视网膜脱离玻璃体切割术后早期高眼压发生率及相关因素
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摘要
目的:探讨视网膜脱离玻璃体切割术(PPV)后早期高眼压发生率和相关的危险因素。方法:回顾性分析2016年5月至2018年4月在我院眼科中心因视网膜脱离行PPV患者227人228只眼。纳入黄斑前膜患者36人36只眼作为对照组。比较视网膜脱离患者性别、术中处理、眼内填充物和是否伴有高度近视等因素,了解高眼压的发生率,分析术后早期发生高眼压的危险因素。结果:视网膜脱离行PPV患者中有65只眼出现高眼压,发生率为28. 5%。术中行单纯光凝、冷凝和光凝+冷凝联合治疗以及对照组患者高眼压发生率分别为27. 9%、10. 5%、34. 4%和2. 8%(P<0. 01)。视网膜脱离术中行硅油填充和空气填充患者高眼压的发生率分别为32. 2%和13. 3%(P<0. 05)。伴有高度近视和不伴有高度近视的视网膜脱离患者高眼压发生率分别为48. 6%和19. 8%(P<0. 01)。视网膜脱离术中行光凝+冷凝联合治疗、硅油填充和伴有高度近视的患者发生高眼压的风险显著增加。结论:视网膜脱离PPV术后早期高眼压的发生与眼内填充物以及有无高度近视有着密切关系。伴有高度近视可以增加视网膜脱离患者PPV术后发生高眼压的风险。术后应长期随访,以避免术后短期眼压升高和长期慢性高眼压带来的视功能损害。
Objective: To investigate the incidence and risk factors of intraocular pressure(IOP) elevation at early stage after pars plana vitrectomy(PPV) for retinal detachment.Methods: To retrospectively analyze 228 eyes(227 patients) with retinal detachment who underwent PPV from May 2016 to April2018. Thirty-six eyes(36 patients) with macular epiretinal membrane were included as control group.Gender, intraoperative procedures, intraocular tamponade and high myopia were involved to analyze the risk factors of IOP elevation at early stage after PPV for retinal detachment.Results: A total of 65 eyes with retinal detachment occurred IOP elevation(28. 5%). The incidence of postoperative IOP el-evation was 27. 9%, 10. 5%, 34. 4% and 2. 8% in patients with photocoagulation, cryotherapy, pho-tocoagulation plus cryotherapy and in control group, respectively(P<0. 05). The incidence of IOP el-evation with retinal detachment in silicone oil tamponade and air tamponade was 32. 2% and 13. 3%,respectively, with significant difference(P<0. 05). The incidence of IOP elevation was 48. 6% in pa-tients with high myopia and 19. 8% in patients without high myopia, with significant difference(P<0. 01). The risk was significantly increased in patients with photocoagulation plus cryotherapy thera-py, silicone oil tamponade, and high myopia.Conclusion: Intraocular tamponade and high myopia are closely related to the occurrence of ocular hypertension at early stage after PPV for retinal detach-ment. High myopia can increase the risk of intraocular pressure elevation after PPV in patients with retinal detachment. Long-term follow -up should be conducted to avoid visual impairment caused by short-term elevated and long-term chronic elevated intraocular pressure.
Objective: To investigate the incidence and risk factors of intraocular pressure(IOP) elevation at early stage after pars plana vitrectomy(PPV) for retinal detachment.Methods: To retrospectively analyze 228 eyes(227 patients) with retinal detachment who underwent PPV from May 2016 to April2018. Thirty-six eyes(36 patients) with macular epiretinal membrane were included as control group.Gender, intraoperative procedures, intraocular tamponade and high myopia were involved to analyze the risk factors of IOP elevation at early stage after PPV for retinal detachment.Results: A total of 65 eyes with retinal detachment occurred IOP elevation(28. 5%). The incidence of postoperative IOP el-evation was 27. 9%, 10. 5%, 34. 4% and 2. 8% in patients with photocoagulation, cryotherapy, pho-tocoagulation plus cryotherapy and in control group, respectively(P<0. 05). The incidence of IOP el-evation with retinal detachment in silicone oil tamponade and air tamponade was 32. 2% and 13. 3%,respectively, with significant difference(P<0. 05). The incidence of IOP elevation was 48. 6% in pa-tients with high myopia and 19. 8% in patients without high myopia, with significant difference(P<0. 01). The risk was significantly increased in patients with photocoagulation plus cryotherapy thera-py, silicone oil tamponade, and high myopia.Conclusion: Intraocular tamponade and high myopia are closely related to the occurrence of ocular hypertension at early stage after PPV for retinal detach-ment. High myopia can increase the risk of intraocular pressure elevation after PPV in patients with retinal detachment. Long-term follow -up should be conducted to avoid visual impairment caused by short-term elevated and long-term chronic elevated intraocular pressure.
引文
[1] Li J, Liu SM, Dong WT, et al. Outcomes of transcon-junctival sutureless 27-gauge vitrectomy for vitreoreti-nal diseases[J]. Int J Ophthalmol, 2018,11(3):408-415.
[2] Yanyali A, Celik E, Horozoglu F, et al. 25-Gauge transconjunctival sutureless pars plana vitrectomy[J].Eur J Ophthalmol, 2006,16(1):141-147.
