中华眼底病杂志

中华眼底病杂志

糖尿病视网膜病变玻璃体切割手术后高眼压的相关因素与处理

查看全文

糖尿病视网膜病变(DR)玻璃体切割手术后高眼压的发生与DR类型、分级、是否合并黄斑脱离、手术方式、填充物种类等相关。早期高眼压发生的主要原因为激光光凝、炎症反应、填充物填充过量、黏弹剂残留、睫状体功能不全;早中期高眼压发生除上述原因外,还与气体膨胀峰值、环扎手术、前房积血相关;中期高眼压发生原因主要为前房积血或硅油进入前房阻塞房角;晚期高眼压发生原因则为青光眼、硅油乳化、糖皮质激素的长期使用、虹膜切口闭锁以及切口闭合。及时对症处理、停用糖皮质激素、降眼压滴眼液和抗青光眼手术治疗后,多数患者眼压可以获得良好控制。但仍有少数患者出现不明原因的难控性高眼压,有待进一步研究探索。

The occurrence of high intraocular pressure (IOP) after vitrectomy for diabetic retinopathy (DR) is related to many factors, including the type and stage of DR, macular detachment, surgical methods, and the type of ocular tamponade. Early high IOP occurred mainly due to laser photocoagulation, inflammatory response, improper ocular tamponade, residual viscoelastic agents and ciliary body dysfunction. In addition to the above reasons, early-middle stage high IOP is also related to tamponade gas expansion peak, encircling scleral buckle and hyphema. The major reason for middle-stage high IOP is hyphema and silicon oil in anterior chamber. The reasons for late-stage high IOP are glaucoma, silicone oil emulsification, long-term use of glucocorticoid, and iris incision closure. Most high IOP can be controlled by proper treatment such as stopping use of glucocorticoid, anti-glaucoma eye drops and surgeries. But there are still a small number of patients with unexplained refractory high IOP, the mechanism need to be further explored.

关键词: 糖尿病视网膜病变/外科学; 高眼压/病因学; 玻璃体切除术; 综述

Key words: Diabetic retinopathy/surgery; Ocular hypertension/etiology; Vitrectomy; Review

