LXII Edward Jackson lecture: Open angle glaucoma after vitrectomy
LXII Edward Jackson lecture: Open angle glaucoma after vitrectomy
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DOI：
10.1016/j.ajo.2006.02.014
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发表时间：
2006-06-01
影响因子：
4.2
通讯作者：
Chang, Stanley
中科院分区：
文献类型：
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作者：
Chang, Stanley
目得：目的：提供玻璃体切除术后晚期开角型青光眼（OAG）的数据和假设。设计：回顾性观察病例系列。方法：回顾性分析453例玻璃体切除术后OAG的记录。排除有混杂因素的眼睛。对65例接受常规玻璃体切除术的患者的68只眼进行了平均56.9个月（范围，7至192个月）的随访。对于主要结果的措施，患者被分为三组：疑似青光眼患者，青光眼发展的患者术后，和患者与预先存在的glaucoma.RESULTS：在青光眼嫌疑人，平均眼内压是显着较高的手术眼相比，对方的眼睛（P = 0.0001）。新发青光眼34眼中，23眼（67.6%）仅发生在玻璃体切除眼。在有晶状体眼中，玻璃体切除术和青光眼发生之间的时间间隔（平均45.95个月）显著长于玻璃体切除术时无晶状体眼（平均18.39个月; P = 0.0115）。有晶状体眼的白内障手术至青光眼发生的时间间隔与无晶状体眼的玻璃体切除术至青光眼诊断的时间间隔相比，差异无统计学意义。在术前患有青光眼的眼睛中，玻璃体切除术眼控制眼内压所需的抗青光眼药物的平均数量显著高于对侧眼（2.9药物+/- 1.2 vs 2.0药物+/- 1.4; P =.0215; n = 14）。结论：玻璃体切除术后OAG的风险增加。透镜的存在可以是保护性的。在手术前确定的OAG中，手术后抗青光眼药物的数量可能会增加。假设氧化应激在发病机制中起作用。
PURPOSE: To present data and an hypothesis for the late development of open angle glaucoma (OAG) after vitrectomy.DESIGN: A retrospective observational case series.METHODS: The records of 453 eyes that had undergone vitrectomy were reviewed for postoperative OAG. Eyes with confounding factors were excluded. Sixty-eight eyes of 65 patients that underwent routine vitrectomy were followed for a mean of 56.9 months (range, seven to 192 months). For the main outcome measures, patients were classified into three groups: patients with suspected glaucoma, patients in whom glaucoma developed after the operation, and patients with pre-existing glaucoma.RESULTS: In glaucoma suspects, the mean intraocular pressure was significantly higher in the operated eye compared with the fellow eye (P =.0001). In eyes with new onset glaucoma, 23 of 34 eyes (67.6%) had it in the vitrectomized eye only. In phakic eyes, the time interval between vitrectomy and the development of glaucoma (mean, 45.95 months) was significantly longer than eyes that were nonphakic at the time of vitrectomy (mean, 18.39 months; P =.0115). When the interval between cataract surgery in phakic eyes to the development of glaucoma was compared with the interval from vitrectomy to glaucoma diagnosis in the nonphakic group, the difference was not statistically significant. In eyes with glaucoma before the operation, the mean number of antiglaucoma medications that were required to control the intraocular pressure was significantly higher in the vitrectomized eye, compared with the fellow eye (2.9 medications +/- 1.2 vs 2.0 medications +/- 1.4; P =.0215; n = 14).CONCLUSION: There is an increased risk of OAG after vitrectomy. The presence of the lens may be protective. In established OAG before the operation, the number of antiglaucoma medications may increase after surd surgery. Oxidative stress is hypothesized to have a role in the pathogenesis.