糖尿病合并视网膜脱离术后高眼压的处理及危险因素探讨

Potential risk factors and treatment of high IOP elevation after operation in retinal detachment eyes of diabetic patients

摘要:

目的：观察糖尿病合并孔源性视网膜脱离患者行玻璃体切割术后短期内眼压的波动情况并探讨可能的危险因素及有效的治疗方法。

方法：连续收集100例糖尿病合并高度近视及孔源性视网膜脱离的患者并分为两组：试验组和对照组，试验组患者术后使用妥布霉素地塞米松滴眼液。分别监测术眼玻璃体切割术术前及术后的眼压情况，神经纤维层厚度(RNFL)和视盘参数，同时记录对侧眼术前的情况。实验数据采用Graphpad 7.0进行分析。

结果：所有的糖尿病患者中有42眼在玻璃体切割术后1wk内出现眼压升高，其中试验组31眼，而对照组11眼。术后5d-1wk及1mo时两组间差异有显著统计学意义。随后，39眼经过治疗后眼压下降，3眼接受了青光眼滤过手术。与眼压升高前的视盘各参数相比，眼压升高后，平均及下方RNFL厚度变薄，盘沿面积变小，同时视杯容积和垂直杯盘比增加。眼压升高患者对侧眼的RNFL厚度相比于从未出现高压眼的患者明显变薄。

结论：玻璃体切割术术后连续使用激素类药物是糖尿病合并视网膜脱离患者术后眼压升高的危险因素，并且可疑青光眼患者使用激素后眼压更易升高。

Abstract:

AIM: To observe the intraocular pressure(IOP)fluctuation at the early stage of pars plana vitrectomy(PPV)and silicon oil tamponade in high myopia with rhegmatogenous retinal detachment(RRD)eyes in diabetic patients and analyze the potential risk factors and effective treatment.

METHODS: One hundred consecutive diabetic patients of rhegmatogenous retinal detachment in highly myopic eyes were retrospectively reviewed. Patients were divided into two groups: the experimental group, those who used Tobramycin Dexamethasone Eye Drops(TDED), and control group. Pre- and postoperative IOPs, retinal nerve fiber layer thickness(RNFL)and optic nerve head parameters were recorded before and after IOP elevation, and in the contralateral eye before the operation. Graphpad 7.01 was used for data analysis.

RESULTS: IOP elevation occurred in 42 eyes within 1wk after vitrectomy in all diabetic participants. Ocular hypertension(OHTN)was observed in 31 of 53 eyes in experimental group and 11 eyes of 47 eyes in control group at the early stage after operation. Significant differences were found between groups in 5d-1wk and 1mo after vitrectomy. In addition, IOP of 39 eyes had decreased by proper treatment and 3 eyes received glaucoma filtration surgery. Compared to the optic disc parameters before IOP elevation, the average and inferior RNFL thickness were thinner and rim area decreased as well as cup volume and vertical C/D radio increased after IOP elevation. The RNFL thickness of the opposite eyes in patients with IOP elevation was found thinner than the ones who never suffered ocular hypertension.

CONCLUSION: Continual use of glucocorticoid after vitrectomy is a potential risk factor of IOP elevation in high myopia with diabetes, and doubtful open angle glaucoma should be focused on its sensibility to glucocorticoid and IOP elevation.