Long-Term Changes in Intraocular Pressure after Vitrectomy for Rhegmatogenous Retinal Detachment, Epi-Retinal Membrane, or Macular Hole.
Long-Term Changes in Intraocular Pressure after Vitrectomy for Rhegmatogenous Retinal Detachment, Epi-Retinal Membrane, or Macular Hole.
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DOI：
10.1371/journal.pone.0167303
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Terasaki H
中科院分区：
文献类型：
--
作者：
Yamamoto K;Iwase T;Terasaki H
目的观察玻璃体手术治疗孔源性视网膜脱离(RRD)、视网膜前膜(ERM)、黄斑裂孔(MH)后远期眼压的变化，探讨视网膜病变与迟发性高眼压的关系。这是一项回顾、观察、比较的研究。我们回顾了54名RRD患者54只眼、117名ERM患者117只眼和75名MH患者75只眼接受20、23或25口径玻璃体切割手术的病历。分别于术前、术后1、3、6、12个月及末次随访时(平均23.95个月)测量眼压。我们将眼压显著升高定义为≥较术前眼压升高4毫米汞柱，在卡普兰-迈耶生存分析中，这种升高被视为“死亡”事件。两组患者的平均随访期没有显著差异。RRD组玻璃体切割术后3个月(P=0.001)、12个月(P=0.011)和末次随访时(P=0.002)的平均眼压均明显高于玻璃体切割前。玻璃体切割术后1个月(P=0.005)、3个月(P=0.009)、12个月(P=0.013)及末次随访时，RRD组的平均眼压均显著高于ERM组(P=0.032)。Kaplan-Meier生存分析显示，RRD组玻璃体切除术后眼压升高的风险显著高于其他组(P<；0.001经对数等级检验)。多因素Logistic回归分析显示，在排除了术前低眼压眼压后，RRD的诊断是唯一与术后眼压升高显著相关的危险因素(优势比，3.208；P=0.003)。玻璃体手术后迟发性眼压升高仅在接受RRD手术的眼睛中观察到。RRD的升高可能与RRD的特殊性质和手术方式有关。临床医生应高度重视玻璃体手术后眼压的长期升高，特别是对RRD眼。
To determine the long-term changes in the intraocular pressure (IOP) following vitrectomy for rhegmatogenous retinal detachment (RRD), epiretinal membrane (ERM), and macular hole (MH), and to investigate the relationship between the retinal disease and the incidence of late-onset IOP elevation. This was a retrospective, observational, comparative study. We reviewed the medical records of 54 eyes of 54 RRD patients, 117 eyes of 117 ERM patients, and 75 eyes of 75 MH patients who underwent 20-, 23- or 25-gauge vitrectomy. The IOPs before surgery and 1, 3, 6, and 12 months following vitrectomy, and also at the final visit (average, 23.95 months) were evaluated. We defined a significant increase in the IOP as an increase of ≥4 mmHg from the preoperative IOP, and this increase was taken to be a ‘death’ event for the Kaplan-Meier survival analyses. The mean follow-up period was not significantly different among the groups. The mean IOP at 3 (P = 0.001) and 12 (P = 0.011) months following the vitrectomy and at the final visit (P = 0.002) were significantly higher than that before the vitrectomy in the RRD group. The mean IOP in the RRD group was significant higher than that in the ERM group at 1 (P = 0.005), 3 (P = 0.009), and 12 (P = 0.013) months following vitrectomy, and at the final visit (P = 0.032). Kaplan-Meier survival analyses showed that the RRD group had a significantly higher risk of an IOP increase following vitrectomy than the other groups (P<0.001 by log-rank test). Multivariate logistic regression analyses showed that a preoperative diagnosis of RRD was the only risk factor that was significantly associated with a postoperative IOP elevation after excluding eyes with a low preoperative IOP (odds ratio, 3.208; P = 0.003). A late-onset IOP elevation following vitrectomy was observed only in eyes that underwent RRD surgery. The elevation was probably caused by the specific characteristics and surgical procedures of RRD. Clinicians should pay more attention to the IOP elevation for long times after vitrectomy especially in eyes with RRD.
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