小梁切除术后早期前房出血危险因素的临床分析

Risk factors of hyphema early after trabeculectomy

目的探讨小梁切除术后早期前房出血的发生率、出血原因及预防处理。方法回顾分析249例(355眼)青光眼小梁切除术后早期前房出血的情况,对各类型青光眼小梁切除术后前房出血发生率、出血量及术后积血吸收情况,全身相关因素等进行总结、分析。结果355眼小梁切除术后,前房出血37眼(10.42%),其中新生血管性青光眼术后发生率为55.55%,急性闭角型青光眼小梁切除术后发生率为8.87%,慢性闭角型青光眼术后发生率为11.49%,原发性开角型青光眼术后发生率为9.24%。14.34%术前高眼压患者术后发生前房出血,伴有高血压病的小梁切除患者术后前房出血发生率为30.43%,伴有糖尿病的术后发生率为26.32%,术前有口服抗凝药物史的术后发生率为31.25%。卡方检验结果显示新生血管性青光眼,术前高眼压,伴有高血压、糖尿病以及术前有抗凝药物服用史的患者,前房出血发生率高。进一步回归分析发现新生血管性青光眼和术前高眼压是小梁切除术后前房出血的独立危险因子。前房出血量1级者19眼,2级者11眼,达3级者7眼,出血后眼压分别为(10.93±2.46)mm Hg(1 mm Hg=0.133 k Pa)、(9.33±1.63)mm Hg、(24.75±12.76)mm Hg,出血量达3级者眼压显著性增高。前房出血组术前平均眼压(32.92±7.32)mm Hg,与未发生前房出血者眼压(28.10±7.70)mm Hg相比,差异有统计学意义。结论前房出血是小梁切除术后常见并发症,术前高眼压、新生血管性青光眼是术后发生前房出血的危险因素;合并高血压、糖尿病和口服抗凝药物患者较无合并全身疾病者,术后前房出血发生率高。少量前房出血对术后眼压无明显影响。

Objective To investigate the incidence,causes and prevention of hyphema early after trabeculectomy.Methods The incidence,grade and severe complications of hyphema in 355 eyes of 249 glaucoma patients who had undergone trabeculectomy were retrospectively analyzed.Results In the first week after operation,hyphema occurred in 37 eyes （10.42％）.The incidence of hyphema after trabeculectomy in neovascular glaucoma patients was 55.55％,in primary acute angle-closure glaucoma patients was 8.87％,in primary chronic angle-closure glaucoma patient was 11.49％,in primary open angle glaucoma was 9.24％,while in patients with introcular pressure （IOP） higher than 21 mm Hg （1 mm Hg =0.133 kPa） was 14.34％.Seven out of 23 glaucoma patients with high blood pressure developed hyphema after trabeculectomy,and 5 out of 19 patients with diabetic mellitus developed hyphema.Thirty-one point two five percent of the anticoagulants used patients developed hyphema.Chi square test showed hyphema easily happened in neovascular glaucoma patients,high IOP patients,high blood pressure patients,diabetic mellitus patients and patients with anticoagulants used.Regression analysis showed that the high preoperative IOP and neovascular glaucoma were the risk factors of hyphema.Among the 37 hyphema patients,19 of them were grade 1 hyphema,11 patients were grade 2,and 7 were grade 3 hyphema.The mean IOP of grade 1 hyphema was （10.93 ±2.46）mm Hg,of grade 2 was （9.33 ± 1.63） mm Hg,while the IOP of grade 3 was （24.75 ± 12.76） mm Hg,significantly higher than that of grade 1 and grade 2 group.The mean IOP of hyphema patients was （32.92 ± 7.32） mm Hg,which was significantly higher than that of non-hyphema patients.Conclusions Hyphema is a common complication early after trabeculectomy.Neovascular glaucoma and high preoperative IOP are the risk factors of hyphema.Hyphema happen more often in glaucoma patients with high blood pressure,diabetic mellitus and anticoagulants used than in those without such systematic complications.Mild hyphema has little impact on postoperative IOP.