急性闭角型青光眼治疗中减压性视网膜病变分类及防治

Classification prevention and treatment of ocular decompression retinopathy in the treatment of acute angle closure glaucoma

目的探讨急性闭角型青光眼(AACG)治疗过程中减压性视网膜病变(ODR)的发病特点及预防措施。方法回顾性病例研究。分析2019年11月至2021年11月山西爱尔眼科医院收治的AACG患者发生ODR的特点,比较分析不同治疗方案对ODR发生的影响,采用超广角激光扫描检眼镜(UWFSLO)和常规眼底照相观察和收集AACG治疗中发生ODR的形态特点。结果42例(48只眼)AACG治疗中发现15只眼ODR,占31.25%;ODR可分为视网膜静脉阻塞样型、微血管瘤样型、视盘血管炎样型和混合型4种形态。视盘血管炎型与混合型比较ODR发生率有显著性差异(χ2=4.26,P<0.05)。术前未输注甘露醇组8/23只眼发生ODR(34.78%),输注甘露醇组5/13只眼发生ODR(38.46%),输注甘露醇+地塞米松注射液组2/12只眼发生ODR(16.67%),三组ODR发生率比较有显著性差异(χ2=22.56,P<0.05)。结论AACG高眼压下行小梁切除术易发生ODR,UWFSLO有助于提高ODR检出率;ODR可分为视网膜静脉阻塞样型、微血管瘤样型、视盘血管炎样型和混合型4型;术前静脉输注甘露醇注射液+地塞米松注射液可减少ODR发生。

Objective To investigate the characteristics and preventive measures of ocular decompression retinopathy(ODR)during the treatment of acute angle closure glaucoma(AACG).Methods Retrospective case series study.The characteristics of ODR in AACG patients admitted to Shanxi Aier Eye Hospital from November 2019 to November 2021 were retrospectively analyzed,and the effects of different treatment schemes on ODR were compared.The morphological characteristics of ODR in AACG treatment were observed and collected by using ultra wide field scanning laser ophthalmoscope(UWF-SLO)and conventional fundus photography.Results ODR was found in 15 eyes(31.25%)of 42 patients(48 eyes)treated with AACG;ODR can be divided into four types:retinal vein occlusion type,microangioma type,optic disc vasculitis type and mixed type.There was a significant difference in the incidence of ODR between optic disc vasculitis type and mixed type(χ2=4.26,P<0.05).ODR occurred in 8/23 eyes of the group without mannitol infusion before surgery(34.78%),5/13 eyes of the group with mannitol infusion(38.46%),and 2/12 eyes of the group with mannitol and dexamethasone injection(16.67%).The incidence of ODR in the three groups was significantly different(χ2=22.56,P<0.05).Conclusions Trabeculectomy under high intraocular pressure of AACG is prone to ODR,and UWF-SLO is helpful to improve the detection rate of ODR;ODR can be divided into four types:retinal vein occlusion type,microangioma type,optic disc vasculitis type and mixed type;Preoperative intravenous infusion of mannitol injection and dexamethasone injection can reduce the occurrence of ODR.