de filtra\u021bie dreneaz\u0103 normal, cu colec\u021bie de fluid subconjunctival \u0219i reflexivitate intrabul\u0103 u\u0219oar\u0103 spre moderat\u0103. Evalueaz\u0103 de asemenea \u00eencapsulat\u0103 chistic\u0103 a bulei de filtratie: apar arii hiporeflective, cu multiple colec\u021bii de lichid, de dimensiuni \u0219i intensit\u0103\u021bi variabile. Evalueaz\u0103 sistemele de drenaj \u00een camera anterioar\u0103, dac\u0103 lumenul ecestora este liber; evalueaz\u0103 sistemele de drenaj \u00een camera posterioar\u0103 sau scler\u0103.<\/li>\n<\/ol>\n

      UBM \u00een cataract\u0103<\/strong><\/p>\n

      \u00a0\u00a0\u00a0\u00a0 Evalueaz\u0103 rela\u021bia anatomo topografica \u00eentre structurile diafragmului irido cristalinian: starea cristalinului \u0219i a zonulei, localizarea cristalinului, necesitatea chirurgiei cataractei. Cu ajutorul UBM se urm\u0103resc pacien\u021bii dup\u0103 chirurgia cataractei: pozi\u021bionarea IOL, hapticelor \u0219i elementelor optice, statusul sacului capsular.<\/p>\n

        \n
      1. \u00cen anomaliile congenitale cristaliniene:<\/li>\n<\/ol>\n

        \u00a0\u00a0\u00a0\u00a0 – \u00een sindromul Peters UBM arat\u0103 adeziuni centrale corneo cristaliniene, sferofakia, cataracta, ectoplasmei lentis, sub\u021bierea irisului, adeziuni iridocorneene.<\/p>\n

        \u00a0\u00a0\u00a0\u00a0 – \u00een microfakie UBM eviden\u021biaz\u0103 cristalin anormal de mic, sub\u021bierea irisului \u0219i a corpului ciliar<\/p>\n

          \n
        1. \u00cen cataract\u0103 apar arii hiperecogene \u00een cristalin, num\u0103rul, forma \u0219i pozi\u021bionarea lor depinzind de tipul cataractei.<\/li>\n
        2. \u00cen cataracta posttraumatic\u0103 apare o \u00eengro\u0219are \u0219i o hiperreflectivitate a corneei, \u00eengro\u0219area camerei anterioare, iris bombe, m\u0103rire de volum \u0219i hiperreflectivitate a cristalinului, unghi camerular \u00eenchis. \u00cen subluxatii apare \u00een UBM deplasarea cristalinului in vitros, hiperreflectivitate a cristalinului, deta\u0219area corpului ciliar. UBM eviden\u021biaz\u0103 ruptura zonulara: hernierea corpului vitros \u0219i deplasarea cristalinului. Distan\u021ba \u00eentre ecuatorul cristalinului \u0219i procesele ciliare trebuie s\u0103 fie mai mare de 1,3 mm. UBM eviden\u021biaz\u0103 pozi\u021bia lentilei intraoculare: localizarea p\u0103r\u021bii optice a IOL corespunz\u0103tor axelor optice; pozi\u021bionarea hapticilor IOL ( \u00een sac sau sulcus).<\/li>\n<\/ol>\n

