原发性开角型青光眼患者单侧小梁切除术后对侧眼眼压变化

Intraocular pressure changes in the contralateral eye after unilateral trabeculectomy for primary open angle glaucoma

目的观察原发性开角型青光眼患者单眼行外路小梁切除术后对侧眼眼压变化趋势。方法回顾性分析2016年12月至2021年1月于我院行单眼外路小梁切除术的37例原发性开角型青光眼患者资料,随访并记录患者术后1 d、2 d、3 d、1周、2周、1个月和3个月对侧未手术眼眼压,与术前基线眼压比较。结果术后1 d、2 d、3 d及1周、2周、1个月和3个月患者对侧眼眼压分别由术前(16.38±4.25)mmHg(1 kPa=7.5 mmHg)升至(18.11±4.03)mmHg、(18.35±5.29)mmHg、(18.03±5.35)mmHg、(17.21±3.33)mmHg、(17.96±3.82)mmHg、(18.57±4.45)mmHg、(17.27±3.73)mmHg,差异均有统计学意义(均为P<0.05)。术后1 d患者对侧眼眼压开始升高,增幅最大出现在术后1个月(3.36±4.56)mmHg(升高21%)。术后3个月患者对侧眼眼压开始回归基线水平。相关性分析结果显示,术后不同时间点患者对侧眼眼压改变与年龄、性别均无相关性(均为P>0.05),与术前基线眼压均呈正相关(均为P<0.05),术后随访期内有11例患者对侧眼眼压控制不佳(继续同术前用药,眼压≥21 mmHg)需要手术或加用降眼压药物。术后对侧眼眼压改变与术前降眼压药物使用时间相关。除术后1 d(P=0.31)外,术前持续用药患者与新用药患者术后其他时间点对侧眼眼压改变差异均有统计学意义(均为P<0.05)。结论原发性开角型青光眼患者行单侧外路小梁切除术后,患者早期可能会出现对侧眼眼压升高,3个月后逐渐降低,恢复至术前基线水平。单侧小梁切除术后应加强未手术眼的眼压监测。

Objective To investigate the intraocular pressure(IOP)changes in the unoperated contralateral eye of postoperative patients with primary open-angle glaucoma(POAG)after trabeculectomy.Methods A total of 37 patients with POAG receiving unilateral trabeculectomy in our hospital from December 2016 to January 2021 were recruited for retrospective analyses.Postoperative follow-up was performed at 1 day,2 days,3 days,1 week,2 weeks,1 month and 3 months.During these follow-up visits,the IOP of the unoperated contralateral eye was recorded to compare with the preoperative baseline,thus observing the IOP changes.Results The IOP of the contralateral eyes increased from(16.38±4.25)mmHg(1 kPa=7.5 mmHg)preoperatively to(18.11±4.03)mmHg,(18.35±5.29)mmHg,(18.03±5.35)mmHg,(17.21±3.33)mmHg,(17.96±3.82)mmHg,(18.57±4.45)mmHg and(17.27±3.73)mmHg at 1 day,2 days,3 days,1 week,2 weeks,1 month and 3 months after trabeculectomy,respectively.The differences were statistically significant(P<0.05).The IOP of the contralateral eyes rose from the postoperative first day and reached the maximum at 1 month(3.36±4.56)mmHg,which was 21%higher than that of baseline.The IOP began to return to the baseline 3 months after trabeculectomy.Correlation analysis revealed that the IOP of the contralateral eyes at each time point postoperatively was not correlated with the age and sex of POAG patients(all P>0.05),while it was positively correlated with baseline IOP(all P<0.05).During the follow-up period,11 POAG patients had a poorly controlled postoperative contralateral IOP(≥21 mmHg and even though preoperative drugs were medicated)that required surgery or additional IOP-lowering drugs.The contralateral IOP changes were correlated with the time point for medicating IOP-lowering drugs.Except for the first day after trabeculectomy(P=0.31),there was a significant difference in the contralateral IOP change during the other follow-up time points between patients with continuous medication preoperatively and those newly medicated(all P<0.05).Conclusion After unilateral trabeculectomy for POAG,the IOP of the contralateral unoperated eye increases in the early stage and gradually decreases to the preoperative baseline 3 months later.It is necessary to strengthen the IOP monitoring of the unoperated eyes after unilateral trabeculectomy in POAG patients.