巩膜外垫压联合玻璃体内注气术治疗玻璃体手术后无硅油填充眼视网膜脱离的临床效果

目的 探讨巩膜外垫压联合玻璃体内注气术治疗玻璃体手术后无硅油填充眼视网膜脱离的临床效果.方法 回顾性系列病例研究.收集2001年1月至2004年5月间在西京医院眼科行巩膜外垫压(或联合环扎)联合玻璃体内注气术治疗的52例(52只眼)玻璃体手术后在无硅油填充状态下发生视网膜脱离患者的临床资料,分析视网膜复位的效果、视力改善情况以及手术并发症等.结果 手术后随访6个月至2年,视网膜复位36只眼(69.2%);4只眼术后早期视网膜复位不良即接受了玻璃体切除联合硅油注入术;12只眼于再次手术后2个月后视网膜脱离复发,需行玻璃体切除术.视力提高32只眼(61.5%),不变3只眼(23.1%),下降8只眼(15.4%).术后发生黄斑前膜和气体性白内障各有1例(1只眼),余未见发生严重并发症者.结论 巩膜外垫压联合玻璃体内注气术对部分玻璃体手术后无硅油填充眼的视网膜脱离具有一定疗效,可减少再次行玻璃体切除术的机会.     

Intraoperative assessment of intraocular pressure in vitrectomized air‐filled and fluid‐filled eyes

Purpose: To ascertain the difference of intraocular pressure (IOP) measurement between vitrectomized air‐filled and fluid‐filled eyes. Methods: Thirty‐one eyes of 31 consecutive patients who underwent conventional vitrectomy and intraocular gas tamponade were assessed. After vitrectomy, IOP of the fluid‐filled eyes was measured by Tono‐Pen. Thereafter, fluid–air exchange was performed, and IOP of the air‐filled eyes was measured again. The IOP within each fluid‐ and air‐filled eye was varied by selecting settings on the vitrectomy system, from 10 to 50 mmHg with 5‐mmHg increments. Postoperatively, IOP was assessed by both Tono‐Pen and Goldmann applanation tonometry (GAT). Linear and nonlinear regression analyses were conducted between intraoperatively measured Tono‐Pen readings and actual IOPs. Bland–Altman plot was used to assess the agreements between postoperatively measured Tono‐Pen readings and GAT readings. Results: The discrepancy between Tono‐Pen readings and actual IOP in fluid‐filled eyes was not significant, except for the profound high pressures over 45 mmHg. However, Tono‐Pen readings in air‐filled eyes were significantly lower than actual IOPs in all ranges, and Tono‐Pen increasingly underestimates IOP at higher levels. Intraoperative Tono‐Pen readings were correlated significantly with actual IOP and a quadratic equation evidenced the best fit (R² = 0.996). Postoperatively, difference of the measurements between Tono‐Pen and GAT was not significant. Conclusion: Tono‐Pen and GAT significantly underestimate actual IOP in air‐filled eyes. It should be considered that actual IOP would be greater than the measured IOP in gas‐filled eyes, even though the IOP is measured as normal.     

非接触眼压计测量高眼压兔模型的准确性

目的:探讨非接触眼压计(NCT)测量高眼压兔模型的准确性。方法:兔全身麻醉后前房、玻璃体腔穿刺,通过平衡盐水柱高低调控眼内压,前房插管显示实际眼压于15.00±0.50,20.00±0.50,25.00±0.50,30.00±0.05,35.00±0.50,40.00±0.50,45.00±0.50mmHg,同时测量相对应的NCT眼压。分析实际眼压与NCT眼压的差异及相关性,以实际眼压作为应变量进行回归分析。结果:兔NCT眼压均低于实际眼压值,有显著性差异(P<0.01)。兔NCT眼压与实际眼压两者具有显著相关性(相关系数r=0.985,P<0.01)。筛选回归方程Y=10.875+1.170X(方差分析F=2691.389,P<0.01),式中Y为实际眼压,X为NCT眼压。结论:NCT能够用于测量高眼压兔模型,实际眼压与NCT眼压之间有直线关系,可借助回归方程通过NCT眼压推断实际眼压,为兔青光眼模型眼压测量提供了实验支持。     

