原发性闭角型青光眼患者术后出现恶性青光眼的危险因素分析

The risk factors of malignant glaucoma of primary angle -closure glaucoma post operation

目的：探讨原发性闭角型青光眼术后发生恶性青光眼的危险因素。方法回顾性分析500例（705眼）行抗青光眼手术的原发性闭角型青光眼患者的临床资料。其中术后发生恶性青光眼的患者25例（30眼）作为观察组，未发生恶性青光眼患者475例（675眼）作为对照组。记录两组患者的性别、年龄、青光眼类型、术前眼压、前房深度、相对晶状体位置、晶状体厚度、眼轴长度、房角结构及手术方式等临床指标。单因素分析采用χ2检验和t检验，多因素分析采用Logistic回归分析。结果单因素分析结果显示：两组性别、年龄、青光眼类型、术前眼压、眼轴长度差异均有统计学意义（χ2＝5．394、4．785、6．475、4．907、4．890，均P＜0.05）。多因素Logistic回归分析结果显示：年龄（OR＝3．774，95％CI 1．765～7．341，P＝0．004）、眼轴长度（OR＝2．684，95％CI 1．363～6．953，P＝0．005）是原发性闭角型青光眼术后发生恶性青光眼的独立危险因素。结论女性、年龄较轻、慢性闭角型青光眼、术前持续高眼压、房角完全关闭、前房较浅、晶体较薄及眼轴较短的原发性闭角型青光眼患者术后容易发生恶性青光眼，尤其是年龄较轻和眼轴较短的患者，应给予足够的重视。

Objective To explore the risk factors of malignant glaucoma of primary angle-closure glaucoma post operation.Methods The clinical data of 500 patients （705 eyes） with primary angle-closure glaucoma who received glaucoma surgery were retrospectivly analyzed.25 patients （30 eyes） with malignant glaucoma after surgery were selected as observation group,475 patients （675 eyes） with no malignant glaucoma after surgery were selected as the control group.The gender,age,type of glaucoma,preoperative intraocular pressure,anterior chamber depth,relative position of the lens , lens thickness , length of optic axis , corner structure and operation method of the two groups we recorded.Single factor analysis was conducted by chi-square test and t test,multiple factors analysis was conducted by Logistic regression analysis.Results Single factor analysis showed that there were significant differences in gender,age,glaucoma types,intraocular pressure and ocular axis length in the two groups （χ2 =5.394,4.785,6.475, 4.907,4.890,all P〈0.05）.Multivariable Logistic regression analysis results showed that age （OR=3.774,95%CI 1.765-3.774,P=0.004）,and length of optic axis （OR=2.684,95% CI 1.363 to 6.953,P=0.005） were independent risk factors of primary angle -closure glaucoma post operation.Conclusion Women, younger age, chronic angle -closure glaucoma, continuous high intraocular pressure, corner completely closed, shallow anterior chamber,crystals thinner and shorter optic axis of primary angle -closure glaucoma patients prone to malignant glaucoma postoperation,especially younger age and optic axis short patients,should be given enough attention.