微创玻璃体切除术后早期大幅眼压波动的影响因素分析

Risk factors for large fluctuations in intraocular pressure in the early stage after microincision vitrectomy surgery

目的:探讨微创玻璃体切除术后早期大幅眼压波动的相关因素。方法:采用病例对照的研究方式,回顾性分析2016年4月至2017年10月微创玻璃体切除术(简称:玻切术)治疗玻璃体视网膜疾病共217例。术后眼压波动≥8 mmHg定义为大幅眼压波动,<8 mmHg为小幅眼压波动,观察分析术后大幅眼压波动相关因素。结果:术后1周大幅眼压波动组共45人(20.7%),小幅眼压波动组172人。大幅眼压波动组平均手术时间为(68.5±44.5)min,小幅眼压波动组平均手术时间为(44.9±26.0)min,差异具有统计学意义(P<0.001)。联合白内障超声乳化术与单纯玻切术相比,大幅眼压波动发生率分别为8.51%及24.12%,两组差异具有统计学意义(P=0.019)。术后房水细胞分级为0至4级时,大幅眼压波动发生率分别为19.08%、20.00%、66.67%、25.00%及0%,差异具有统计学意义(P=0.044)。回归分析发现手术时间、房水细胞是术后早期大幅眼压波动的危险因素。结论:玻切术后大幅眼压波动与多种围手术期因素有关,其中手术时间、前房炎症反应是引起术后早期大幅眼压波动的危险因素。

Objective： To investigate the risk factors for large fluctuations in intraocular pressure（IOP） in the early stage after microincision vitrectomy surgery（MIVS）. Methods： With the use of the case-control method, a ret-rospective analysis was performed from the clinical data of 217 patients who underwent MIVS for the treatment of vit-reoretinal diseases in our hospital from April 2016 to October 2017. A postoperative fluctuation in IOP of ≥8 mmHgwas defined as large fluctuation, and a fluctuation of 〈8 mmHg was defined as small fluctuation. The risk factors forlarge fluctuations in IOP after surgery were analyzed. Results： At one week after surgery, 45 patients（20.7%） expe-rienced large fluctuations in IOP and 172 experienced small fluctuations. There was a significant difference in meantime of operation between the large fluctuation group and the small fluctuation group [（68.5 ± 44.5）minutes vs（44.9±26.0）minutes, P〈0.001]. There was a significant difference in the incidence rate of large fluctuations inIOP between the MIVS-phacoemulsification group and the MIVS group（8.51% vs 24.12%, P = 0.019）. The inci-dence rates of large fluctuations in IOP in patients with anterior chamber cell grade 0 ~ 4 were 19.08 %, 20.00%,66.67%, 25.00%, and 0%, respectively, and there was a significant difference between these groups（P = 0.044）. Theregression analysis showed that time of operation and anterior chamber cell grade were risk factors for large fluctua-tions in IOP in the early stage after surgery. Conclusion： Large fluctuations of IOP after MIVS were associated with various perioperative factors, among which time of operation and inflammatory response in the anterior chamber were risk factors for large fluctuations of IOP in the early stage after surgery.