增殖性糖尿病性视网膜病变玻璃体切割术后高眼压的研究-《眼科新进展》

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Title:: Study on secondary ocular hypertension after vitrectomy for proliferative diabetic retinopathy

作者:: 周林; 姚进; ２１００２９江苏省南京市，南京医科大学附属眼科医院

Author(s):: ZHOU Lin ; YAO Jin; Eye Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu Province，China

关键词:: 增殖性糖尿病性视网膜病变; 玻璃体切割术; 高眼压

Keywords:: proliferative diabetic retinopathy ; vitrectomy; ocular hypertension

DOI:: 10.13389/j.cnki.rao.2015.0021

文献标志码:: A

摘要:: 目的　探讨玻璃体切割手术治疗增殖性糖尿病性视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＰＤＲ）术后高眼压发生的相关危险因素及治疗方法。方法　选取行玻璃体切割术的１０８例１２１眼ＰＤＲ患者进行回顾性分析，观察术后高眼压的发生率，并对引起术后高眼压的相关因素进行统计学分析。术后早期高眼压的诊断标准为：术后２周内任何时间非接触性眼压计测眼压＞２１ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）。结果　玻璃体切割术后３３眼（２７．２７％）发生高眼压，眼内充填与平衡液充填者的发病率为３２．６３％和７．６９％，两组比较差异有统计学意义（Ｐ＜０．０５）。术中行全视网膜光凝与补充视网膜光凝者的发病率分别为４２２２％和１８．４２％，两组比较差异有统计学意义（Ｐ＜０．０５）。术前视网膜病变Ⅳ期、Ⅴ期、Ⅵ期组的发病率分别为１２．００％、２２００％、４１．３０％，各组比较差异有统计学意义（Ｐ＜０．０５）。术前未合并视网膜脱离与合并视网膜脱离组的发病率分别为１８６７％和４１．３０％，两组比较差异有统计学意义（Ｐ＜０．０５）。术中联合晶状体切除术与术中未联合晶状体切除术组的发病率为３５．２１％和１６．００％，两组比较差异有统计学意义（Ｐ＜０．０５）。经Ｌｏｇｉｓｔｉｃ回归分析发现，玻璃体切割术后早期高眼压的独立危险因素是术前合并视网膜脱离及术中眼内充填。结论　术前合并视网膜脱离、术中联合晶状体切除、术中眼内充填、术中行全视网膜光凝与ＤＲ玻璃体切割术后高眼压相关，引起术后高眼压的独立危险因素为术前合并视网膜脱离及术中眼内充填。早期发现、个体化治疗可以最大程度地挽救患者的视力。

Abstract:: Objective To explore the correlative factors and management of secondary ocular hypertension after vitrectomy for proliferative diabetic retinopathy ( PDR) . Methods Totally 108 cases ( 121 eyes) with PDR underwent vitrectomy were retrospectively analyzed to observe the incidence of postoperative ocular hypertension, and the relevant factors that caused postoperative ocular hypertension were statistically analyzed. Early postoperative ocular hypertension diagnostic criteria: Any time within postoperative 2 weeks the intraocular pressure ( IOP) measured by non-contact tonometer was more than 21 mmHg ( I kPa = 7. 5 mmHg) . Results The ocular hypertension after vitrectomy occurred in 33 eyes ( 27. 27% ) . and the incidence in eyes with intraocular filling and balanced liquid filling were 32. 63% and 7. 6g% .respectively, the difference was statistically sigruficant (P < 0. 05 ) . The incidences in eyes with intraoperative panretinal photocoagulation and additional retinal photocoagulation were 42. 22% and 18 . 42% . respectively , and the difference was statistically significant ( P < 0. 05 ) . The incidences in eyes with PDR staged lV , V . VI were 12. 00% .22. 00% .41. 30% ,respectively,and the difference was statistically significant (P < 0. 05 ). The incidences in eyes with unconsolidated preoperative retinal detachment and retinal detachment were 18. 67% ,41. 30% , respectively, and the difference was statistically significant (P < 0. 05 ) . The incidences in eyes with or without intraoperative lensectomy were 35. 21% . 16. 00% ,respectively , and the difference was statistically significant (P < 0. 05 ) . Logistic regression analysis showed that preoperative retinal detachment and intraoperative intraocular filling were independent risk factors that caused early postoperative ocular hypertension after vitrectomy. Conclusion Postoperative ocular hypertension after vitrectomy are related to preoperative retinal detachment ,intraoperative lensectomy,intraoperative intraocular filling , and intraoperative panretinal photocoagulation. Retinal detachment preoperative and intraoperative intraocular filling are independent risk factors that caused early postoperative ocular hypertension after vitrectomy. The vision can be recovered if ocular hypertension can be controlled effectively timely with individualized therapy.

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

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