微创玻璃体切除术后早期高眼压发生的相关因素分析

Analysis of risk factors for early ocular hypertension after microincision vitrectomy surgery

目的探讨微创玻璃体切除术后引起早期高眼压的相关因素。方法 2016年4月至2017年10月我院开展的微创玻璃体切除术治疗玻璃体视网膜疾病的患者217例。观察术后高眼压发生率,并对影响眼压高低的相关因素进行分析。结果微创玻璃体切除术后26眼(11.98%)发生高眼压。高眼压组术前最佳矫正视力(Log MAR)、手术时间、术后眼压高于无高眼压组;两组间前房闪辉及房水细胞分级差异有统计学意义(P<0.05)。有晶体眼、人工晶体眼及无晶体眼术后高眼压发生率比较,差异无统计学意义(P=0.065)。25 g玻切术组高眼压发生率高于27 g玻切术组(P=0.026)。硅油组高眼压发生率为22.3%,灌注液组为4.7%,空气组无高眼压发生,三组间差异有统计学意义(P<0.001)。糖尿病视网膜病变、眼内填充物(硅油)、术后前房闪辉及术后眼压波动是引起微创玻璃体切除术后早期高眼压的独立危险因素。结论微创玻璃体切除术后早期高眼压的发生受多种因素影响,对于手术时间长、糖尿病视网膜病变患者、眼内填充物为硅油及术后前房炎症反应重的患者尤其要重视术后早期高眼的防治。

Objective To investigate the risk factors for early intraocular pressure （IOP） elevation in patients who underwent microincision vitrectomy surgery （ MIVS）.Methods From April 2016 to October 201 7,2 17 eyes with various types of vitreoretinal dis-eases were undergone MI VS in our hospital.The incidence of ocular hypertension after the surgery was observed and the related factors influencing the ocular hypertension were analyzed.Results There were 26 eyes （1 1 . 98% ） occurring IOP elevation postoperatively.The mean preoperative best correct visual acuity （ BCVA） operation time and IOP after operation in the high IOP group were higher or longer than those in the non-high IOP group.There were significant differences in the grading of aqueous flare and anterior chamber cell counting between the two groups （P 〈0.05 ） .There was no significant difference in incidence of elevation of IOP among patients with phakic, pseudo-phakic and aphakic eyes （ P=0.065 ） .The incidence of elevated IOP in the 25 gauge vitrectomy group was higher than that in the 27 gauge vitrectomy group （P=0.026 ） . The incidence of elevated IOP was found 22.3% in the silicone oil filled group, 4.1% in the perfusion fluid filled group and 0% in the air filled group （ P 〈0.0 1 ） . Logistic regression analysis showed that diabetic retinopathy,intraocular tamponade （silicone oil） ,postoperative atrial flare and postoperative intraocular pressure fluctuation were inde-pendent risk factors for early ocular hypertension after MIVS.Conclusion The occurrence of early ocular hypertension after MIVS was affected by many factors, especially for patients with long operation time, diabetic retinopathy, silicone oil tamponade and severe postop-erative anterior chamber inflammation.