摘要
目的:探讨硅油填充术后继发性青光眼(silicone oil glaucoma,SOG)的相关危险因素及处理方法。方法:回顾性分析本院眼科行玻璃体切除联合眼内硅油填充的患者114例118眼。术中保留晶状体78眼,摘除晶状体40眼;摘除晶状体眼中,植入人工晶状体27眼。硅油填充时间≤6mo者39眼,>6mo者79眼。随访时间16.2±4.9mo。术前排除原发性和继发性青光眼。硅油填充术后1mo后如果连续3次测量眼压高于21mmHg(1mmHg=0.133kPa),同时排除炎症和新生血管性青光眼引起的眼压升高者诊断为SOG。确诊后给予降眼压药物治疗,治疗约2wk眼压仍不能降至正常者行硅油取出术,如果眼压仍不能降至正常者行抗青光眼手术。统计分析采用SPSS 16.0软件中的单因素Logistic回归分析。结果:发生SOG的32眼,摘除晶状体16眼(50%),硅油填充时间>6mo 27眼(84.4%),硅油乳化20眼(62.5%)。17眼抗青光眼药物治疗后2wk内眼压恢复正常,15眼行硅油取出术,术后4眼眼压仍高,1眼行抗青光眼药物治疗,2眼行小梁切除术,1眼行睫状体光凝术。有无摘除晶状体(P=0.024),硅油填充时间是否超过6mo(P=0.014),有无发生硅油乳化(P=0.000)对是否出现继发性青光眼的影响差异有统计学意义。结论:联合晶状体摘除、硅油填充时间超过6mo和硅油乳化是SOG的危险因素,首选抗青光眼药物保守治疗,如果无效需及时取出硅油。
AIM：To evaluate the related risk factors and treatment method of secondary glaucoma after pars plana vitrectomy and silicone oil tamponade.
METHODS： The retrospective study analyzed 114 patients （ 118 eyes ） who were treated with pars plana vitrectomy combined with silicone oil tamponade.Lenses were reserved in 78 eyes and were taken away in 40 eyes among which intraocular lens were implanted in 17 eyes. There were 39 eyes in which the filling time of silicone was no more than 6 months while 79 eyes in which the filling time was more than 6 months.The follow-up time was （ 16.2 ±4.9 ） months. Primary and secondary glaucoma were excluded before the vitrectomy.Silicone oil glaucoma （ SOG ） was diagnosed when intraocular pressure （ IOP ） was measured higher than 21mmHg （1mmHg=0.133kPa） three times in succession at least 1 month after silicone oil tamponade and inflammation and neovascular glaucoma should be excluded. Anti -glaucoma drugs were administrated once SOG was diagnosed.If the IOP was not controlled after 2 weeks, the silicone oil was taken away.If the IOP was still high, the anti-glaucoma surgery was operated.The data was analyzed by the SPSS 16.0 software using a binary logistic regression analysis.
RESULTS： Among the 32 eyes of SOG, lenses were removed in 16 eyes （50%）.The filling time of silicone oil was more than 6 months in 27 eyes （84.4%） and silicone oil emulsion happened in 20 eyes （62.5%）.IOP returned normal in 17 eyes after administrating anti-glaucoma medication within 2 weeks.Silicone oils were taken away in 15 eyes. However, 4 eyes still had high IOP after surgery; one of them was given anti-glaucoma drugs once more; two of them underwent trabeculectomy and one of them underwent cyclophotocoagulation.The lens conditions （whether it was taken away or not, P=0.024）, the silicone oil filling time （ whether the time was more than 6 months, P=0.014）, and the status of the silicone oil （ whether emulsification occurred or not, P=0.000 ） were all found to be significantly related to the incidence of the secondary glaucoma.
CONCLUSION：Removal of lens, more than 6 months of silicone oil filling time and silicone oil emulsion are the risk factors of SOG and anti-glaucoma drugs are the first choice for conservative treatment. If IOP can＇t be controlled, the silicone oil should be removed in time.
出处
《国际眼科杂志》
CAS
2013年第12期2507-2509,共3页
International Eye Science