术后不需低头位的玻璃体手术治疗黄斑裂孔性视网膜脱离

目的探讨术后不需低头位的玻璃体手术疗效.方法对27例(27只眼)近视性黄斑裂孔视网膜脱离患者,经闭合式玻璃体切除、剥膜后气液交换,以16%C3F8全玻璃体腔填充;3例同时行晶状体超声乳化吸出术,其中2例植入人工晶状体,术后早期避免仰卧位,其他体位不受限.结果 21例(78%)患者术后不需低头位即获黄斑裂孔闭合、视网膜复位.另6例分别因惰性气体吸收较快、视网膜黄斑白孔及视网膜下组织增生,而致黄斑裂孔未闭并伴下方视网膜脱离;其中3例气泡吸收较快者于术后10 d改嘱低头位,2例获视网膜复位.随访时间＞6个月.22例(81%)保持视网膜平伏,黄斑裂孔愈合;视力≥0.1者19例;主要并发症为晶状体混浊(6/19)和一过性高眼压(3/27).结论术后不需低头位的玻璃体手术,并以16% C3F8气体填充全玻璃体腔,治疗黄斑裂孔视网膜脱离的效果良好,尤其适用于老年或体弱患者.     

Sustained elevation of intraocular pressure after intravitreal injections of bevacizumab in eyes with neovascular age-related macular degeneration

Background

The use of intravitreal anti-VEGF agents in general, and of bevacizumab (Avastin) in particular, has become the common first-line treatment of neovascular age-related macular degeneration (AMD). Several reports addressed the possible elevation of intraocular pressure (IOP) following intravitreal injection of anti-VEGF. The aim of this study was to determine the prevalence of sustained IOP elevation following intravitreal bevacizumab injections for neovascular AMD and identify possible risk factors for the development of increased IOP.

Methods

This retrospective cohort study included 174 consecutive patients (201 eyes) receiving intravitreal bevacizumab (1.25?mg/0.05?ml) as treatment for neovascular AMD. The records of the study patients were reviewed for age, gender, history of glaucoma, phakic status, IOP levels, length of follow-up, total number of injections, intervals between injections, and IOP management in eyes that exhibited IOP elevation. Sustained IOP elevation was defined as IOP ≥22?mmHg and a change from baseline of ≥6?mmHg recorded on at least two consecutive visits and lasting ≥30?days. Risk factors for an IOP increase were identified from the association between the studied variables and IOP elevations.

Results

Sustained IOP elevation was found in 22 of 201 eyes (11%). The increased IOP was controlled with topical medications in all eyes. Among the variables studied, only male gender [OR?=?3.1, 95% CI (1.1, 8.5) p?=?0.029] and length of interval between injections <8?weeks [OR?=?3.0, 95%CI (1.1, 7.9), p?=?0.028] emerged as risk factors for IOP elevation in a multivariable model. The prevalence of IOP elevation was significantly higher when the interval between injections was <8?weeks than ≥8?weeks (17.6 and 6%, respectively, p?=?0.009). Pre-existing glaucoma was not associated with IOP elevation (p?=?0.9).

Conclusions

Sustained IOP elevations can occur in normotensive eyes undergoing intravitreal bevacizumab treatment for neovascular AMD. This phenomenon was related to shorter intervals between injections, with 8?weeks being taken as the cut-off point. AMD eyes that receive intravitreal bevacizumab injections need to be monitored for IOP changes, especially those in which the intervals between injections are <8?weeks.     

25%全氟丙烷全氣液交换眼眼壓動態觀察

目的探討25%C3F8氣體玻璃體切割術後作爲玻璃體臨時替代物的效果.方法玻璃體切割術後應用25%C3F8氣體作全氣液交换,前瞻性研究術後眼壓動態燮化情况.結果術中控制眼黶正常,術後觀察眼壓變化平穩.球内氣體半衰期爲19天.結論在較復雜玻璃體手術中應用25%C3F8作爲玻璃體臨時替代物是有效和安全的..     

Correlation between quantity of silicone oil emulsified in the anterior chamber and high pressure in vitrectomized eyes

PURPOSE: To assess the existence of any correlation between the quantity of silicone oil emulsified in the anterior chamber and the incidence of high intraocular pressure in vitrectomized eyes. METHODS: Forty-nine eyes of 49 patients underwent vitrectomy with silicone oil injection as an adjuvant procedure. At the time of observation, between September 1999 and September 2000, 13 eyes (26.5%) were phakic; 23 eyes (47%) were pseudophakic; and 13 eyes (26.5%) were aphakic. Ultrasound biomicroscopy, slit-lamp biomicroscopy, and gonioscopy were performed to quantify the presence of silicone oil emulsified in the anterior chamber. RESULTS: The 13 phakic eyes did not have a high intraocular pressure. In 8 of the 13 eyes, ultrasound biomicroscopy detected only scarce oil emulsification in the anterior chamber (0.304 mm); in 5 of the 13 eyes, gonioscopy and ultrasound biomicroscopy did not detect anterior chamber oil emulsification. Fourteen of 23 pseudophakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.922 mm). Nine of 23 pseudophakic eyes did not have a high intraocular pressure; of these, ultrasound biomicroscopy detected little anterior chamber oil emulsification (0.209 mm). The 13 aphakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.795 mm). The coefficient of correlation for the measurements obtained was 0.98 (F = 62.3, P = 0.05; t = 11.1, P = 0.001). CONCLUSION: This study showed a high correlation between the incidence of high intraocular pressure and the quantity of emulsified silicone oil in the anterior chamber.     

