穿透性Schlemm管成形术后短期高眼压的发生率及时间分布特征  

The incidence and time distribution of early transient intraocular pressure elevation after penetrating canaloplasty

作　　者：古娟 叶雯青 陈仪泽 程欢欢 张绍丹 周韦禾 曹阳 周孟田 解彦茜 乐融融 徐丽娟 梁远波 Gu Juan;Ye Wenqing;Chen Yize;Cheng Huanhuan;Zhang Shaodan;Zhou Weihe;Cao Yang;Zhou Mengtian;Xie Yanqian;Le Rongrong;Xu Lijuan;Liang Yuanbo(Eye Hospital of Wenzhou Medical University,National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院,国家眼部疾病临床医学研究中心,温州325027

出　　处：《中华眼科杂志》2022年第11期882-889,共8页Chinese Journal of Ophthalmology

基　　金：国家重点研发计划(2020YFC2008200)。

摘　　要：目的探讨青光眼患者穿透性Schlemm管成形术后短期高眼压发生率及时间分布特征。方法回顾性病例系列研究。收集2015年6月至2020年3月于温州医科大学附属眼视光医院接受穿透性Schlemm管成形术的青光眼患者的临床资料。术后短期高眼压定义为术后1周至3个月眼压升高至21 mmHg(1 mmHg=0.133 kPa), 并在随后的3个月内下降至21 mmHg以内且保持稳定。观察手术前后眼压、降眼压药物用药数量、短期高眼压的发生时间和持续时间。主要采用广义估计方程进行统计学分析, 非正态分布的计量资料以M(Q1, Q3)表示。结果研究期间共277例(315只眼)患者行穿透性Schlemm管成形术, 其中299只眼(94.9%)完成术后6个月随访, 34只眼(10.8%)术后眼压持续升高, 判定为手术失败, 最终纳入234例(265只眼)患者, 其中男性161例(184只眼)、女性73例(81只眼), 年龄为42(26, 54)岁, 术前眼压为(37.7±11.1)mmHg, 使用降眼压药物3(2, 4)种。术后短期高眼压发生率为43.0%(114/265)。原发性开角型青光眼、原发性闭角型青光眼、发育性青光眼和继发性青光眼患者穿透性Schlemm管成形术后短期高眼压的发生率分别为42.7%(35/82)、37.8%(17/45)、27.7%(13/47)和53.8%(49/91)。其中91.2%(104/114)术眼术后短期高眼压时间集中发生在术后第1~4周, 88.6%(101/114)术眼眼压峰值发生在术后1~5周内, 眼压峰值为(32.4±8.2)mmHg(21.3~54.8 mmHg)。69.3%(79/114)术眼术后高眼压持续时间≤4周。结论穿透性Schlemm管成形术后短期高眼压的发生率可达40%以上, 其中继发性青光眼患者的发生率较高, 发育性青光眼患者的发生率相对较低。术后短期高眼压发生时间和峰值多出现在术后1~4周。Objective To report the incidence and time distribution of early transient intraocular pressure(IOP)elevation after penetrating canaloplasty.Methods Retrospective case series study.Data of patients treated by penetrating canaloplasty for glaucoma in the Eye Hospital of Wenzhou Medical University from June 2015 to March 2020 were collected.Early transient IOP elevation was defined as an increase of IOP to over 21 mmHg on the first week to the third month after surgery followed by a decrease to 21 mmHg or less within 3 months.Main outcome measures included IOP,quantity of medication use,the occurrence time and duration of IOP elevation.Generalized estimating equations were used for statistical analysis,and measurement data with non-normal distribution was represented as M(Q1,Q3).Results A total of 277 patients(315 eyes)achieved 360-degree catheterization of the canal successfully,and 299 eyes(94.9%)completed the postoperative 6-month follow-up.Thirty-four eyes(10.8%)had persistently high IOP,so the surgical treatment failed in them.Consequently,234 patients(265 eyes)were enrolled in the analyses,including 161 males(184 eyes)and 73 females(81 eyes).The median age was 42(26,54)years,the mean preoperative IOP was(37.7±11.1)mmHg,and the mean number of drugs used was 3(2,4).The incidence of early transient IOP elevation was 43.0%(114/265)in all enrolled eyes,42.7%(35/82)in eyes with primary open angle glaucoma,37.8%(17/45)in eyes with primary angle closure glaucoma,27.7%(13/47)in eyes with congenital glaucoma and 53.8%(49/91)in eyes with secondary glaucoma.The IOP began to increase on the first to fourth week in 91.2%(104/114)of eyes with early transient IOP elevation and reached the peak[21.3 mmHg to 54.8 mmHg;mean,(32.4±8.2)mmHg]in 88.6%(101/114)on the first to fifth week after surgery.The IOP elevation lasted for no more than 4 weeks in 69.3%(79/114)of eyes.Conclusions Over 40.0%of patients with penetrating canaloplasty may experience postoperative transient IOP elevation.The incidence is relatively high in seconda

关 键 词：青光眼 SCHLEMM管 小梁切除术 高眼压 发病率 时间 

分 类 号：R779.6[医药卫生—眼科]