O'Connell S R, Majji A B, Humayun M S, de Juan E
The Vitreoretinal Service, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Ophthalmology. 2000 Feb;107(2):318-23. doi: 10.1016/s0161-6420(99)00047-0.
To study the effect of dissecting epiciliary proliferative tissue in eyes that are hypotonous.
Retrospective noncomparative case series.
Eight patients (nine eyes).
Normalization of intraocular pressure and preservation of vision.
A chart review was conducted to locate all surgical procedures performed primarily for hypotony. Nine procedures on eight eyes of eight patients seen in the vitreoretinal service of the Wilmer Ophthalmological Institute were identified and included in this study. Six of these eyes had undergone prior surgery for retinal detachment in association with proliferative vitreoretinopathy, one had undergone surgery for retinal detachment in the setting of a ruptured globe, and two had undergone cataract surgery and coined the diagnoses of uveitis (juvenile rheumatoid arthritis and sarcoid). Dissection and removal of the epiciliary proliferative tissue and lens capsule was undertaken by two surgeons (EdJ and MSH) using either a pars plana or limbal approach. The main outcome measures were intraocular pressure (IOP) and visual acuity after an average follow-up of 26 months (range, 9-48 months).
In the immediate postoperative period, all patients showed an increase in IOP (average increase of 6.3 mm Hg; range, 3-14 mmHg). This average increase in IOP decreased to 5.2 mmHg at 6 months and 4.2 mm Hg at 12 or more months of follow-up. The rate of the IOP decrease appeared to lessen with time, suggesting long-term stabilization. Visual acuity remained stable in all patients, although the final level of vision was low.
Surgical intervention for hypotony with greater than 1 year follow-up continues to show elevated IOP in some patients, despite the fact that the large initial increase in IOP is not sustained. No eye had phthisis develop or became painful. However, no eye had marked improvement in vision. Further study is needed to uncover the main contributing factors that result in hypotony before IOP can be maintained for prolonged periods in more hypotonous eyes and before these eyes can regain more vision.
研究在低眼压眼中解剖睫状体增生组织的效果。
回顾性非对照病例系列。
8例患者（9只眼）。
眼压恢复正常及视力保留情况。
查阅病历以找出所有主要因低眼压而进行的手术。确定并纳入了威尔默眼科研究所玻璃体视网膜科诊治的8例患者8只眼中的9次手术。其中6只眼曾因视网膜脱离合并增殖性玻璃体视网膜病变接受过手术，1只眼曾因眼球破裂合并视网膜脱离接受过手术，2只眼曾接受白内障手术并被诊断为葡萄膜炎（青少年类风湿性关节炎和结节病）。由两位外科医生（EdJ和MSH）采用睫状体平坦部或角膜缘入路进行睫状体增生组织及晶状体囊膜的解剖和切除。主要观察指标为平均随访26个月（9 - 48个月）后的眼压（IOP）和视力。
术后即刻，所有患者眼压均升高（平均升高6.3 mmHg；范围3 - 14 mmHg）。随访6个月时，眼压平均升高值降至5.2 mmHg，随访12个月及以上时降至4.2 mmHg。眼压下降速率似乎随时间减缓，提示长期稳定。所有患者视力保持稳定，尽管最终视力水平较低。
对低眼压进行手术干预且随访超过1年，部分患者眼压仍持续升高，尽管最初眼压大幅升高的情况未持续。没有眼发生眼球痨或疼痛。然而，没有眼的视力有明显改善。在更多低眼压眼中眼压能够长期维持以及这些眼能够恢复更多视力之前，需要进一步研究以找出导致低眼压的主要因素。
