玻璃体切割联合硅油填充术后高眼压的病因评价及处理

Etiological Evaluation and Management of High Intraocular Pressure after Vitrectomy Combined with Silicone Oil Filling

目的 分析玻璃体切割联合硅油填充术后高眼压的发生原因,并采取针对性干预措施。方法 随机选取2017年1月—2021年12月于兴化市人民医院实施玻璃体切割联合硅油填充术治疗的患者80例为研究对象,并根据眼压是否升高分为对照组(术后眼压正常,n=40)、观察组(术后高眼压,n=40),分析玻璃体切割联合硅油填充术后高眼压的发生原因,同时采取合理措施处理。结果 单因素分析显示,观察组年龄、性别、临床分期以及术后美开朗滴眼液点眼比例与对照组相比,差异无统计学意义(P>0.05),观察组高度近视、硅油填充过量、合并糖尿病、术中晶状体摘除、术中全视网膜光凝或冷冻、术后体位不当与对照组相比,差异有统计学意义(P<0.05)。多因素分析结果显示,高度近视(OR=1.521)、硅油填充过量(OR=1.264)、合并糖尿病(OR=1.568)、术中晶状体摘除(OR=1.614)、术中全视网膜光凝或冷冻(OR=0.314)、术后体位不当(OR=1.271)是诱发高眼压的独立影响因素(P<0.05)。结论 高度近视、糖尿病、术中及术后操作不当均可导致玻璃体切割联合硅油填充术后发生高眼压,因此在治疗中需加强预防及干预,尽可能在术前合理控制患者血糖水平,且操作过程中医务人员需规范自身行为,减少其他因素对治疗及预后效果影响。

Objective To analyze the causes of high intraocular pressure after vitrectomy combined with silicone oil filling,and to take targeted interventions.Methods Eighty patients who underwent vitrectomy combined with silicone oil filling in Xinghua People's Hospital from January 2017 to December 2021 were randomly selected as research objects,and were divided into control group(normal intraocular pressure after surgery,n=40)and observation group(high intraocular pressure after surgery,n=40)according to whether the intraocular pressure increased.The causes of intraocular hypertension after vitrectomy combined with silicone oil filling were analyzed and reasonable measures were taken.Results Univariate analysis showed that there was no statistically significant difference between the observation group and the control group in age,gender,clinical stage and percentage of postoperative beauty drops(P>0.05);high myopia,excessive silicone oil filling,complicated diabetes,intraoperative lens removal,intraoperative panretinal photocoagulation or freezing,postoperative improper posture in the observation group compared with the control group,and improper postoperative posture,the difference was statistically significant(P<0.05).The results of multifactor analysis showed that High myopia(OR=1.521),excessive silicone oil filling(OR=1.264),complicated diabetes(OR=1.568),intraoperative lens extraction(OR=1.614),intraoperative panretinal photocoagulation or freezing(OR=0.314),and postoperative improper postural position(OR=1.271)were the independent factors that induced ocular hypertension(P<0.05).Conclusion High myopia,diabetes,intraoperative and postoperative improper operation can all lead to intraocular hypertension after vitrectomy combined with silicone oil filling.Therefore,prevention and intervention should be strengthened in the treatment,and patients´blood sugar level should be controlled reasonably before surgery as far as possible.Medical staff should regulate their own behavior during the operation to reduce the influence of other factors on the treatment and prognosis.