硅油填充术后继发性青光眼局部降眼压药物治疗效果观察

Clinical research on the focal treatment for silicone oil glaucoma

目的比较不同局部降压药物对硅油填充术后继发性青光眼（SOG）的疗效。方法于2010年4月至2016年4月在上海市第一人民医院眼科行硅油注入术的患者，监测手术1月之后的眼压。当发现眼压为22-30 mmHg时，随机使用盐酸左布诺洛尔滴眼液（A1组）或拉坦前列素滴眼液（A2组）；当眼压为31-39 mmHg时，随机使用盐酸左布诺洛尔滴眼液＋酒石酸溴莫尼定滴眼液（B1组）或拉坦噻吗滴眼液（B2组）。在治疗后的3 d、9 d，比较不同药物的降压幅度和有效率。结果符合研究标准的SOG共84只眼。在治疗3 d后，4组观察对象的降压幅度为：A1组（22只眼）（3.95±2.57）mmHg （15.62%），A2组（21只眼）（6.33±3.12）mmHg （24.84%），B1组（21只眼）（8.28±3.56）mmHg （24.58%），B2组（20只眼）（11.15±4.23）mmHg （32.74%），A、B组间差异均有统计学意义（t =2.74，P =0.01） （t=2.42，P =0.02）。有效例数：A1组11只眼（50%），A2组15只眼（71.43%），B1组8只眼（38.10%），B2组12只眼（60.00%），A、B组间差异均无统计学意义（χ^2=2.06, P=0.22）（χ^2=1.97，P=0.16）。在治疗9 d后，降压幅度为：A1组（4.18±3.25）mmHg （16.19%），A2组（7.17±3.40）mmHg （28.30%），B1组（9.71±3.92）mmHg （28.78%），B2组（13.28±3.47）mmHg （39.12%），A、B组间差异均有统计学意义（t=2.95，P=0.01）（t=3.08，P =0.004）。有效例数：A1组10只眼（45.45%），A2组16只眼（76.19%），B1组8只眼（38.10%），B2组14只眼（70.0%），A、B组间差异均有统计学意义（χ^2=4.25，P=0.04）（χ^2=4.19，P=0.04）。结论在治疗SOG时，局部单独或联合应用前列腺素衍生物滴眼液疗效更显著。

Objective To compare the effects of topical antiglaucomatous agents on silicone oil glaucoma （SOG）. Methods Eyes, which SOG was diagnosed at least 1 month after silicone oil tam- ponade, were selected for this experiment. The patients whose intraocular pressure （IOP） was 22-30mmHg, were divided randomly into two subgroups, group A1 （treated by levobunolol hydrochlo- ride eye drops） and subgroup A2 （treated by latanoprost eye drops）. The patients whose IOP was 31-39mmHg, were divided randomly into two subgroups, group B1 （treated by both levobunolol hy- drochloride and brimonidine tartrate eye drops） and subgroup B2 （treated by latanoprost and timolol maleate eye drops）. The effectiveness and IOP reduction were compared after using eye drops for 3 days and 9 days. Results SOG occurred in 84 eyes. After using the eye drops for 3 days, IOP reduction was 3.95±2.57mmHg （15.62%） for 22 eyes in group A1, 6.33±3.12mmHg （24.84%） for 21 eyes in group A2, 8.28±3.56 mmHg （24.58%） for 21 eyes in group B1 and 11.15±4.23 mmHg （32.74%） for 20 eyes in group B2 respectively. The difference was statistically significant within group A （t =2.74, P =0.01） and group B （t =2.42, P =0.02）. The number of effective cases of the four groups was 11 eyes （50%） for group A1, 15 eyes （71.43%） for group A2, 8 eyes （38.10%） for group B1 and 12 eyes （60.00%） for group B2 respectively, and the difference was not statistically significant within group A （χ^2=2.06, P =0.22） and group B （χ^2=1.97, P =0.16）. After using the eye drops for 9 days, The IOP reduction was 4.18±3.25mmHg （16.19%） and 7.17±3.40mmHg （28.30%） for groups A, and 9.71±3.92mmHg （28.78%） and 13.28±3.47mmHg （39.12%） for groups B respectively. The difference was statistically significant both within group A （t =2.95, P =0.01） and group B （t =3.08, P =0.004）. The number of effective cases of the four groups was 10 eyes （45.45%） for group A1, 16 eyes （76.19%） for group A2, 8 eyes （38.10%） for group B1 and 14 eyes （70.0%） for group B2 respectively, and the difference was statistically significant within group A （χ^2=4.25, P = 0.04） and group B（χ^2=4.19, P =0.04）. Conclusions Alone or in combination, prostaglandin derivatives eve droos can be more effective for the treatment of SOG.