目的:探讨增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切割术后顽固性高眼压的原因及有效处理方法。方法:回顾性分析我院2008-11/2010-10因PDR行玻璃体切割术后的眼压状况。结果:患者119眼中共有25眼(21.0%)于玻璃体切割术后发生眼压顽固性增高,经药物治疗后眼压维持正常者18眼(72.0%),7眼需要手术治疗;25眼中,19眼(76.0%)为术后1wk内出现眼压升高,6眼眼压升高发生在术后2～18mo。眼压升高原因:在术后3mo后出现眼压升高的5眼中,除1眼为瞳孔闭锁导致高眼压,其余4眼均出现了新生血管性青光眼,其中3眼在硅油取出时联合白内障摘除,1眼为玻璃体切割联合白内障摘除手术。119眼中,行硅油注入42眼(35.3%),C3F8注入12眼(10.1%),但在眼压升高的25眼中有11眼联合硅油注入(44%,P=0.41),有无硅油注入眼压升高差异无显著性。2眼C3F8注入(7.7%,P=0.83),有无C3F8注入眼压升高差异无显著性。结论:PDR玻璃体切割术后顽固性高眼压多可通过药物将眼压控制正常,术中硅油注入不是眼压增高的主要因素,远期的眼压升高与新生血管性青光眼有关,术中或术后是否摘除白内障需要慎重考虑。

AIM:To seek the reasons and effective methods to treat the intractable high intraocular pressure (IOP) after vitrectomy of proliferative diabetic retinopathy (PDR).METHODS:Postoperative IOP of eyes with PDR after vitrectomy were retrospectively analyzed within 2 years in our hospital.RESULTS:Twenty-five eyes (21.0%) occurred intractable high IOP in 119 eyes.IOP in 18 (72.0%) of 25 eyes could be controlled by using medical treatment,while 7 eyes required surgery.19 (76.0%) of 25 eyes had high IOP within one week after surgery,the other 6 eyes had high IOP at 2 to 18 months after surgery.The reasons of postoperative high IOP happened in 3 months after surgery included pupil atresia in one eye and neovascular glaucoma in 4 eyes.These 4 eyes with neovascular glaucoma had received phacoemulsification cataract surgery.In 119 eyes,silicone oil injection was in 42 eyes (35.3%),C3F8 injection in 12 eyes (10.1%).In 25 eyes with postoperative high IOP,11 eyes had received vitrectomy combined with silicone oil injection (44%,P= 0.41).IOP had no statistically significant difference between the eyes with and without silicone oil.2 eyes were injected C3F8 (7.7%,P=0.83),IOP had no statistically significant difference between the eyes with and without C3F8.CONCLUSION:The intractable high IOP after vitrectomy treating PDR usually can be controlled by medication.Silicone oil as intraocular tamponade is not the primary factor for postoperative high IOP.As long-dated high IOP may be associated with neovascular glaucoma.Intraoperative or postoperative cataract extraction requires carefully consideration.

R779.6

中国广东省科技计划项目基金资助项目(No.2008B030301178)~~