硅油填充手术后继发性青光眼的临床观察

摘要

目的 探讨硅油填充手术后继发性青光眼(SOG)的危险因素和治疗方法.方法 玻璃体切割手术同时眼内硅油填充的93例患者95只眼纳入本研究.其中,手术中保留晶状体37只眼,摘除晶状体58只眼;摘除晶状体眼中,植入人工晶状体10只眼.硅油填充时间≤6个月者32只眼,＞6个月者63只眼.手术后1、2周,1个月时复查眼底和眼压,均随访至硅油取出.随访时间2～25个月,平均随访时间(9.5±5.1)个月.手术后1个月眼压高于21 mm Hg(1 mm Hg=0.133 kPa),同时排除有明显原发因素及新生血管性青光眼等其他继发因素所引起的眼压升高者诊断为SOG.SOG确诊后,立刻给予盐酸卡替洛尔、布林佐胺滴眼液、甘露醇静脉滴注降眼压治疗,治疗1周眼压仍不能降至正常者行硅油取出手术,仍不能降至正常者行小梁切除手术.结果 21只眼发生SOG,占总眼数的22.1%.21只眼的平均硅油填充时间为(10.8±5.1)个月.其中,16只眼为无晶状体眼,占无晶状体眼的33.3%;5只眼为有晶状体眼或人工晶状体眼,占有晶状体眼或人工晶状体眼的10.6%.18只眼的硅油填充时间＞6个月,占硅油填充时间＞6个月眼的28.6%;3只眼的硅油填充时间≤6个月,占硅油填充时间≤6个月眼的9.4%.17只眼查见硅油乳化,占81.0%.行硅油取出手术后17只眼1周内眼压恢复正常,占SOG眼的81.0%.结论 无晶状体眼、硅油填充时间长是SOG发病的危险因素,硅油乳化是主要的发病原因,及时取出硅油是有效的治疗方法.%Objective To investigate the risk factors and treatment of silicone oil glaucoma (SOG).Methods Ninety-five eyes of 93 patients who underwent pars plana vitrectomy and silicone oil tamponade were evaluated in this study. The lens was removed in 58 eyes in which intraocular lens (IOL) was implanted in 10 eyes, so 48 eyes were aphakic. Silicone oil tamponade time was ≤6 months in 32 eyes,and ＞6 months in 63 eyes. The follow-up time ranged from 2 to 25 months, with a mean of (9.5±5.1)months. The fundus and intraocular pressure (IOP) were evaluated at 1 week, 2 weeks and 1 month after surgery. The diagnosis of SOG was established if the one-month postoperative IOP ＞ 21 mm Hg (1 mm Hg=0.133 kPa), and primary and neovascular glaucoma were excluded. After the diagnosis of SOG, carteolol hydrochloride and brinzolamide solution were immediately applied to the eye, and intravenous mannitol infusion was performed. If the IOP still can not be controlled after 1 week of such treatment, silicone oil removal surgery will be performed. If removal of silicone oil can not control the IOP,trabeculectomy surgery will be performed. Results SOG occurred in 21 eyes (22.1%), including 5 phakic eyes (10.6% of 47 phakic eyes) and 16 aphakic eyes (33.3% of 48 aphakic eyes) , 3 eyes (9.4% of 32 eyes)with short tamponade time (≤6 months) and 18 eyes (28.6% of 63 eyes) with long tamponade time (＞6months). The average silicone oil tamponade time was (10.8±5.1) months. Emulsification of the silicone oil occurred in 17 eyes (81.0%). After silicone oil removed, IOP was controlled in 17 eyes (81.0%) within one week. Conclusions Aphakic eye and the duration of silicone oil tamponade are the risk factors of SOG.Emulsification of silicone oil is the main cause. Silicone oil removal is an effective way to treat SOG.