微创玻璃体切除术后早期高眼压发生的相关因素分析
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摘要
目的探讨微创玻璃体切除术后引起早期高眼压的相关因素。方法 2016年4月至2017年10月我院开展的微创玻璃体切除术治疗玻璃体视网膜疾病的患者217例。观察术后高眼压发生率,并对影响眼压高低的相关因素进行分析。结果微创玻璃体切除术后26眼(11.98%)发生高眼压。高眼压组术前最佳矫正视力(Log MAR)、手术时间、术后眼压高于无高眼压组;两组间前房闪辉及房水细胞分级差异有统计学意义(P<0.05)。有晶体眼、人工晶体眼及无晶体眼术后高眼压发生率比较,差异无统计学意义(P=0.065)。25 g玻切术组高眼压发生率高于27 g玻切术组(P=0.026)。硅油组高眼压发生率为22.3%,灌注液组为4.7%,空气组无高眼压发生,三组间差异有统计学意义(P<0.001)。糖尿病视网膜病变、眼内填充物(硅油)、术后前房闪辉及术后眼压波动是引起微创玻璃体切除术后早期高眼压的独立危险因素。结论微创玻璃体切除术后早期高眼压的发生受多种因素影响,对于手术时间长、糖尿病视网膜病变患者、眼内填充物为硅油及术后前房炎症反应重的患者尤其要重视术后早期高眼的防治。
Objective To investigate the risk factors for early intraocular pressure( IOP) elevation in patients who underwent microincision vitrectomy surgery( MIVS).Methods From April 2016 to October 2017,217 eyes with various types of vitreoretinal diseases were undergone MIVS in our hospital.The incidence of ocular hypertension after the surgery was observed and the related factors influencing the ocular hypertension were analyzed.Results There were 26 eyes( 11. 98%) occurring IOP elevation postoperatively.The mean preoperative best correct visual acuity( BCVA),operation time and IOP after operation in the high IOP group were higher or longer than those in the non-high IOP group. There were significant differences in the grading of aqueous flare and anterior chamber cell counting between the two groups( P < 0. 05).There was no significant difference in incidence of elevation of IOP among patients with phakic,pseudo-phakic and aphakic eyes( P = 0. 065).The incidence of elevated IOP in the 25 gauge vitrectomy group was higher than that in the 27 gauge vitrectomy group( P = 0. 026).The incidence of elevated IOP was found 22. 3% in the silicone oil filled group,4. 7% in the perfusion fluid filled group and 0% in the air filled group( P < 0. 01).Logistic regression analysis showed that diabetic retinopathy,intraocular tamponade( silicone oil),postoperative atrial flare and postoperative intraocular pressure fluctuation were independent risk factors for early ocular hypertension after MIVS.Conclusion The occurrence of early ocular hypertension after MIVS was affected by many factors,especially for patients with long operation time,diabetic retinopathy,silicone oil tamponade and severe postoperative anterior chamber inflammation.
Objective To investigate the risk factors for early intraocular pressure( IOP) elevation in patients who underwent microincision vitrectomy surgery( MIVS).Methods From April 2016 to October 2017,217 eyes with various types of vitreoretinal diseases were undergone MIVS in our hospital.The incidence of ocular hypertension after the surgery was observed and the related factors influencing the ocular hypertension were analyzed.Results There were 26 eyes( 11. 98%) occurring IOP elevation postoperatively.The mean preoperative best correct visual acuity( BCVA),operation time and IOP after operation in the high IOP group were higher or longer than those in the non-high IOP group. There were significant differences in the grading of aqueous flare and anterior chamber cell counting between the two groups( P < 0. 05).There was no significant difference in incidence of elevation of IOP among patients with phakic,pseudo-phakic and aphakic eyes( P = 0. 065).The incidence of elevated IOP in the 25 gauge vitrectomy group was higher than that in the 27 gauge vitrectomy group( P = 0. 026).The incidence of elevated IOP was found 22. 3% in the silicone oil filled group,4. 7% in the perfusion fluid filled group and 0% in the air filled group( P < 0. 01).Logistic regression analysis showed that diabetic retinopathy,intraocular tamponade( silicone oil),postoperative atrial flare and postoperative intraocular pressure fluctuation were independent risk factors for early ocular hypertension after MIVS.Conclusion The occurrence of early ocular hypertension after MIVS was affected by many factors,especially for patients with long operation time,diabetic retinopathy,silicone oil tamponade and severe postoperative anterior chamber inflammation.