引用本文: 曹曼婧, 唐罗生. 糖尿病视网膜病变玻璃体切割手术后高眼压的相关因素与处理. 中华眼底病杂志, 2017, 33(4): 420-423. doi: 10.3760/cma.j.issn.1005-1015.2017.04.026 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery[J]. Ophthalmology, 2002, 109(10): 1807-1812.
2. 刘世波, 张琦. PDR玻璃体切除术后早期影响眼压的相关因素分析 [J]. 国际眼科杂志, 2013, 13(5): 883-886. DOI: 10.3980/j.issn.1672-5123.2013.05.12.Liu SB, Zhang Q.Proliferative diabetic retinopathy after vitrectomy early factors affect IOP[J]. Int Eye Sci, 2013, 13(5): 883-886. DOI: 10.3980/j.issn.1672-5123.2013.05.12.
3. 李旭青, 蔡晓峰, 庹瑶, 等. 糖尿病视网膜病变玻璃体视网膜术后高眼压发生率及相关因素[J]. 局解手术学杂志, 2014, 23(6): 642-644. DOI: 10.11659/jjssx.1672-5042.201406027.Li XQ, Cai XF, Tuo Y, et al. Incidence rate and related factors of intraocular pressure after vitro-retinal surgery for patients with diabetic retinopathy[J]. J Reg Anat Oper Surg, 2014, 23(6): 642-644. DOI: 10.11659/jjssx.1672-5042.201406027.
4. 冯小志, 黎作为. 糖尿病视网膜病变行玻璃体视网膜术后高眼压发生的危险因素分析 [J]. 白求恩医学杂志, 2015, 13(2): 181-2.Feng XZ, Li ZW. The risk factor of ocular hypertension in diabetic retinopathy patients after vitrectomy[J]. Journal of Bethune Medical Science, 2015, 13(2): 181-182.
5. 孟丽珠, 陈松, 韩泉洪, 等. PDR患者玻璃体视网膜术后高眼压的危险因素及疗效分析 [J]. 眼科新进展, 2010, 30(6): 537-539.Meng LZ, Chen S, Han QH, et al. Analysis on risk factors and curative effects of high intraocular pressure after vitreoretinal surgery for proliferative diabetic retinopathy[J]. Rec Adv Ophthalmol, 2010, 30(6): 537-539.
6. Sharma YR, Pruthi A, Azad RV, et al. Impact of early rise of intraocular pressure on visual outcome following diabetic vitrectomy[J]. Indian J Ophthalmol, 2011, 59(1): 37-40.
7. 曾军, 唐罗生, 朱晓华, 等. 眼内硅油填充术后致高眼压原因分析[J]. 眼视光学杂志, 2006, 8(4): 231-232. DOI: 10.3760/cma.j.issn.1674-845X.2006.04.008.Zeng J, Tang LS, Zhu XH, et al. Clinical analysis of high intraocular pressure after silicone oil tamponade[J]. Chinese J of Optometry & Ophthalmology, 2006, 8(4): 231-232. DOI: 10.3760/cma.j.issn.1674-845X.2006.04.008.
8. 刘永坚, 陈真, 李勇. 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 [J]. 泸州医学院学报, 2016, 39(4): 353-355. DOI: 10.3969/j.issn.1000-2669.2016.04.015.Liu YJ, Chen Z, Li Y.Analysis of risk factors for early ocular hypertension after vitrectomy for proliferative diabetic retinopathy[J]. Journal of Luzhou Medical College, 2016, 39(4): 353-355. DOI: 10.3969/j.issn.1000-2669.2016.04.015.
9. Honavar SG, Goyal M, Majji AB, et al. Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments[J]. Ophthalmology, 1999, 106(1): 169-176.
10. 徐静娴, 于佳明, 张劲松. 增殖型糖尿病视网膜病变玻璃体切割术后视力不良的相关因素研究 [J]. 中国实用眼科杂志, 2010, 28(6): 594-597. DOI: 10.3760/cma.j.issn.1006-4443.2010.06.013Xu JX, Yu JM, Zhang JS.Predisposing factors to the poor visual acuity after vitrectomy in the treatment of proliferative diabetic retinopathy[J]. Chin J Pract Ophthalmol, 2010, 28(6): 594-597. DOI: 10.3760/cma.j.issn.1006-4443.2010.06.013
11. Muether PS, Hoerster R, Kirchhof B, et al. Course of intraocular pressure after vitreoretianl surgery is early postoperative intraocular pressure elevation predictable?[J]. Retina, 2011, 31(8): 1545-1551. DOI: 10.1097/IAE. 0b013e31820f4b05.
12. Hasegawa Y, Okamoto F, Sugiura Y, er al. Intraocular pressure elevation after vitrectomy for various vitreoretinal disorders[J]. Eur J Ophthalmol, 2014 24(2): 235-241. DOI: 10.5301/ejo.5000350.
13. 张良, 赵云云, 黄中宁, 等. PDR玻璃体切割术后顽固性高眼压的原因及处理[J]. 国际眼科杂志, 2011, 11(10): 1780-1782. DOI: 10.3969/j.issn.1672-5123.2011.10.032.Zhang L, Zhao YY, Hunag ZN, et al. Reasons and management of intractable high intraocular pressure after vitrectomy of proliferative diabetic retinopathy[J]. Int Eye Sci, 2011, 11(10): 1780-1782. DOI: 10.3969/j.issn.1672-5123.2011.10.032.
14. Framme C, Klotz S, Wolf-Schnurrbusch UE, et al. Intraocular pressure changes following 20G pars-plana vitrectomy[J]. Acta Ophthalmol, 2012, 90(8): 744-749. DOI: 10.1111/j.1755-3768.2011.02251.x.
15. 李晖, 宋蓓文, 杜新华, 等.增殖性糖尿病性视网膜病变玻璃体切割术后高眼压分析[J]. 上海交通大学学报, 2008, 28(6): 694-697.Li H, Song BW, Du XH, et al. Analysis of secondary high intraocular pressure after vitreoretinal surgery for proliferative diabetic retinopathy[J]. Journal of Shanghai Jiaotong University(Medical Science), 2008, 28(6): 694-697.
16. Wakabayashi Y, Usui Y, Okunuki Y, et al. Intraocular VEGF level as a risk factor for postoperative complications after vitrectomy for proliferative diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2012, 53(10): 6403-6410.
17. Park SP, Ahn JK, Lee GH.Morphologic changes in the anterior segment after phacovitrectomy for proliferative diabetic retinopathy[J]. J Cataract Refract Surg, 2009, 35(5): 868-873. DOI: 10.1016/j.jcrs.2008.12.032.