Long-term evaluation of dexamethasone intravitreal implant in vitrectomized and non-vitrectomized eyes with macular edema secondary to non-infectious uveitis

Purpose

To compare dexamethasone (DEX) intravitreal implant effect in non-vitrectomized (non-PPV) vs vitrectomized (PPV) eyes with macular edema (ME) secondary to non-infectious uveitis.

Methods

Medical records of patients with uveitic ME treated with DEX-intravitreal implant were reviewed. Main outcome measures were changes in central retinal thickness (CRT), best corrected visual acuity (BCVA), intraocular pressure (IOP), vitreous haze and adverse events. Statistical analysis was performed by Longitudinal Linear model using the General Estimating Equation methodology.

Results

Forty-two eyes of 32 patients were included. Median follow-up time was 18 months (interquartile range (IQR): 12–24). Median CRT showed its maximum decrease at the first month in non-PPV and PPV eyes without statistically significant differences between both groups (P=NS). Median Snellen BCVA, converted to logarithm (LogMAR), showed its maximum improvement at third month in both groups without statistically significant differences between them (P=NS). Median IOP was higher in non-PPV eyes than in PPV eyes from third (P=0.025) to 12th month (P=0.013). Vitreous haze score improved in both groups since first month and showed no differences (P=0.706). Reinjection was performed in 45.2% of eyes at a median time of 5 months IQR: (5–6). Ocular hypertension (47.6%) was the most common adverse event.

Conclusions

DEX-intravitreal implant for uveitic ME has similar long-term safety profile and good response measured in terms of CRT decrease, BCVA, and vitreous haze improvement in both groups. Non-PPV eyes following DEX-intravitreal implant showed higher IOP increase than PPV eyes, showing the need for close IOP monitoring.     

Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation

PURPOSE: To evaluate intraocular pressure (IOP) after phacoemulsification and intraocular lens (IOL) implantation in nonglaucomatous eyes with and without exfoliation. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: One hundred ninety-six eyes that had phacoemulsification with IOL implantation were examined. Eyes with a history of intraocular disease or surgery that could affect IOP were excluded. The study comprised the remaining 160 eyes: 23 with exfoliation (EXF group) and 137 without exfoliation (non-EXF group). Follow-up data were available for 136 eyes. The same surgeon performed all surgeries. Patients were examined on the first postoperative day and after 1 week, 4 months, and 1.0 to 2.7 years. RESULTS: One day postoperatively, IOP rose in the EXF group from a mean preoperative level of 16.3 mm Hg +/- 2.7 (SD) to 21.0 +/- 8.5 mm Hg, a 28.4% increase (P =.0061). In the non-EXF group, mean IOP rose from 16.2 +/- 3.4 mm Hg to 20.5 +/- 5.7 mm Hg, a 29.9% increase (P =.001). In 4 eyes (17.4%) in the EXF group and 8 eyes (5.8%) in the non-EXF group, IOP increased to 30 mm Hg or higher at 1 day. After this, significant IOP decreases occurred in both the EXF and non-EXF group, respectively, as follows: 14.2 +/- 3.0 mm Hg (12.0% decrease from preoperative value; P =.001) and 15.0 +/- 2.9 mm Hg (5.9%; P =.001) 1 week postoperatively; 12.8 +/- 2.7 mm Hg (20.2%; P =.0002) and 13.8 +/- 2.7 mm Hg (13.2%; P =.001) after 4 months; and 12.3 +/- 2.6 mm Hg (23.2%; P =.0001) and 12.7 +/- 2.7 mm Hg (21.2%; P =.001) after 1.0 to 2.7 years. There was no significant difference between the 2 groups. CONCLUSION: After phacoemulsification with IOL implantation, IOP decreased significantly and remained lower than preoperatively in eyes with and without exfoliation. One day postoperatively, transient pressure peaks were more common in eyes with exfoliation. One eye without exfoliation developed glaucoma.     

高眼压下小梁切除术23例临床分析

目的 探讨高眼压状态下施行小梁切除术的疗效。方法 术前术中用多种方法使眼压逐渐下降后，再按常规完成手术。结果 82．6％的患者术后不用抗青光眼药物，眼压能控制在21mmHg以下，无严重并发症发生。结论 对青光眼患者眼压不能满意控制的情况下，应该果断选择手术治疗。