玻璃体切除术后早期高眼压发生率及相关因素的分析
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摘要
目的探讨不同疾病下玻璃切除术后早期高眼压发生率和相关的危险因素。方法回顾性分析2015年1月至2017年3月于我院眼科中心行玻璃体切除术(PPV)患者310例(323只眼)。比较患者性别、术前原发病、术中操作、眼内填充物和是否伴有高度近视,以了解高眼压的发生率,分析PPV术后发生高眼压的危险因素。结果有43只眼出现高眼压,发生率为13. 3%。视网膜脱离、IV期及以上糖尿病性视网膜病(DR)、单纯玻璃体积血、黄斑裂孔患者术后高眼压发生率分别为24. 3%、15. 1%、6. 9%和1. 8%,差异具有统计学意义(P <0. 001)。行光凝和未行光凝患者高眼压发生率分别为17. 5%和5. 9%,差异具有统计学意义(P <0. 01),行冷凝和未行冷凝患者高眼压发生率分别为27. 6%和7. 1%,差异具有统计学意义(P <0. 0001)。术中行硅油填充、气体填充和未行眼内填充患者高眼压发生率分别为19. 4%、15. 8%和0. 9%,差异具有统计学意义(P <0. 0001)。伴有高度近视的患者PPV术后早期高眼压的发生率明显高于不伴有高度近视的患者,差异具有统计学意义(P <0. 001),并且高眼压的发生和高度近视具有明显的相关性(r=0. 214,P <0. 01)。Logistic回归分析提示光凝、冷凝、硅油填充和气体填充是PPV术后高眼压的独立危险因素。结论 PPV术后早期高眼压的发生和原发病、术中操作和眼内填充物有着密切关系。高度近视与术后高眼压的发生明显相关。光凝、冷凝和眼内填充是PPV术后发生高眼压的独立危险因素。对PPV术后患者应严密监测眼压变化,尤其是视网膜脱离和IV期及以上DR患者。
Objective To investigate the incidence and risk factors of high intraocular pressure( IOP) at early stage after pars plana vitrectomy( PPV) in different diseases. Methods We retrospectively analyzed 323 eyes of 310 patients who underwent PPV in our hospital from January 2015 to March 2017. Gender,preoperative primary disease,intraoperative procedures,intraocular tamponade and the presence of accompanying high myopia were assessed to analyze the incidence and risk factors of high IOP at early stage after PPV. Results 43 eyes demonstrated high IOP after the surgery with an incidence of 13. 3%. The incidence of high IOP for patients with retinal detachment,stage IV and above diabetic retinopathy,simple vitreous hemorrhage and macular hole was 24. 3%,15. 1%,6. 9% and 1. 8%,respectively( P <0. 001). The incidence of high IOP was 17. 5% in the photocoagulation group and 5. 9% in the non-photocoagulation group,with a statistically significant difference( P < 0. 01). The incidence of high IOP in the retinal? cryotherapy group was significantly higher than in the non-retinal cryotherapy group( 27. 6% vs. 7. 1%,P < 0. 0001). The incidence of high IOP in patients with silicone oil tamponade,air tamponade and without any tamponade was 19. 4%,15. 8% and 0. 9%,respectively,and the difference was significant( P < 0. 0001). The incidence of high IOP in patients with high myopia was significantly higher than those without high myopia( P < 0. 001),and there was a significant association between incident high IOP and high myopia( r = 0. 214,P < 0. 01). Logistic regression analysis showed that photocoagulation,retinal cryotherapy,silicone oil tamponade and air tamponade were independent risk factors for high IOP after PPV. Conclusions The occurrence of high IOP early after PPV is closely related to the primary disease,intraoperative procedures and intraocular tamponades. High myopia is associated with postoperative IOP elevation. Photocoagulation,retinal cryotherapy and intraocular tamponade are independent risk factors for high IOP after PPV. The changes of IOP after PPV should be closely monitored,especially in patients with retinal detachment or stage IV and above diabetic retinopathy.
