玻璃体切割术后持续性角膜上皮缺损的危险因素分析

Analysis of Risk Factors of Persistent Corneal Epithelial Defect after Pars Plana Vitrectomy

目的:分析玻璃体切割术(pars plana vitrectomy,PPV)后发生持续性角膜上皮缺损(persistent corneal epithelialdefect,PCED)的危险因素。方法:回顾性分析2014年9月至2015年10月于我院行PPV的患者546例,567眼的临床资料,采用Logistic回归分析PPV后发生PCED的危险因素。结果:术后PCED的发生率为2.8%(16/567),Logistic回归显示术中角膜上皮刮除、硅油填充、糖尿病及术后持续高眼压等是导致患者术后PCED的危险因素,OR值分别为3.23、1.51、2.31及1.23;超声乳化及人工晶体植入与PCED的发生无显著相关性(OR=1);2例(2眼)患者PPV后发生了顽固的PCED,最后被确诊为单纯疱疹病毒性角膜炎(herpes simplex virus keratitis,HSK);2例(2眼)患者术后持续的高眼压导致PCED。结论:术中行角膜上皮刮除或角膜上皮损伤、术中行玻璃体腔内硅油填充、糖尿病及术后持续的高眼压是PPV后发生PCED的常见原因,此外对顽固性PCED还应警惕HSK的发生。

Objective： To investigate the risk factors of persistent corneal epithelial defects （PCED） after pars plana vitrectomy （PPV） . Methods： The clinical data of 546 patients （567 eyes） received PPV from Sep 2014 to Oct 2015 in our hospital were retrospectively analyzed. Logistic regression was used to analyze the risk factors of PCED after PPV. Results ： The incidence rate of postoperative PCED was 2.8% （16/567） . Logistic regression showed that intraoperative epithelial debridement, intravitreal silicone oil tamponade, diabetes mellitus and postoperative persistent high intraoeular pressure were risk factors of PCED after PPV （OR=3.23, 1.51, 2.31 and 1.23 respectively） . Phaeoemulsifieation and intraoeular lens implanting had no significant association with PCED （OR=1） . Two patients （2 eyes） had recalcitrant PCED after PPV, and were diagnosed as herpes simplex virus keratitis （HSK） . Two patient （2 eyes） had postoperative persistent intraoeular pressure which caused PCED. Conclusions： Intraoperative epithelial debridement, intravitreal silicone oil tamponade, diabetes mellitus and postoperative persistent high intraoeular pressure are risk factors of PCED after PPV. In addition, recalcitrant PCED should also be alert to the occurrence of HSK.