【摘要】： 目的: 探討玻璃體視網(wǎng)膜手術(shù)后早期高眼壓的發(fā)生率、發(fā)病因素、發(fā)生時(shí)間、治療方法,及治療后的效果,目的是積極預(yù)防該并發(fā)癥的產(chǎn)生,有效的控制,減少眼壓的升高對(duì)視功能恢復(fù)的影響。 方法: 隨機(jī)觀察我科由同一術(shù)者行玻璃體視網(wǎng)膜手術(shù)的患者190例(204眼),平均年齡在14～83歲,平均年齡52.6歲。術(shù)前常規(guī)眼科檢查。術(shù)中根據(jù)病情選擇眼內(nèi)填充物,平衡鹽灌注液、C3F8氣體(濃度在12㳠～18㳠)或硅油。可聯(lián)合鞏膜扣帶術(shù),或晶狀體手術(shù)。術(shù)畢指測(cè)眼壓為T(mén)n。術(shù)后給予抗炎治療。術(shù)后住院觀察5～15天,高眼壓是指測(cè)眼壓為T(mén)+1及以上,或用NCT測(cè)眼壓高于25mmHg(三次取平均值),患者主訴術(shù)眼脹痛,伴同側(cè)頭痛,裂隙燈觀察角膜水腫混濁等。 結(jié)果: 1.190例(204眼)中術(shù)后早期高眼壓的發(fā)生率為21.1㳠。2.術(shù)前不同疾病組術(shù)后發(fā)生高眼壓的發(fā)生率:PDR組為28.4㳠,原發(fā)性視網(wǎng)膜脫離組為20.5㳠,視網(wǎng)膜血管疾病中玻璃體積血組為7.7㳠,眼外傷組為14.3㳠。差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05)。3.不同年齡組術(shù)后高眼壓的發(fā)生情況:14歲～29歲組為13.3㳠,30～49歲組為22.5㳠,50～69歲組為20.4㳠;70歲以上組為26.7㳠。4.術(shù)后不同時(shí)間組發(fā)生高眼壓的43眼中,發(fā)生于術(shù)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.不同眼內(nèi)填充物組術(shù)后高眼壓的發(fā)生率:平衡鹽灌注液組5.9㳠,C3F8氣體組22.5㳠,硅油組29.3㳠。各組間P0.05,差異有統(tǒng)計(jì)學(xué)意義。6.術(shù)中聯(lián)合行晶狀體手術(shù)有23.7㳠發(fā)生術(shù)后高眼壓;術(shù)中視網(wǎng)膜脫離的患者聯(lián)合行鞏膜扣帶術(shù)有28.6㳠發(fā)生術(shù)后高眼壓。聯(lián)合手術(shù)組與未聯(lián)合組比較P0.05,差異沒(méi)有統(tǒng)計(jì)學(xué)意義。7.眼壓增高的術(shù)眼,根據(jù)眼壓和角膜水腫的情況給予藥物治療。 結(jié)論: 玻璃體視網(wǎng)膜手術(shù)后的早期高眼壓是多因素共同作用的結(jié)果。術(shù)中避免導(dǎo)致眼壓升高的原因,減少眼內(nèi)填充硅油和氣體,術(shù)后密切監(jiān)測(cè)術(shù)眼情況,早期發(fā)現(xiàn),并根據(jù)原因做積極治療,保護(hù)視功能。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R779.6

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