23G玻璃体切除术后糖皮质激素性高眼压的临床特征和危险因素  

Clinical characteristics and risk factors of glucocorticoid-induced ocular hypertension after 23G vitrectomy

作　　者：严茜茜[1] 陈婷 江双红[1] 聂玉红 陈震[1] 艾明[1] Yan Xixi;Chen Ting;Jiang Shuanghong;Nie Yuhong;Chen Zhen;Ai Ming(Department of Eye Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院眼科中心,430060

出　　处：《临床眼科杂志》2021年第3期208-211,共4页Journal of Clinical Ophthalmology

摘　　要：目的观察23G玻璃体切除术后糖皮质激素性高眼压的临床特点并分析其危险因素。方法回顾性分析2019年1月至2019年7月期间在我院行23G玻璃体切除术的患者术后使用糖皮质激素药物及眼压变化情况,应用logistic回归分析高眼压的危险因素。激素性高眼压定义为术后眼压超过23 mmHg,且停用局部激素滴眼液及使用降眼压药物后眼压恢复正常。结果排除术前患有青光眼或高眼压症、糖尿病视网膜病变、眼外伤、术后瞳孔阻滞引起高眼压、术后前房或玻璃体腔出血的患者后,本研究共纳入156例符合要求的患者。平均年龄为(56.6±10.9)岁,男性占55.8%。手术适应证主要为孔源性视网膜脱离(66.7%),视网膜静脉阻塞合并玻璃体腔出血(10.3%),单纯玻璃体积血(5.7%)。术后激素性高眼压患者41例,发生率为26.3%。68.2%的病例出现在术后5~7 d,眼压升高的形式多为24 h以内突然上升,其中≥30 mmHg者占70.7%,≥40 mmHg者占34.1%。停用糖皮质激素滴眼液及使用降眼压药物治疗,所有高眼压患者眼压在3 d内降低到正常值。近视是术后激素性高眼压的独立危险因素,OR值为5.87(P<0.001)。结论23G玻璃体切除术后需根据眼部炎症反应尽早停用糖皮质激素滴眼液,尤其是需填充硅油的近视患者。Objective To observe the clinical characteristics of glucocorticoid-induced ocular hypertension(GIOH)after 23G vitrectomy and evaluate possible risk factors.Methods A retrospective analysis study was performed,and the use of glucocorticoids and changes of intraocular pressure(IOP)in patients who underwent 23G vitrectomy in our hospital from January 2019 to July 2019 were analyzed.Logistic regression analysis was used to evaluate possible risk factors for GIOH.In the current study,GIOH was defined as postoperative IOP≥23 mmHg and could be controlled by using glaucoma eye drops together with stopping the use of tropical glucocorticoid eye drops.Results A total of 156 patients were included after excluding patients with a history of glaucoma or ocular hypertension,diabetic retinopathy,ocular trauma,postoperative pupillary block caused by intraocular hypertension,postoperative anterior chamber hemorrhage or vitreous hemorrhage.The average age of the study participants was 56.6±10.9 years,and male accounted for 55.8%.The main surgical indications were rhegmatogenous retinal detachment(66.7%),vitreous hemorrhage caused by retinal vein occlusion(10.3%),and simple vitreous hemorrhage(5.7%).There were 41 patients(26.3%)with GIOH,with 68.2%of the patients occurring on the fifth to seventh day after the surgery.In most cases,IOP increased suddenly within 24 hours(70.7%were≥30 mmHg and 34.1%were≥40 mmHg).The IOPs of all patients with GIOH decreased to the normal range within 3 days after stopping the glucocorticoid eye drops and additionally treating with glaucoma medications.Myopia was an independent risk factor for GIOH,with an OR of 5.87(P<0.001).Conclusions Glucocorticoid eye drops should be stopped early after the 23G vitrectomy based on the ocular inflammation reaction level,especially for myopic patients who need silicone oil tamponade.

关 键 词：糖皮质激素性高眼压 玻璃体切除术 近视 硅油 

分 类 号：R779.6[医药卫生—眼科]