18. Henderer JD, Budenz DL, Flynn HW Jr, et al. Elevated intraocular pressure and hypotony following silicone oil retinal tamponade for complex retinal detachment: incidence and risk factors[J]. Arch Ophthalmol, 1999, 117(2): 189-195.
19. Perez RN, Phelps CD, Burton TC.Angel-closure glaucoma following scleral buckling operations[J]. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol, 1976, 81(2): 247-252.
20. Han DP, Lewis H, Lambrou FH Jr, et al. Mechanisms of intraocular pressure elevation after pars plana vitrectomy[J]. Ophthalmology, 1989, 96(9): 1357-1362.
21. Murphy CC, Burnett CA, Spry PG, et al. A two centre study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma[J]. Br J Ophthalmol, 2003, 87(10): 1252-1257.
22. Parke DW 3rd, Sisk RA, Houston SK, et al. Ocular hypertension after intravitreal triamcinolone with vitrectomy and phacoemulsification[J]. Clin Ophthalmol, 2012, 6: 925-931. DOI: 10.2147/OPTH.S32934.
23. Wang L, Liu J, Lu T.Clinical analysis of early and mid-late elevated intraocular pressure after silicone oil injection[J]. Eye Sci, 2014, 29(2): 85-89.
24. 高立新, 张薇.增殖性糖尿病视网膜病变的玻璃体手术治疗[J]. 中国实用眼科杂志, 2005, 23(1): 55-58. DOI: 10.3760/cma.j.issn.1006-4443.2005.01.015.Gao LX, Zhang W.Vitrectomy for proliferative diabetic retinopathy[J]. Chin J Pract Ophthalmol, 2005, 23(1): 55-58. DOI: 10.3760/cma.j.issn.1006-4443.2005.01.015.
25. Singh CN, Iezzi R, Mahmoud TH. Intraocular pressure instability after 23-gauge vitrectomy[J]. Retina, 2010, 30(4): 629-634. DOI: 10.1097/IAE.0b013e3181c106de.
26. Kawana K, Okamoto F, Hiraoka T, et al. Ciliary body edema after scleral buckling surgery for rhegmatogenous retinal detachment[J]. Ophthalmology, 2006, 113(1): 36-41.
27. Ruby AJ, Grand MG, Williams D, et al. Intraoperative acetazolamide in the prevention of intraocular pressure rise after pars plana vitrectomy with fluid-gas exchange[J]. Retina, 1999, 19(3): 185-187.
28. Summanen P.Neovascular glaucoma following vitrectomy for diabetic eye disease [J]. Acta Ophthalmol (Copenh), 1988, 66(1): 110-116.
29. Goto A, Inatani M, Inoue T, et al. Frequency and risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy[J]. J Glaucoma, 2013, 22(7): 572-576. DOI: 10.1097/IJG.0b013e31824d514a.
30. Schwarzer H, Mazinani B, Plange N, et al. Clinical observations and occurrence of complications following heavy silicone oil surgery[J/OL]. Biomed Res Int, 2014, 2014: 706809[2014-04-14]. http://dx.doi.org/10.1155/2014/706809. DOI: 10.1155/2014/706809.
31. Taban M, Ventura AA, Sharma S, et al. Dynamic evaluation of sutureless vitrectomy wounds: an optical coherence tomography and histopathology study[J]. Ophthalmology, 2008, 115(12): 2221-2228. DOI: 10.1016/j.ophtha.2008.08.027.
32. Wang J, Chen S, Jiang F, et al. Vitreous and plasma VEGF levels as predictive factors in the progression of proliferative diabetic retinopathy after vitrectomy [J/OL]. PLoS One, 2014, 9(10): 110531[2014-10-16]. https://doi.org/10.1371/journal.pone.0110531. DOI: 10.1371/journal.pone.0110531.
33. Itakura H, Kishi S, Kotajima N, et al. Persistent secretion of vascular endothelial growth factor into the vitreous cavity in proliferative diabetic retinopathy after vitrectomy[J]. Ophthalmology, 2004, 111(10): 1880-1884.
34. Smith JM, Steel DH.Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy[J/CD]. Cochrane Database Syst Rev, 2011(5): CD008214. DOI: 10.1002/14651858.CD008214.pub2.
35. 王祥硅, 李永平, 李石毅, 等. Avastin在增生型糖尿病视网膜病变手术中的应用及作用机制 [J]. 中华实验眼科杂志, 2011, 29(1): 53-57. DOI: 10.3760/cma.j.issn.2095-0160.2011.01.014.Wang XG, Li YP, Li SY, et al. Application of avastin in vitrectomy for proliferative diabetic retinopathy and its mechanism[J]. Chin J Exp Ophthalmol, 2011, 29(1): 53-57. DOI: 10.3760/cma.j.issn.2095-0160.2011.01.014.
36. Pakzad-Vaezi K, Albiani DA, Kirker AW, et al. A randomized study comparing the efficacy of bevacizumab and ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 521-524. DOI: 10.3928/23258160-20141118-06.
37. Lee GH, Ahn JK, Park YG.Intravitreal triamcinolone reduces the morphologic changes of ciliary body after pars plana vitrectomy for retinal vascular diseases[J]. Am J Ophthalmol, 2008, 145(6): 1037-1044. DOI: 10.1016/j.ajo.2008.01.029.
38. Blodi CF.Microsurgery of retinal detachment [J]. Am J Ophthalmol, 1990, 109(5): 617-620.
39. Ahn SJ, Woo SJ, Ahn J, et al. Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy[J]. Eye (Lond), 2012, 26(6): 796-802. DOI: 10.1038/eye.2012.23.
40. Guthrie G, Magill H, Steel DH.23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes[J]. Ophthalmologica, 2015, 233(2): 104-111. DOI: 10.1159/000369258.
41. Farouk MM, Naito T, Sayed KM, Outcomes of 25-gauge vitrectomy for proliferative diabetic retinopathy[J]. Graefes Arch Clin Exp Ophthalmol, 2011, 249(3): 369-376. DOI: 10.1007/s00417-010-1506-7.