复杂玻璃体视网膜手术联合硅油填充术后继发性青光眼的危险因素分析

Analysis of risk factors of secondary glaucoma after complex vitreoretinal surgery combined with silicone oil tamponade

目的分析复杂玻璃体视网膜手术联合硅油填充术后继发青光眼的危险因素。方法病例对照研究。纳入南阳市眼科医院2019年8月至2022年10月接受玻璃体切除术、玻璃体腔注药联合硅油填充术的190例(190只眼)为研究对象,根据患者术后是否继发青光眼分为继发组(48例)和未继发组(142例)。采用受试者工作特征(ROC)曲线分析预测价值;采用logistic回归实验分析影响患者治疗效果的相关因素;采用内部数据验证Nomogram模型临床效能。结果两组患者年龄及性别等一般资料,差异均无统计学意义(均P>0.05);继发组患者与未继发组比较,联合巩膜环扎占比[37.50%(18/48)vs 19.01%(27/142)]、硅油乳化比[62.50%(30/48)vs 41.55%(59/142)]较高,摘出晶状体占比[41.67%(20/48)vs 61.97%(88/142)]较低,硅油填充时间[(7.50±1.80)个月vs(5.50±2.20)个月]较长(均P<0.05);硅油填充时间的曲线下面积(AUC)为0.755,最佳截断值为6个月(P<0.001);联合巩膜环扎(是)、摘出晶状体(否)、硅油乳化(是)、硅油填充时间(>6个月)均为影响玻璃体切除、玻璃体腔注药联合硅油填充术后继发青光眼的危险因素(OR=1.80、1.58、1.93、2.22,95%CI=1.121-2.069、1.231-2.504、1.274-2.695、1.521-2.977,均P<0.05);模型预测术后继发青光眼的风险C-index为0.763(95%CI=0.652-0.820);模型预测影响患者术后继发青光眼的风险阈值>0.07。结论联合巩膜环扎、未摘出晶状体、硅油乳化、硅油填充时间>6个月均为影响玻璃体切除、玻璃体腔注药联合硅油填充术后继发青光眼的危险因素,本研究基于危险因素所构建的Nomogram预测模型可以有效预测术后青光眼的发生。

Objective To analyse the risk factors of secondary glaucoma after complex vitreoretinal surgery combined with silicone oil tamponade.Methods This was a case control study.A total of 190 eyes of 190 patients who underwent vitrectomy and intravitreal injection of drugs combined with silicone oil filling in Nanyang Eye Hospital from Aug.2019 to Oct.2022 were included.And the patients were divided into the secondary group(n=48)and the non-secondary group(n=142)based on whether secondary glaucoma was performed after surgery.The receiver operating characteristic(ROC)curve was used to analyse the predictive value;the logistic regression experiment was used to analyse the factors associated with the prognosis of the patients;and the internal data was used to verify the clinical efficacy of the Nomogram model.Results In the comparison of the general data of age and gender between the two groups,the difference was not statistically significant(all P>0.05).Compared with the non-secondary group,the patients in the secondary group had a higher percentage of combined scleral ring ligation[37.50%(18/48)vs 19.01%(27/142)],higher silicone-oil emulsification ratio[62.50%(30/48)vs 41.55%(59/142)],lower percentage of removal of the lens[41.67%(20/48)vs 61.97%(88/142)],and longer silicone oil filling time[(7.50±1.80)months vs(5.50±2.20)months](all P<0.05);the area under curve(AUC)for silicone oil filling time was 0.755,with an optimal cut-off value of 6 months(P<0.001);the combination of scleral ring ligation(yes),lens removal(no),silicone oil emulsification(yes),and silicone oil filling time(>6 months)were all risk factors affecting secondary glaucoma after vitrectomy intravitreal injection combined with silicone oil filling(OR=1.80,1.58,1.93,2.22;95%CI=1.121-2.069,1.231-2.504,1.274-2.695,1.521-2.977;all P<0.05);the model predicted a C-index of 0.763(95%CI=0.652-0.820)for the risk of secondary glaucoma after surgery;and the model predicted a risk threshold of>0.07 for secondary glaucoma affecting the patient after surgery.Conclusion Combined scleral buckling,unextracted lens,silicone oil emulsification,and silicone oil filling time>6 months are all risk factors affecting secondary glaucoma after vitrectomy intravitreal injection with silicone oil filling,and the Nomogram prediction model constructed based on the risk factors in the present study is effective in predicting the occurrence of postoperative glaucoma.