视网膜脱离玻璃体视网膜手术后高眼压临床分析

Intraocular pressure elevation following vitreoretinal surgery

目的 探讨视网膜脱离患者玻璃体视网膜手术后高眼压的发生率和危险因素。方法 对 13 0 4例 (13 2 5眼 )视网膜脱离行玻璃体视网膜手术后发生高眼压患者的临床资料进行回顾性分析 ,高眼压的诊断标准为非接触式眼压计眼压≥ 2 5mmHg。 结果 有 40 9眼术后发生高眼压 ,发生率3 0 86%。其中术后 2周内 3 3 3眼发生高眼压占高眼压的发生率 81 41% ,术后 2～ 4周内 60眼发生高眼压 (14 66% ) 1月后 16眼发生高眼压 (3 2 6% )。其中C3F8填充组和硅油填充组高眼压发生率分别为 3 1 3 6%和 2 8 84% ,两组比较无显著差异 (P >0 0 5 )。联合巩膜外环扎组和未环扎组高眼压发生率分别为 43 94%和 11 0 2 % ,差异有显著性 (P <0 0 1)。无晶体眼组有晶体眼组高眼压发生率分别为 5 1 0 8%及 2 9 3 5 % ,有非常显著差异 (P <0 0 1)。外伤性视网膜脱离和原发性及糖尿病性视网膜脱离高眼压发生率分别为 49 5 5 %、 2 9 18%及 2 7 77% ,三组间比较无显著差异 (P >0 0 5 )。PVRB级、C级和D级组高眼压发生率分别为 2 4 60 %、 3 3 0 1%及 43 62 % ,趋势卡方检验有显著差异(P <0 0 1)。结论 高眼压是视网膜脱离患者玻璃体视网膜手术后常见并发症 ,外伤性视网膜脱离。

Objective To investigate the incidence and risk factors of intraocular pressure(IOP)elevation in patients who have undergone vitreoretinal surgery for retinal detachment.Methods 1304 patients(1325 eyes)with retinal detachment who underwent vitreoretinal surgery were reviewed.Ocular hypertension was defined as IOP 25mmHg or more by non-touch tonometry examination.Results The IOP occurred in 409 eyes after operation(30.86%).Among them the IOP occurred mostly within 2 weeks(333 eyes,81.41%),and within 2～4 weeks(60 eyes,14.66%),and after 1 month(16 eyes,3.26%).The rate of IOP elevation with intraocular tamponade of C3F8 or silicone oil was 31.36% or 28.86%,the difference being not statistically significant( P >0.05).The rate of IOP elevation in sclera buckling was 43.94%,and 11.02% for no sclera buckling,the difference being statistically different( P <0.01).The rate of IOP elevation in aphakia was 51.08%,and 29.35% for phakia,the difference being statistically different( P <0.01).The rate of IOP elevation among the traumatic,original and diabetic retinal detachment was 49.55%,29.18% and 27.77% respectively.The rate of IOP elevation among grade B,C and D of proliferative vitreoretinopathy was 24.60%,33.01% and 43.62% respectively( P <0.01).Conclusions IOP elevation was a common complication of vitreoretinal surgery for retinal detachment.The risk factors of ocular hypertension include traumatic retinal detachment,sclera buckling and severe proliferative vitreoretinopathy.