玻璃体视网膜手术后患者早期高眼压的临床分析

目的 研究玻璃体视网膜手术后早期高眼压的发生率和危险因素.方法 采用系列病例研究,回顾性分析2005年6月至2007年6月北京协和医院眼科收治的玻璃体视网膜手术患者422例(446只眼)的临床资料,应用Goldmann压平眼压计测量术前和术后早期各组患者眼压情况,眼压升高标准为≥25 mm Hg,对引起术后早期眼压升高的因素进行统计分析.结果 422例(446只眼),男190例,女232例,平均年龄(55±14)岁,术前眼压平均(14±3)mm Hg.术后2周内,共185只眼眼压升高,发生率为41%,其中术后第1天眼压升高152只眼,占早期眼压升高的82%.单纯玻璃体切割组、C3F8填充组和硅油填允组高眼压发生率分别为19%、53%和55%,硅油组和C3F8组术后眼压升高发生率均高于单纯组(P<0.01),两组比较差异无统计学意义(P>0.05).引起手术后眼压升高的危险因素有:C3F8填充(X2=37.82,P<0.01)、硅油填充(X2=27.84,P<0.01)、晶状体切除(X2=8.98,P<0.01)、眼内激光(X2=7.41,P<0.01)、糖尿病(X2=12.12,P<0.01)、年龄(X2=7.07,P<0.01).结论 玻璃体视网膜术后眼压升高是常见的并发症,其早期相关危险因素有:硅油填充、C3F8填充、晶状体切割、眼内光凝、糖尿病和高龄.

Clinical analysis of intraocular pressure elevation following vitreoretinal surgery

Objective To study the incidence and risk factors of intraocular pressure (IOP) elevation in patients who underwent vitreoretinal surgery. Methods Data for 422 patients (446 eyes)who underwent vitreoretinal surgery from June 2005 to June 2007 were retrospectively analyzed, lOP was measured before surgery and on day 1,2,3,7-14 after surgery with Goldmann applanation tonometer. Ocular hypertension was defined as IOP 25mmHg or more. All factors were analyzed for association with Ocular hypertension. Results 232 of the 422 patients were female. 190 were male. The IOP was elevated significandy in 185 eyes(41% )after surgery within 2 weeks. Among them the lOP occurred mostly in day 1 ( 152 eyes , 82% ). The rate of lOP elevation with intraocular tamponade of C3F8 or silicone oil was 53 % or 55% , the difference being not statistically significant (P>0.05) . The incidence of high IOP in C3F8 injection group and silicone oil injection group were statistically higher than simple pars plana vitrectomy group( P<0.01). The risk factors of ocular hypertension include C3F8 injection (X2=37.82, P<0.01),silicone oil injection (X2= 27.84, P<0.01 ), lentectomy ( X2 = 8.98, P<0.01 ), scatter endolaser (X2 = 7.41 ,P <0.01), diabetes( X2 = 12.12, P<0.01 ) and increasing patient age (X2 = 7.07, P <0.01 ). Conclusion IOP elevation was a common complication of vitreoretinal surgery. The risk factors of ocular hypertension include C3F8 injection, silicone oil injection, lentectomy, scatter endolaser, diabetes and increasing patient age.