内窥镜下玻璃体切除术治疗低眼压的临床分析

Clinical analysis of treating hypotony using vitrectomy assisted with intraocular videoendoscope

目的:探讨眼内窥镜治疗长期低眼压的可行性。方法:回顾性分析我科从2005-06/2007-12用眼内窥镜诊治的17例眼外伤导致的长期低眼压病例眼压恢复情况。结果:手术后1,2,3mo时分别测得的平均眼压与手术前眼压相比提高明显(P<0.01),进一步比较发现手术前与手术后1,2,3mo平均眼压差异均有统计学意义(P<0.01,P<0.01,P<0.01)。17例眼外伤性长期低眼压病例,眼压恢复正常的成功率为47%,其中合并睫状体萎缩性病变的成功率为33%,而无睫状体萎缩性病变的成功率为55%两组间差异无统计学意义(P=0.620);手术前眼压<6.00mmHg的病例,眼压恢复正常的成功率为44%,而手术前眼压>6.00mmHg病例的眼压恢复正常成功率为63%,两组间差异无统计学意义(P=0.637);手术前1,2,3mo的病程与眼压恢复的相关性无统计学意义(r=-0.335,P=0.188;r=-0.310,P=0.226;r=-0.325,P=0.203)。结论:眼内窥镜辅助的玻璃体切除术能够恢复部分眼外伤性长期低眼压患者的眼压,手术前眼压、睫状体病变情况和尽快行眼内窥镜下睫状体探察手术可能是恢复部分长期低眼压的关键。

AIM ：To explore the feasibility of treating chronic ocular hypotony with eye endoscope. METHODS： The data of 17 cases of traumatic chronic ocular hypotony were analyzed retrospectively. RESULTS： The ocular pressure before surgery was significantly higher than after surgery（ P 〈 0.01 ）, and the difference among 1 month,2 months and 3 months was significantly too （ P = 0. 01, P = 0.01, P = 0.01 ）. In all cases, ocular pressure was attained normal level in 8 cases（47% ） ; 2 cases were attained normal ocular pressure in 6 cases（33%） with ciliary body atrophy; 6 ones in 11 cases （55%） without ciliary body atrophy; the difference was not significant（ P = 0. 620）. The success rate in cases with ocular pressure less than 6.0mmHg before surgery was 44%, while 63% in cases with ocular pressure more than 6.00mmHg before surgery. The difference was not significant too （ P = 0. 637）. The convalescence of ocular pressure was not correlated with the course of disease before surgery （r=-0.335,P=0.188; r=-0. 310; P= 0.226 ; r = -0.325, P= 0. 203）. CONCLUSION： The ocular pressure of part traumatic chronic ocular hypotony can attain normal level using eye endoscope assisted vitrectomy. The main effective elements may be ocular pressure, pathology of ciliary body and the course of ocular hypotony before surgery.