引文
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[17]晁炜静.玻璃体视网膜手术后患者早期高眼压的临床分析[J].中华医学杂志,2009,89(5):318-320.
[18]黄庆,张军军.玻璃体切除硅油填充术后高眼压临床分析[J].临床眼科杂志,2012,20(3):217-219.
[19]周浩.LASIK手术时眼压波动对视神经轴突影响的实验研究[J].眼视光学杂志,2003,5(3):136-138.
[2]Eckardt C.Transconjunctival sutureless 23-gauge vitrectomy[J].Retina,2005,25(2):208-211.
[3]Oshima Y,Wakabayashi T,Sato T,et al.A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery[J].Ophthalmology,2010,117(1):93-102.
[4]Rizzo S,Genovesi-Ebert F,Murri S,et al.25-gauge,sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery:a comparative pilot study[J].Graefe's archive for clinical and experimental ophthalmology,2006,244(4):472-479.
[5]刘三梅,钟捷,樊映川.20-G与23-G玻璃体切割术治疗视网膜脱离的对比分析.[J].实用医院临床杂志,2013,10(2):113-115.
[6]李杰,刘三梅,李芳,等.27 g微创玻璃体切除手术的发展及应用[J].国际眼科杂志,2016,16(8):1483-1486.
[7]张招德,宋晏平,王雨晴,等.25 g微创眼后段玻璃体切割术的临床应用[J].中国实用眼科杂志,2013,31(3):321-323.
[8]程朝晖,胡博杰,刘巨平,等.23 g玻璃体切割手术相关并发症分析[J].中华眼底病杂志,2012,28(2):142-144.
[9]沈丽萍,卢红,楼定华,等.玻璃体切割手术后高眼压的临床分析[J].中华眼底病杂志,2002,18(2):106-108.
[10]Khan MA,Shahlaee A,Toussaint B,et al.Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease[J].Am J Ophthalmol,2016,161:36-43.
[11]Rizzo S,Polizzi S,Barca F,et al.Comparative Study of 27-Gauge versus 25-Gauge Vitrectomy for the Treatment of Primary Rhegmatogenous Retinal Detachment[J].J Ophthalmol,2017,2017(3):1-5
[12]Kunikata H,Nishida K.Visual outcome and complications of 25-gauge vitrectomy for rhegmatogenous retinal detachment;84 consecutive cases[J].Eye,2010,24(6):1071-1077.
[13]李凤鸣,谢立信.中华眼科学[M].北京:人民卫生出版社,2014.
[14]赵堪兴,杨培增.眼科学[M].第7版.北京:人民卫生出版社,2012.
[15]俞学群,曹国平.玻璃体切割术后高眼压的发生率和特点及相关危险因素分析[J].国际眼科杂志,2015,15(5):853-855.
[16]刘世波,张琦.PDR玻璃体切除术后早期影响眼压的相关因素分析[J].国际眼科杂志,2013,13(5):883-886.
[17]晁炜静.玻璃体视网膜手术后患者早期高眼压的临床分析[J].中华医学杂志,2009,89(5):318-320.
[18]黄庆,张军军.玻璃体切除硅油填充术后高眼压临床分析[J].临床眼科杂志,2012,20(3):217-219.
[19]周浩.LASIK手术时眼压波动对视神经轴突影响的实验研究[J].眼视光学杂志,2003,5(3):136-138.