PDR玻璃体切割术后顽固性高眼压的原因及处理

Reasons and management of intractable high intraocular pressure after vitrectomy of proliferative diabetic retinopathy

目的:探讨增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切割术后顽固性高眼压的原因及有效处理方法。方法:回顾性分析我院2008-11/2010-10因PDR行玻璃体切割术后的眼压状况。结果:患者119眼中共有25眼(21.0%)于玻璃体切割术后发生眼压顽固性增高,经药物治疗后眼压维持正常者18眼(72.0%),7眼需要手术治疗;25眼中,19眼(76.0%)为术后1wk内出现眼压升高,6眼眼压升高发生在术后2～18mo。眼压升高原因:在术后3mo后出现眼压升高的5眼中,除1眼为瞳孔闭锁导致高眼压,其余4眼均出现了新生血管性青光眼,其中3眼在硅油取出时联合白内障摘除,1眼为玻璃体切割联合白内障摘除手术。119眼中,行硅油注入42眼(35.3%),C3F8注入12眼(10.1%),但在眼压升高的25眼中有11眼联合硅油注入(44%,P=0.41),有无硅油注入眼压升高差异无显著性。2眼C3F8注入(7.7%,P=0.83),有无C3F8注入眼压升高差异无显著性。结论:PDR玻璃体切割术后顽固性高眼压多可通过药物将眼压控制正常,术中硅油注入不是眼压增高的主要因素,远期的眼压升高与新生血管性青光眼有关,术中或术后是否摘除白内障需要慎重考虑。

AIM：To seek the reasons and effective methods to treat the intractable high intraocular pressure （IOP） after vitrectomy of proliferative diabetic retinopathy （PDR）.METHODS：Postoperative IOP of eyes with PDR after vitrectomy were retrospectively analyzed within 2 years in our hospital.RESULTS：Twenty-five eyes （21.0%） occurred intractable high IOP in 119 eyes.IOP in 18 （72.0%） of 25 eyes could be controlled by using medical treatment,while 7 eyes required surgery.19 （76.0%） of 25 eyes had high IOP within one week after surgery,the other 6 eyes had high IOP at 2 to 18 months after surgery.The reasons of postoperative high IOP happened in 3 months after surgery included pupil atresia in one eye and neovascular glaucoma in 4 eyes.These 4 eyes with neovascular glaucoma had received phacoemulsification cataract surgery.In 119 eyes,silicone oil injection was in 42 eyes （35.3%）,C3F8 injection in 12 eyes （10.1%）.In 25 eyes with postoperative high IOP,11 eyes had received vitrectomy combined with silicone oil injection （44%,P= 0.41）.IOP had no statistically significant difference between the eyes with and without silicone oil.2 eyes were injected C3F8 （7.7%,P=0.83）,IOP had no statistically significant difference between the eyes with and without C3F8.CONCLUSION：The intractable high IOP after vitrectomy treating PDR usually can be controlled by medication.Silicone oil as intraocular tamponade is not the primary factor for postoperative high IOP.As long-dated high IOP may be associated with neovascular glaucoma.Intraoperative or postoperative cataract extraction requires carefully consideration.