          UBM \u00een vizualizarea tumorilor oculare<\/strong><\/p>\n

          \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 UBM e util \u00een vizualizarea tumorilor conjunctivale, limbice, iriene, de corp ciliar, tumori din periferia coroidei- pentru a determina m\u0103rimea, structura, interac\u021biunea cu structurile \u00eenconjur\u0103toare, gradul de invazie, pentru fixarea tratamentului \u0219i evaluarea eficien\u021bei acestuia. Se pot vizualiza tumori benigne epibulbare (chisti sclerali lipodermoizi); melanoame conjunctivale; tumori benigne iriene; melanoame iriene (apare \u00eengro\u0219are localizat\u0103 a irisului cu modific\u0103ri ale suprafe\u021bei anterioare sau posterioare, cu reflexivitate redus\u0103 \u00een compara\u021bie cu \u021besuturile intacte). \u00cen melanomul de corp ciliar apare hiporeflexivitatea \u00eengro\u021b\u0103rii localizate a corpului ciliar; se poate forma cataract\u0103 datorit\u0103 interac\u021biunii cu ecuatorul cristalinului. Melanomul iridociliar are o reflexivitate redus\u0103 spre moderat\u0103. Invazia r\u0103d\u0103cinii irisului \u0219i a unghiului camerular este eviden\u021biat\u0103 prin reducerea reflexivit\u0103\u021bii comparativ cu structurile din jur. Chistii irieni pe UBM apar ca \u0219i chisti cu pere\u021bi fini, f\u0103r\u0103 reflectivitate intern\u0103. Chistii de corp ciliar apar ca forma\u021biuni\u00a0 rotunde sau ovalare, solitare sau multiple, cu perete fin hiperecogen \u0219i f\u0103r\u0103 reflectivitate intern\u0103.<\/p>\n

          UBM \u00een traumatismele oculare<\/strong><\/p>\n

          UBM poate eviden\u021bia hiphema; acumul\u0103ri sanguine \u00een camera anterioar\u0103; recesie angular\u0103; prolaps sau ruptura a r\u0103d\u0103cinii irisului; fistule \u00eentre camera anterioar\u0103 \u0219i spa\u021biul supracoroidian; \u00eengustarea camerei anterioare; expunerea pintenului scleral; deplasarea irisului \u0219i corpului ciliar; sinechii iridocorneene; corpi str\u0103ini \u00een camera anterioar\u0103.<\/p>\n

          UBM e contraindicat \u00een pl\u0103gi penetrante ale ochiului; chirurgie ocular\u0103 recent\u0103; ulcer cornean; infec\u021bii ale suprafe\u021bei oculare; la pacien\u021bii necooperan\u021bi.<\/p>\n

          \u00cen concluzie UBM e o metod\u0103 nou\u0103 de folosire a ultrasunetelor \u00een investigarea polului anterior ocular, ce permite captarea de imagini in vivo ale acestuia cu o rezolu\u021bie foarte \u00eenalt\u0103.<\/em><\/strong><\/p>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          \u00a0\u00a0\u00a0\u00a0 Biomicroscopia ultrasonic\u0103 (UBM) este o metod\u0103 noninvaziv\u0103 care utilizeaz\u0103 frecven\u021ba ultrasonic\u0103 (25-60 MHz) pentru evaluarea cantitativ\u0103 \u0219i calitativ\u0103 a structurilor segmentului anterior ocular. \u00a0\u00a0\u00a0\u00a0 Avantaje ale UBM: Vizualizarea structurilor […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[78],"tags":[],"class_list":["post-9010","post","type-post","status-publish","format-standard","category-oftalmologie"],"yoast_head":"\nBiomicroscopia ultrasonica in diagnosticul patologiei segmentului anterior ocular<\/title>\n<meta name=\"description\" content=\"Biomicroscopia ultrasonica in diagnosticul patologiei segmentului anterior ocular este o metod\u0103 noninvaziv\u0103 care utilizeaz\u0103 frecven\u021ba ultrasonic\u0103\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/9010-2\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Biomicroscopia ultrasonica in diagnosticul patologiei segmentului anterior ocular\" \/>\n<meta property=\"og:description\" content=\"Biomicroscopia ultrasonica in diagnosticul patologiei segmentului anterior ocular este o metod\u0103 noninvaziv\u0103 care utilizeaz\u0103 frecven\u021ba ultrasonic\u0103\" \/>\n<meta property=\"og:url\" content=\"https:\/\/jurmed.ro\/medici\/9010-2\/\" \/>\n<meta property=\"og:site_name\" content=\"Jurmed - 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