眼球减壓與視網膜出血

目的探讨在青光眼,白内障等内眼手术时,眼球减压性视网膜出血的原因、发病机制、高危因素及防治措施。方法 对我院15年中的内眼手术2346例按照术式进行分组,包括青光眼小梁切除术组;青光眼虹膜局切术组;白内障囊内摘除术组;白内障囊外摘除术组。对其术前术后的视力情况、眼压情况、眼底情况、全身情况进行了追踪调查。结果 在4组内眼手术中以小梁切除术组的平均眼压最高,视网膜出血的发生率最高,为3.77％,而虹膜周切术组、白内障囊内摘除术组、白内障囊外摘除术组则分别为0.47％、0.97％、0.37％。经统计学处理,小梁切除术组均显著高于其它三组(P<0.01)。在小梁切除术组中视网膜出血的发生率,高眼厌组高于正常眼厌组,分别为14.76％与1.41％(P<0.001),长病程组高于短病程组,分别为6.12％与2.19％(P<0.01),全身情况异常组(具有高危因素)高于全身情况正常组,分别为7.88％与1.58％(P<0.01)。结论 眼球减厌是内眼手术发生视网膜出血的主要原因之一,其它危险因素还包括眼厌的峰值过高,高眼厌持续的时间过长,有高血厌、动脉硬化等血管机能的异常等。

Ocular decompression and retinal hemorrhage

Objective To find out the cause, mechanism and prevention of decompression retinal hemorrhage during surgical treatment of cataract and glaucoma. Methods All 2346 cases of internal ophthalmopathy treated in our hospital in the past 15 years by surgery were divided into 4 groups according to the surgical procedures: trabeculectemy for glaucoma, peripheral iridotomy for glaucoma, intra-capsular extraction of cataract, extracapsular extraction of cataract. Vision, intraocular pressure, fundus and general condition of the body before and after surgery were studied. Results Among the four groups, trabeculectomy group ranked the first in terms of the average intraocular pressure and the occurrence of retinal hemorrhage (3.77%). The occurrence of retinal hemorrhage was 0.47%, 0.97% and 0.37% respectively for the other 3 groups of peripheral iridotomy, intracapsular ectraction of cataract and extracapsular extraction of catatact. The occurrence of retinal hemorrhage in trabeculectomy group was significantly higher than those of the other 3 groups. In the trabeculectomy group, the occurrence of retinal hemorrhage was positively associated with intraocular pressure and the course of the disease; it also increased in patients with high risk factors of the general physical condition. Conclusion Ocular decompression is the major cause of retinal hemorrhage during surgical treatment of internal eye diseases. Other risk factors include excessive peak value of intraocular pressure, long duration of this high intraocular pressure, high blood pressure, arteriosclosis, etc.