视网膜脱离患者玻璃体切除硅油填充术后3天高眼压发生率及危险因素

Incidence and risk factors of intraocular pressure elevation within postoperative three days in retinal detachment patients treated by pars plana vitrectomy with silicone oil tamponade

目的探讨玻璃体切除及硅油填充术治疗视网膜脱离术后3天内眼压升高的发生比例及危险因素。设计前瞻性病例系列。研究对象2018年2-8月北京大学第三医院连续行玻璃体切除术联合硅油填充术治疗的视网膜脱离患者135例。方法使用回弹式眼压计测量患者术后2、4、6~8小时、1、2、3天的眼压。任何时间眼压≥25 mmHg定义为眼压升高。生存期定义为从玻璃体切除术结束至第一次眼压≥25 mmHg发生时的时间间隔(小时)。采用Cox回归分析评估术后3天内发生高眼压的相关危险因素。采用Kaplan-Meier生存曲线可视化不同病因的视网膜脱离患者的生存概率。主要指标高眼压发生率及危险因素。结果135例患者中44例(32.6%)发生眼压升高,眼压升高在术后第1天发生率最高(20.2%)。Cox分析显示视网膜脱离的病因与眼压升高显著相关(P=0.006),以原发性孔源性视网膜脱离作为对照,糖尿病性牵引性视网膜脱离和复发性视网膜脱离发生眼压升高的风险分别为3.5倍(P=0.002,HR=3.41)和3倍(P=0.010,HR=2.91)。糖尿病牵引性视网膜脱离和复发性视网膜脱离的总生存率显著低于原发性视网膜脱离和外伤性视网膜脱离(P<0.05)。结论视网膜脱离患者行玻璃体切除硅油填充术后3天内眼压升高比例约占1/3,主要发生在术后第1天。对于玻璃体切除硅油填充眼特别是糖尿病牵引性视网膜脱离及复发性视网膜脱离者,术后第1天复查仍有必要性。

Objective To investigate the incident rate and risk factors of intraocular pressure(IOP)elevation within 3 days afterpars plana vitrectomy and silicone oil tamponade for retinal detachment.Design Prospective case series.Participants 135 cases of retinal detachment patients who were treated by vitrectomy with silicone oil tamponade from February to August 2018 in Peking University Third Hospital were consecutively included.Methods IOP at hours 2,4,6~8,and days 1,2,3 after surgery were recorded.IOP≥25 mmHg at any time was defined as IOP elevation.Survival time was defined as the time interval(hours)from the end of vitrectomy to the onset of the first IOP elevation.Cox regression analysis was used to evaluate the risk factors associated with postoperative IOP elevation.Kaplan-Meier survival curves were constructed to visualize the probability of overall survival of patients with different etiology of retinal detachment.Main Outcome Measures Incidence and risk factors for IOP elevation.Results Among 135 patients enrolled,44(32.6%)patients developed IOP elevation,with the incident rate peaked at the postoperative day one(20.2%).The etiology of retinal detachment was significantly associated with the IOP elevation(P=0.006).Compared to primary rhegmatogenous retinal detachment,patients with diabetic tractional retinal detachment and recurrent retinal detachment had 3.5(P=0.002,hazards ratio(HR)=3.41)and 3(P=0.010,HR=2.91)folds of increased risk for IOP elevation.The overall survival probability of diabetic traction retinal detachment and recurrent retinal detachment was significantly lower than that of primary rhegmatogenous retinal detachment and traumatic retinal detachment(all P<0.05).Conclusion Early-onset IOP elevation occurs in one-third of retinal detachment eyes with silicone oil tamponade,with the incidence peaked at the first postoperative day.The first postoperative day visit,at least IOP examination,is still necessary for eyes underwent vitrectomy and silicone oil tamponade,especially those with diabetic tractional retinal detachment and recurrent retinal detachment.