玻璃体视网膜手术后早期低眼压和睫状体脱离的临床观察

目的 观察玻璃体视网膜手术后早期睫状体脱离的发生率及其自然病程，并分析其与手术后早期低眼压的关系。方法 利用超声生物显微镜检查(UBM)连续观察行玻璃体视网膜手术治疗的患者46例46只眼。按玻璃体视网膜手术后不同填充内容分组：气体填充组11例11只眼，硅油填充组8例8只眼，平衡盐溶液（BSS）填充组27例27只眼。按手术后眼压分组：眼压<10 mm Hg（1 mm Hg=0.133 kPa)组25例25只眼，≥10 mm Hg组21例21只眼。玻璃体视网膜手术后第3天行UBM确定有无睫状体脱离，手术后每天用非接触眼压计监测眼压，有睫状体脱离者每隔7 d复查1次，直至睫状体脱离复位，所有患者均随访观察14～35 d。结果 手术后睫状体脱离20例，占本组患者的43.5％。无睫状体脱离者26例，占本组患者的56.5%。玻璃体视网膜手术后气体填充组睫状体脱离发生率 27.3％，硅油填充组25.0％，而BSS填充组为55.6％。睫状体脱离者手术后平均眼压(6.47±4.49) mm Hg （1 mm Hg=0.133 kPa），无睫状体脱离者平均眼压(15.61±7.72) mm Hg，两者差异有统计学意义（t=8.031,P＜0.001）。手术后眼压<10 mm Hg组患者睫状体脱离发生率为68.0％，眼压≥10 mm Hg组患者睫状体脱离发生率为14.3％，两组差异有统计学意义(χ2＝15.60, P＜0.001)。玻璃体视网膜手术后早期睫状体脱离患者除1例因低眼压引起视盘水肿而需行气体填充外，其余患者均在手术后30 d内自行复位。结论 手术后早期睫状体脱离是玻璃体视网膜手术的常见并发症。玻璃体视网膜手术后行BSS填充患者手术后睫状体脱离的发生率高。绝大多数患者睫状体脱离能够在玻璃体视网膜手术后30 d内自行复位。

Clinical obsrevation on early postoperative intraocular hypotension and ciliary deatchment after vitrectomy

Objective To observe the incidence of ciliary detachment and its relationship with intraocular hypotension soon after vitrectomy.Methods A total of 46 eyes of 46 patients who underwent vitrectomy were examined by ultrasound biomicroscope (UBM).The patients were divided into three groups according to different tamponade: gas group (11 eyes),silicone oil group (8 eyes) and balanced saline solution (BSS) group (27 eyes).Basing on the postoperative intraocular pressure (IOP),the patients were divided into two groups: IOP<10 mm Hg (25 eyes) and IOP≥10 mm Hg (21 eyes).UBM was applied to determine the tomographic features of the ciliary body 3 days after the surgery.IOP were monitored by non-contact tonometer daily after the surgery.The eyes with ciliary detachment were then examined once a week till the ciliary detachment reattached.The follow-up period was from 14 to 35 days.Results After vitrectomy,ciliary detachment was observed in 20 eyes of 46 eyes (43.5%),The incidence of ciliary detachment was 27.3% in gas group,25.0% in silicone oil group,and 55.6% in BSS group.The average IOP in eyes with ciliary detachment [(6.47±4.49) mm Hg (1 mm Hg=0.133 kPa)] was significantly lower than that in the eyes without ciliary detaehmen [(15.61±7.72) mm Hg] (t=8.031,P<0.001).The incidence of ciliary detachment was higher in eyes with postoperative IOP <10 mm Hg (68.0%) than that in the eyes with postoperative IOP≥10 mm Hg (14.3%) (χ2=15.60,P<0.001).All eyes with postoperative ciliary detachment got spontaneous reattaehment within 30 days after the surgery except that one eye had optic disc edema due to severe intraocular hypotension.Conelusions Early postoperative ciliary detachment is a common complication after vitrectomy.Eyes filled with BSS have the highest incidence of postoperative ciliary detachment.Most of the patients with ciliary detachment may get spontaneous reattahment within 30 days after the surgery.