穿透性角膜移植术后发生继发性青光眼的影响因素及治疗方法

Influential factors and effect analysis of treatment for secondary glaucoma after penetrating keratoplasty

目的探讨穿透性角膜移植术(penetrating keratoplasty,PKP)后发生继发性青光眼的影响因素和治疗方法。方法回顾性临床研究。收集2016年1月至2018年11月在山东省眼科医院行PKP术后继发青光眼患者60例(60眼),根据发病时间、发作次数、术前有无青光眼病史对术后发生继发性青光眼患者进行分组。采用t检验、Mann-Whitney U检验或χ2检验比较组间的临床资料,采用Logistic回归分析术后发生早期青光眼、术后青光眼多次发作的危险因素。结果PKP术后继发性青光眼患者60例(60眼),随访(16.0±11.0)个月,总发生率为10.5%(60/573)。术后早期青光眼发病率为6.1%(35/573),主要诱因包括术后严重前房炎症及虹膜粘连19例,浅前房5例,其他11例。35例患者中药物治疗21例,联合手术治疗14例,以小梁切除术为主,共8例,最终眼压控制率为71.4%(25/35)。术后晚期青光眼发生率为4.4%(25/573),激素类药物诱发15例,周边虹膜前粘连6例,其他4例。单纯药物治疗21例,眼压控制率72%(18/25)。不同发病时间组间前房积脓、青光眼治疗方式比较,差异均有统计学意义(χ2=6.898,P=0.009;χ2=4.000,P=0.046);术前有青光眼者术后青光眼发作频繁,差异有统计学意义(χ2=5.137,P=0.023)。术前严重的前房积脓是术后早期继发性青光眼发生的危险因素,术前青光眼病史是继发性青光眼多次发作的危险因素。结论严重的角膜感染、青光眼病史、糖皮质激素药物使用是PKP术后青光眼发生的影响因素。PKP治疗的不同时期继发性青光眼防治重点不同,单纯药物和手术治疗对眼压控制均有效且无明显差异。

Objective To investigate the influencing factors and treatment outcomes of secondary glaucoma after penetrating keratoplasty(PKP).Methods A retrospective clinical study was conducted on 60 cases(60 eyes)with secondary glaucoma occurred after PKP at the Shandong Eye Hospital from January 2016 to November 2018.All patients were grouped according to the time of onset,the number of episodes and the history of glaucoma.Clinical data were compared with t test,Mann-Whitney U test orχtest among groups.Logistic regression analysis was used to analyze the risk factors of having early glaucoma and multiple attacks of glaucoma after operation.Results Sixty patients(60 eyes)with secondary glaucoma were included,and followed up for(16.0±11.0)months.The total incidence of secondary glaucoma was 10.5%(60/573).The incidence of early postoperative glaucoma was 6.1%(35/573),and the main causes included severe anterior chamber inflammation and iris adhesion in 19 cases and shallow anterior chamber in 5 cases and other factors in 11 cases.Among 35 patients,21 patients underwent drug therapy,14 patients underwent combined surgery,and trabeculectomy was the main operative method,which was performed in 8 patients.The final intraocular pressure control rate was 71.4%(25/35).The incidence of late postoperative glaucoma was 4.4%(25/573),induced by hormonal drugs in 15 cases,by peripheral anterior synechia in 6 cases and other factors in 4 cases.Twenty one patients were treated with drug alone,and the intraocular pressure control rate was 72%(18/25).There were significant differences in anterior chamber empyema and the treatment of glaucoma between the different onset time groups(χ2=6.898,P=0.009;χ2=4.000,P=0.046).Preoperative glaucoma patients have more frequent glaucoma episodes after operation,and the difference was statistically significant(χ2=5.137,P=0.023).Severe anterior chamber empyema was a risk factor for secondary glaucoma in the early postoperative period.The history of preoperative glaucoma was a risk factor for frequent episodes of secondary glaucoma.Conclusion Severe corneal infection,history of glaucoma,glucocorticoid drugs are the influencing factors of post-PKP glaucoma.The prevention and treatment of secondary glaucoma in different periods of PKP treatment were different.Simple drug treatment and operation were both effective for control of intraocular pressure,and had no significant difference.