增殖性糖尿病视网膜病变玻璃体切割术后早期高眼压的危险因素分析  

Analysis of risk factors for early ocular hypertension after vitrectomy for proliferative diabetic retinopathy

作　　者：刘永坚[1] 陈真[1] 李勇[1] 

机构地区：[1]广东省增城市新塘医院眼科,广东增城511340

出　　处：《泸州医学院学报》2016年第4期353-355,共3页Journal of Luzhou Medical College

基　　金：广州市医药卫生科技新技术新项目推广应用项目(20151A041009)

摘　　要：目的:探究增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切割术后早期高眼压的相关危险因素,为增殖性糖尿病视网膜病变手术治疗提供合理的临床指导。方法:回顾性分析2013年7月至2015年11月在我院进行玻璃体切割术的85例(112眼)PDR患者术后两周内的眼压情况,并且对临床引发高眼压的相关因素进行系统性的分析。结果:PDR患者在玻璃体切割术后高眼压的发生率为29.4%(33眼),不同手术方式高眼压的发生率差异有统计学意义(P<0.01)。PDR分期呈现Ⅵ期>Ⅴ期>Ⅳ期的趋势,差异具有统计学意义(P=0.021)。眼内填充平衡液时高眼压的发生率15.4%,较硅油(37.8%)和全氟丙烷C3F8(47.8%)填充明显偏低(P<0.01),术后出血组高眼压的发生率为83.3%,明显高于术后无出血组(P<0.01)。多因素Logistics回归分析表明手术方式、眼内填充物、术后出血为影响PDR患者玻璃体切割术后高眼压的独立危险因素。结论:选择23G玻璃体切割术,避免术后出血,眼内以平衡液填充可以有效降低PDR患者在玻璃体切割术后早期高眼压的发生率。Objective： To explore the potential risk factors for early ocular hypertension after vitrectomy in patients with proliferative diabetic retinopathy, so as to provide reasonable clinical guidelines for the treatment of proliferative diabetic retinopathy using operation. Methods： Eighty five patients（112 eyes） with PDR were admitted to our department from July 2013 to November 2015 were selected for a retrospective study, and their intraocular pressure（IOP） two weeks after vitrectomy and the potential IOP risk factors were analyzed. Results：The incidence rate of high IOP after vitrectomy in patients with PDR was 29.4%（33 eyes）, which were significantly different amongst different surgical methods（P〈0.01）. PDR stagings were significantly different, withⅥ期 Ⅴ期 Ⅳ期. The incidence rate of high IOP during intraocular liquid equilibrium filling was 15.4%compared to 37.8% in silicone oil, and 47.8% in C3F8（P〈0.01）. The incidence rate of high IOP in patients with postoperative hemorrhage（83.3%） was significantly higher than those without postoperative bleeding（P〈0.01）.Multivariate logistics regression analysis showed that the independent risk factors of postoperative high intraocular pressure in patients with PDR were methods of operation, intraocular filling, and postoperative hemorrhage.Conclusion： It is effective to reduce the incidence of high intraocular pressure in patients with PDR by using a balanced fluid filling in the eye, selection of 23 G vitrectomy, and avoidance of postoperative hemorrhage.

关 键 词：增殖性糖尿病视网膜病变 玻璃体切割术 高眼压 危险因素 

分 类 号：R774.1[医药卫生—眼科]