糖尿病黄斑水肿患者地塞米松玻璃体腔植入剂治疗后继发眼压升高的影响因素分析

Factor analysis of secondary intraocular hypertension after intravitreal dexamethasone implantation in patients with diabetic macular edema

目的观察并分析糖尿病黄斑水肿(DME)患者地塞米松玻璃体腔植入剂(DEX)治疗后继发性眼压升高的危险因素。方法回顾性观察研究。2016年1月至2022年3月于哈尔滨二四二医院眼科检查确诊并行DEX治疗的2型糖尿病(T2DM)继发DME患者352例纳入研究。其中,男性221例,女性131例;年龄(55.56±8.09)岁。弥散性黄斑水肿、黄斑囊样水肿分别为194、158例。所有患者均行玻璃体腔植入DEX治疗。治疗后每一个月测量1次眼压,连续3个月,以眼压>25 mm Hg(1 mm Hg=0.133 kPa)或较基线升高>10 mm Hg为继发眼压升高。收集相关临床资料,采用二元logistic回归分析DME患者DEX治疗后继发眼压升高的危险因素。结果352例中,眼压升高组116例(32.95%,116/352)。其中,治疗后1、2、3个月发生者分别为29(25.00%,29/116)、69(59.48%,69/116)、18(15.52%,18/116)例。与眼压正常组比较,治疗后1、2、3个月眼压升高组患者眼压明显升高,差异有统计学意义(t=10.771、21.116、13.761,P<0.001)。与眼压正常组比较,眼压升高组患者年龄更小(t=6.967),糖尿病病程(t=5.950)、眼轴长度(AL)(t=14.989)更长,DME 3级(Z=6.284)、DEX植入睫状体扁平部比例(χ^(2)=23.275)、糖化血红蛋白(HbA1c)水平(t=10.764)更高(P<0.05)。Logistic回归分析结果显示,AL较长[比值比(OR)=1.428,95%可信区间(CI)1.054~1.934]、DEX植入睫状体扁平部(OR=1.358,95%CI 1.063~1.735)、HbA1c偏高(OR=1.702,95%CI 1.225~2.366)是DME患者DEX治疗后继发眼压升高的危险因素(P<0.05);年龄偏大是保护因素(OR=0.548,95%CI 0.380~0.789,P<0.05)。结论AL较长、DEX植入睫状体扁平部、HbA1c偏高是DME患者DEX治疗后继发眼压增高的危险因素;年龄偏大是保护因素。

Objective To observe and analyze the risk factors of secondary intraocular hypertension in diabetic macular edema(DME)patients after treatment with dexamethasone vitreous cavity implant(DEX).Methods A retrospective observational study.A total of 352 patients with type 2 diabetes mellitus(T2DM)secondary macular edema diagnosed by ophthalmic examination and treated with DEX in Department of Ophthalmology of Harbin 242 Hospital from January 2016 to March 2022 were included in the study.Among them,221 were males and 131 were females,with the mean age of(55.56±8.09)years.There were 194 patients with disseminated macular edema,158 patients with cystoid macular edema.All patients underwent vitreous cavity implantation of DEX.Intraocular pressure(IOP)was measured once a month for 3 months after treatment,with IOP over than 25 mm Hg(1 mm Hg=0.133 kPa)or higher than 10 mm Hg from baseline as secondary intraocular hypertension.The relevant clinical data were collected,and the risk factors of secondary intraocular hypertension in DME patients after DEX treatment were analyzed by binary logistic regression.Results Among 352 patients,116 patients(32.95%,116/352)were in the intraocular hypertension.Among them,29 patients(25.00%,29/116),69 patients(59.48%,69/116)and 18 patients(15.52%,18/116)occurred intraocular hypertension at 1,2 and 3 months after treatment,respectively.Compared with the normal IOP group,the IOP in the intraocular hypertension group increased significantly at 1,2 and 3 months after treatment,with statistical significance(t=10.771,21.116,13.761;P<0.001).Compared with normal IOP group,the patients in the intraocular hypertension group had younger age(t=6.967),longer duration of diabetes(t=5.950),longer axial length(AL)(t=14.989),higher proportion of DME grade 3(Z=6.284),higher proportion of DEX implantation in pars plana(χ^(2)=23.275),and higher HbA1c level(t=10.764),the differences were statistically significant(P<0.05).Logistic regression analysis showed that longer AL[odds ratio(OR)=1.428,95%confidence interval(CI)1.054-1.934],DEX implantation in pars plana(OR=1.358,95%CI 1.063-1.735),and higher HbA1c(OR=1.702,95%CI 1.225-2.366)were the risk factors for secondary intraocular hypertension in DME patients after DEX treatment(P<0.05),older age was a protective factor(OR=0.548,95%CI 0.380-0.789,P<0.05).Conclusions Long AL,DEX implantation in pars plana and high HbA1c are the risk factors for secondary intraocular hypertension after DEX treatment in DME patients,older age is a protective factor.