Objective To investigate the incidence and risk factors of high intraocular pressure( IOP) at early stage after pars plana vitrectomy( PPV) in different diseases. Methods We retrospectively analyzed 323 eyes of 310 patients who underwent PPV in our hospital from January 2015 to March 2017. Gender,preoperative primary disease,intraoperative procedures,intraocular tamponade and the presence of accompanying high myopia were assessed to analyze the incidence and risk factors of high IOP at early stage after PPV. Results 43 eyes demonstrated high IOP after the surgery with an incidence of 13. 3%. The incidence of high IOP for patients with retinal detachment,stage IV and above diabetic retinopathy,simple vitreous hemorrhage and macular hole was 24. 3%,15. 1%,6. 9% and 1. 8%,respectively( P <0. 001). The incidence of high IOP was 17. 5% in the photocoagulation group and 5. 9% in the non-photocoagulation group,with a statistically significant difference( P < 0. 01). The incidence of high IOP in the retinal? cryotherapy group was significantly higher than in the non-retinal cryotherapy group( 27. 6% vs. 7. 1%,P < 0. 0001). The incidence of high IOP in patients with silicone oil tamponade,air tamponade and without any tamponade was 19. 4%,15. 8% and 0. 9%,respectively,and the difference was significant( P < 0. 0001). The incidence of high IOP in patients with high myopia was significantly higher than those without high myopia( P < 0. 001),and there was a significant association between incident high IOP and high myopia( r = 0. 214,P < 0. 01). Logistic regression analysis showed that photocoagulation,retinal cryotherapy,silicone oil tamponade and air tamponade were independent risk factors for high IOP after PPV. Conclusions The occurrence of high IOP early after PPV is closely related to the primary disease,intraoperative procedures and intraocular tamponades. High myopia is associated with postoperative IOP elevation. Photocoagulation,retinal cryotherapy and intraocular tamponade are independent risk factors for high IOP after PPV. The changes of IOP after PPV should be closely monitored,especially in patients with retinal detachment or stage IV and above diabetic retinopathy.
引文
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[16] Framme C,Klotz S,Wolf-Schnurrbusch UE,et al. Intraocular pressure changes following 20G pars-plana vitrectomy[J]. Acta Ophthalmol,2012,90(8):744-749.
[17] Ichhpujani P,Jindal A,Jay KL. Silicone oil induced glaucoma:a review[J]. Graefes Arch Clin Exp Ophthalmol,2009,247(12):1585-1593.
[18] Pendergast SD,Mc Cuen BW,2nd:Visual field loss after macular hole surgery[J]. Ophthalmology,1996,103(7):1069-1077.
[19] Ferrini W,Pournaras JA,Wolfensberger TJ. Expansion of intraocular gas bubbles due to altitude:do meteorological factors play a role[J]. Klin Monbl Augenheilkd,2010,227(4):312-314.
[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. Intraocular pressure elevation after simple pars plana vitrectomy[J]. Ophthalmology,1997,104(5):781-786.
[5] Honavar SG,Goyal M,Majji AB,et al. Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments[J]. Ophthalmology,1999,106(1):169-176
[6] 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.
[7] 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.
[8] Yan H,Dhurjon L,Chow DR,et al. Visual field defect after pars plana vitrectomy[J]. Ophthalmology,1998,105(9):1612-1616.
[9] Kerrison JB,Haller JA,Elman M,et al. Visual field loss following vitreous surgery[J]. Arch Ophthalmol,1996,114(5):564-569.
[10] Alm A,Bill A. The oxygen supply to the retina. II. Effects of high intraocular pressure and of increased arterial carbon dioxide tension on uveal and retinal blood flow in cats. A study with radioactively labelled microspheres including flow determinations in brain and some other tissues[J]. Acta Physiol Scand,1972,84(3):306-319.
[11] Pillunat LE,Anderson DR,Knighton RW,et al. Autoregulation of human optic nerve head circulation in response to increased intraocular pressure[J]. Exp Eye Res,1997,64(5):737-744.
[12] la CM,Lux A,Heegaard S. Visual loss under silicone oil[J]. Klin Monbl Augenheilkd,2010,227(3):181-184.
[13] 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):1545-1552.
[14] Pavlin CJ,Rutnin SS,Devenyi R,et al. Supraciliary effusions and ciliary body thickening after scleral buckling procedures[J].Ophthalmology,1997,104(3):433-438.
[15] Liang JC,Huamonte FU. Reduction of immediate complications after panretinal photocoagulation[J]. Retina,1984,4(3):166-170.
[16] Framme C,Klotz S,Wolf-Schnurrbusch UE,et al. Intraocular pressure changes following 20G pars-plana vitrectomy[J]. Acta Ophthalmol,2012,90(8):744-749.
[17] Ichhpujani P,Jindal A,Jay KL. Silicone oil induced glaucoma:a review[J]. Graefes Arch Clin Exp Ophthalmol,2009,247(12):1585-1593.
[18] Pendergast SD,Mc Cuen BW,2nd:Visual field loss after macular hole surgery[J]. Ophthalmology,1996,103(7):1069-1077.
[19] Ferrini W,Pournaras JA,Wolfensberger TJ. Expansion of intraocular gas bubbles due to altitude:do meteorological factors play a role[J]. Klin Monbl Augenheilkd,2010,227(4):312-314.