玻璃体视网膜手术后早期高眼压的临床观察

发布时间：2018-10-19 09:39

【摘要】： 目的: 探讨玻璃体视网膜手术后早期高眼压的发生率、发病因素、发生时间、治疗方法,及治疗后的效果,目的是积极预防该并发症的产生,有效的控制,减少眼压的升高对视功能恢复的影响。方法: 随机观察我科由同一术者行玻璃体视网膜手术的患者190例(204眼),平均年龄在14～83岁,平均年龄52.6岁。术前常规眼科检查。术中根据病情选择眼内填充物,平衡盐灌注液、C3F8气体(浓度在12㳠～18㳠)或硅油。可联合巩膜扣带术,或晶状体手术。术毕指测眼压为Tn。术后给予抗炎治疗。术后住院观察5～15天,高眼压是指测眼压为T+1及以上,或用NCT测眼压高于25mmHg(三次取平均值),患者主诉术眼胀痛,伴同侧头痛,裂隙灯观察角膜水肿混浊等。结果: 1.190例(204眼)中术后早期高眼压的发生率为21.1㳠。2.术前不同疾病组术后发生高眼压的发生率:PDR组为28.4㳠,原发性视网膜脱离组为20.5㳠,视网膜血管疾病中玻璃体积血组为7.7㳠,眼外伤组为14.3㳠。差异没有统计学意义(P0.05)。3.不同年龄组术后高眼压的发生情况:14岁～29岁组为13.3㳠,30～49岁组为22.5㳠,50～69岁组为20.4㳠;70岁以上组为26.7㳠。4.术后不同时间组发生高眼压的43眼中,发生于术后前三天的有30眼,第四天到1周的有9眼,一周以后的有4眼。5.不同眼内填充物组术后高眼压的发生率:平衡盐灌注液组5.9㳠,C3F8气体组22.5㳠,硅油组29.3㳠。各组间P0.05,差异有统计学意义。6.术中联合行晶状体手术有23.7㳠发生术后高眼压;术中视网膜脱离的患者联合行巩膜扣带术有28.6㳠发生术后高眼压。联合手术组与未联合组比较P0.05,差异没有统计学意义。7.眼压增高的术眼,根据眼压和角膜水肿的情况给予药物治疗。结论: 玻璃体视网膜手术后的早期高眼压是多因素共同作用的结果。术中避免导致眼压升高的原因,减少眼内填充硅油和气体,术后密切监测术眼情况,早期发现,并根据原因做积极治疗,保护视功能。
[Abstract]:Objective: to investigate the incidence of intraocular hypertension (IOP) in the early stage after vitreoretinal surgery (vitreoretinal surgery), the incidence of intraocular pressure (IOP), the time of occurrence, the treatment method, and the effect of the treatment, in order to prevent the complication and control it effectively. Reduce the effect of increased intraocular pressure on the recovery of visual function. Methods: 190 patients (204 eyes) who underwent vitreoretinal surgery in our department were randomly observed. The average age was 14 ~ 83 years old and the mean age was 52.6 years old. Routine ophthalmic examination before operation. Intraoperative selection of intraocular fillers according to the condition, balance of salt perfusion solution, C3F8 gas (concentration at 12?) Or silicone oil. It can be combined with scleral buckling or lens surgery. Measurement of intraocular pressure to Tn. at the end of operation Anti-inflammatory therapy was given after operation. The intraocular pressure (IOP) was measured to be T 1 or above, or the intraocular pressure (IOP) measured by NCT was higher than that of 25mmHg (3 times average). The patients complained of ocular distension and pain, accompanying headache and slit lamp to observe corneal edema and opacity. Results: in 1.190 cases (204 eyes), the incidence of early postoperative high IOP was 21. 1 and 2. 2. The incidence of high intraocular pressure was 28.4m in PDR group, 20.5g in primary retinal detachment group, 7.7m in vitreous hemorrhage group and 14.3g in ocular trauma group. The difference was not statistically significant (P0.05). The incidence of postoperative high intraocular pressure in different age groups was 13.3 / 30 / 49, 22.5 / 5069, 20.4 / 70, 26.7 / 4respectively in 14 ~ 29 years old group and 30 years old group and 49 years old group respectively. High IOP occurred in 43 eyes in different time groups, 30 eyes in the first three days, 9 eyes in the fourth day to one week, and 4 eyes after one week. The incidence of high intraocular pressure in different intraocular fillers group was 5.9C _ 3F _ 8 and 29.3C _ 3F _ 8 respectively. The difference was statistically significant (P 0.05). Combined intraoperative lens surgery was 23. 7? Postoperative high intraocular pressure and 28. 6% scleral buckling were performed in patients with retinal detachment. Postoperative high intraocular pressure occurred. There was no significant difference between the combined operation group and the uncombined group (P 0.05). Surgical eyes with elevated intraocular pressure are given medication according to intraocular pressure and corneal edema. Conclusion: early high intraocular pressure after vitreoretinal surgery is the result of multiple factors. To avoid the cause of intraocular pressure increase, reduce silicone oil and gas filling, closely monitor the postoperative eye condition, early detection, and according to the cause of active treatment to protect visual function.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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