23G玻璃体切割术后早期高眼压的相关危险因素分析及处理

Related risk factor analysis and treatment of high intraocular pressure after 23- gauge pars plana vitrectomy

摘要:

目的：分析23G玻璃体切割术后高眼压的发生率、特点及相关的危险因素，为处理及预防提供依据。

方法：对于我院行23G玻璃体切割手术的患者146眼临床资料进行回顾分析，术后早期高眼压诊断标准为术后2wk内任一时间眼压测量值≥25mmHg。采用卡方检验进行统计学分析； 对于术后早期高眼压患者根据眼压程度采用单一或联合降眼压药物治疗。

结果：患者146眼中发生术后高眼压者42眼，占28.8%，平均出现自术后3.38d。单纯气换组、C₃F₈填充组及硅油填充组术后高眼压发生率分别为14.5%，33.3%和39.3%，C₃F₈组和硅油填充组与单纯气换组比较均有统计学意义； 未行激光机冷冻处理组、部分视网膜光凝组、全视网膜光凝组及冷冻组术后早期高眼压的发生率分别为13.6%，27.4%，34.5%和35.7%，部分视网膜光凝组与未处理组相比较没有统计学意义，而其他两组与未处理组比较有统计学意义； 不同原发病术后均有早期高眼压的发生，但分布不均衡。通过处理眼压均控制理想。

结论：23G玻璃体切割术后早期高眼压的危险因素是多方面的，主要与眼内填充物、术中处理方式有关，不同原发病对于高眼压的影响在于其对术式的影响。术后早期高眼压多为一过性，合理药物治疗可控制。

Abstract:

AIM: To investigate the incidence, characteristic and risk factors of high intraocular pressure(IOP)after 23- gauge pars plana vitrectomy(PPV)to provide a basis for treatment and prevention.

METHODS: We retrospectively studied 135 cases(146 eyes)who underwent 23-gauge PPV in our department and analyzed the factors that might be related to the state of high IOP. The ocular hypertension was defined as IOP ≥ 25mmHg at any time within 2 weeks after surgery. The statistical analysis was performed by Chi-square test. Single or combined pressure-lowering drugs were used according to the degree of IOP.

RESULTS: The high IOP occurred in 42 eyes(28.8%), and the average time was at 3.38 days after operation. The rate of IOP elevation in pure liquid exchange group, C₃F₈ tamponade group and silicone oil tamponade group were 14.5%, 33.3%, 39.3% respectively. There was statistical difference between C₃F₈ group, silicone oil tamponade group and pure liquid exchange group. The incidence rate of high IOP in non-cryotherapy group, partial retinal photocoagulation group, panretinal photocoagulation group or cryotherapy group were 13.6%, 27.4%, 34.5%, 35.7% respectively. There was no difference between the non-cryotherapy group and the partial retinal photocoagulation group, while the differences between the non-cryotherapy group and the other two groups were significant. High IOP would occur after any primary disease surgery, but the incidence was unbalanced. All elevated IOP were satisfactorily controlled.

CONCLUSION: The risk factors of high IOP after 23-gauge PPV are various,mainly related to intraocular tamponade and the treatment during the surgery. Influence of the primary disease on the high IOP mostly lies in the treatment. The high IOP after 23-gauge PPV mostly is transient which can be controlled by rational using of drugs.