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[4] Desai UR, Alhalel AA, Schiffman RM,et al. Intraocu-lar pressure elevation after simple pars plana vitrectomy[J]. Ophthalmology, 1997,104(5):781-786.
[5] Antoun J, Azar G, Jabbour E, et al. Vitreoretinal sur-gery with silicone oil tamponade in primary uncomplicat-ed rhegmatogenous retinal detachment:clinical out-comes and complications[J]. Retina, 2016,36(10):1 906-1 912.
[6] Framme C, Klotz S, Wolf-Schnurrbusch UE, et al. In-traocular pressure changes following 20G pars-plana vit-rectomy[J]. Acta Ophthalmol, 2012,90(8):744-749.
[7] Anderson NG, Fineman MS, Brown GC. Incidence of intraocular pressure spike and other adverse events after vitreoretinal surgery[J]. Ophthalmology, 2006, 113(1):42-47.
[8] Honavar SG, Goyal M, Majji AB, et al. Glaucoma af-ter pars plana vitrectomy and silicone oil injection for complicated retinal detachments[J]. Ophthalmology,1999,106(1):169-176; discussion 177.
[9] Paques M, Massin P, Santiago PY, et al. Visual field loss after vitrectomy for full-thickness macular holes[J].Am J Ophthalmol, 1997,124(1):88-94.
[10] Yan H, Dhurjon L, Chow DR, et al. Visual field de-fect after pars plana vitrectomy[J]. Ophthalmology,1998,105(9):1 612-1 616.
[11] Kerrison JB, Haller JA, Elman M, et al. Visual field loss following vitreous surgery[J]. Arch Ophthalmol,1996,114(5):564-569.
[12] Muether PS, Hoerster R, Kirchhof B, et al. Course of intraocular pressure after vitreoretinal surgery:is early postoperative intraocular pressure elevation predictable?[J]. Retina, 2011,31(8):1 545-1 552.
[13] Pavlin CJ, Rutnin SS, Devenyi R, et al. Supraciliary effusions and ciliary body thickening after scleral buck-ling procedures[J]. Ophthalmology, 1997, 104(3):433-438.
[14] Ichhpujani P, Jindal A, Jay Katz L. Silicone oil in-duced glaucoma:a review[J]. Graefes Arch Clin Exp Ophthalmol, 2009,247(12):1 585-1 593.
[15] Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vit-rectomy and silicone oil injection[J]. Ophthalmologica,2018,240(3):129-134.
[2] Yanyali A, Celik E, Horozoglu F, et al. 25-Gauge transconjunctival sutureless pars plana vitrectomy[J].Eur J Ophthalmol, 2006,16(1):141-147.
[3] Tranos P, Bhar G, Little B:Postoperative intraocular pressure spikes:the need to treat[J]. Eye(Lond), 2004,18(7):673-679.
[4] Desai UR, Alhalel AA, Schiffman RM,et al. Intraocu-lar pressure elevation after simple pars plana vitrectomy[J]. Ophthalmology, 1997,104(5):781-786.
[5] Antoun J, Azar G, Jabbour E, et al. Vitreoretinal sur-gery with silicone oil tamponade in primary uncomplicat-ed rhegmatogenous retinal detachment:clinical out-comes and complications[J]. Retina, 2016,36(10):1 906-1 912.
[6] Framme C, Klotz S, Wolf-Schnurrbusch UE, et al. In-traocular pressure changes following 20G pars-plana vit-rectomy[J]. Acta Ophthalmol, 2012,90(8):744-749.
[7] Anderson NG, Fineman MS, Brown GC. Incidence of intraocular pressure spike and other adverse events after vitreoretinal surgery[J]. Ophthalmology, 2006, 113(1):42-47.
[8] Honavar SG, Goyal M, Majji AB, et al. Glaucoma af-ter pars plana vitrectomy and silicone oil injection for complicated retinal detachments[J]. Ophthalmology,1999,106(1):169-176; discussion 177.
[9] Paques M, Massin P, Santiago PY, et al. Visual field loss after vitrectomy for full-thickness macular holes[J].Am J Ophthalmol, 1997,124(1):88-94.
[10] Yan H, Dhurjon L, Chow DR, et al. Visual field de-fect after pars plana vitrectomy[J]. Ophthalmology,1998,105(9):1 612-1 616.
[11] Kerrison JB, Haller JA, Elman M, et al. Visual field loss following vitreous surgery[J]. Arch Ophthalmol,1996,114(5):564-569.
[12] Muether PS, Hoerster R, Kirchhof B, et al. Course of intraocular pressure after vitreoretinal surgery:is early postoperative intraocular pressure elevation predictable?[J]. Retina, 2011,31(8):1 545-1 552.
[13] Pavlin CJ, Rutnin SS, Devenyi R, et al. Supraciliary effusions and ciliary body thickening after scleral buck-ling procedures[J]. Ophthalmology, 1997, 104(3):433-438.
[14] Ichhpujani P, Jindal A, Jay Katz L. Silicone oil in-duced glaucoma:a review[J]. Graefes Arch Clin Exp Ophthalmol, 2009,247(12):1 585-1 593.
[15] Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vit-rectomy and silicone oil injection[J]. Ophthalmologica,2018,240(3):129-134.