单眼小梁消融术后对侧眼的眼压同感反应  

Ophthalmotonic consensual reaction in the fellow eye following unilateral trabectome

作　　者：杨臻 孟素坤 张纯[1,2] YANG Zhen;MENG Sukun;ZHANG Chun(Department of Ophthalmology,Peking University Third Hospital,Beijing 100191,China;Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科,北京100191 [2]眼部神经损伤的重建保护与康复北京市重点实验室,北京100191

出　　处：《山东大学耳鼻喉眼学报》2024年第5期43-51,共9页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：北京市自然科学基金昌平重点研究专题(L234016)

摘　　要：目的观察开角型青光眼患者单眼小梁消融术后对侧眼的眼压波动趋势、眼压同感反应(ophthalmotonic consensual reaction,OCR)现象并探究其影响因素。方法单中心回顾性观察性研究。纳入2016年1月至2022年9月于北京大学第三医院眼科就诊并接受单眼小梁消融术的开角型青光眼(Open-angle glaucoma,OAG)患者97例(97只眼),收集所有病例的人口学资料、双眼既往眼部疾病史及抗青光眼手术史、双眼局部所用的降眼压药种类及数目及包括双眼基线眼压和术后1 d、1周、1个月、3个月、6个月眼压在内的眼科检查资料。将对侧眼的眼压相较基线水平升高≥4 mm Hg或较基线水平相对升高≥20%定义为对侧眼发生OCR现象。采用秩和检验比较在术后各随访时间点对侧眼眼压较基线的变化,采用秩和检验、Fisher精确检验以及logistic回归探究术后1 d对侧眼发生OCR现象的影响因素,采用秩和检验和Spearman相关性分析探究术后1 d对侧眼眼压升高幅度的影响因素。结果在手术眼接受小梁消融术后,相比于基线眼压(17.3±6.5)mm Hg,对侧眼眼压仅在术后1 d升高至(18.1±7.8)mm Hg(P=0.008),但在其他术后随访时间点较基线无显著变化(P>0.05);术后1 d对侧眼OCR现象的发生率为34.0%,高于其他术后随访时间点;健康的对侧眼是单眼小梁消融术后1 d对侧眼发生OCR现象的独立危险因素;当术前手术眼基线眼压越高或术后1 d手术眼眼压下降幅度越大时,术后1 d对侧眼眼压升高幅度越大。结论单眼小梁消融术术后早期会引起对侧眼的眼压升高,在术后早期需要监测对侧眼的眼压波动。Objective To observe the intraocular pressure(IOP)fluctuations and the phenomenon of ophthalmotonic consensual reaction(OCR)in the fellow eye following trabectome in one eye and to investigate its correlative influencing factors in patients with open-angle glaucoma(OAG).Methods In this single-center retrospective observational study,the eyes of 97 individuals with OAG undergoing unilateral trabectome from January 2016 to September 2022 were evaluated.Data were collected on demographics,past ocular disease and surgical history,the kind and number of preoperative anti-glaucoma medications,ophthalmic examination data,including baseline IOP in both eyes,and the IOP of both eyes at one day,one week,one month,three months,and six months postoperatively.An IOP change(ΔIOP)≥4 mm Hg or a 20%increase from the baseline values was defined as OCR in the fellow eye.Paired rank sum test was used to compare the difference between baseline IOP values and IOP at different time points postoperatively,and the influencing factors of OCR phenomenon in the fellow eye on postoperative day 1 were investigated using rank sum test,Fisher’sexact test,and logistic regression,while the influencing factors of the magnitude ofΔIOP in the fellow eye at postoperative day 1 were investigated using rank sum test and Spearman correlation analysis.Results The baseline IOP of all fellow eyes was 17.3±6.5 mm Hg,significantly increasing to 18.1±7.8 mm Hg at postoperative day 1(P=0.008),while IOP in the fellow at other postoperative time points did not significantly change from the baseline level(P>0.05).The incidence of OCR in fellow eyes at postoperative day 1 was 34.0%,which was higher than those of other postoperative time points.Healthy fellow eye was an independent risk factor of OCR in the fellow eye following trabectome in the surgical eye at postoperative day 1.At postoperative day 1,ΔIOP in fellow eyes was positively correlated with the magnitude of IOP reduction and the baseline IOP level in surgical eyes.Conclusion A consensual IOP r

关 键 词：对侧眼 开角型青光眼 眼压同感反应 小梁消融术 眼压波动 

分 类 号：R775[医药卫生—眼科]