视网膜病变手术与眼循环。
ROP surgery and ocular circulation.
作者信息
van Heuven W A J, Kiel J W
机构信息
Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
出版信息
Eye (Lond). 2008 Oct;22(10):1267-72. doi: 10.1038/eye.2008.18. Epub 2008 Mar 21.
PURPOSE
Visual results following vitreoretinal surgery for stages 4 and 5 retinopathy of prematurity are often disappointing, even when anatomic results are good. This poses the question whether the surgery or the post-operative care causes the optic atrophy. A hypothesis is proposed that ocular perfusion pressure (mean blood pressure minus intraocular pressure) during or after surgery may be too low to provide adequate ocular blood flow.
METHODS
This report analyses the published results of retinopathy of prematurity surgery, the techniques used, as well as data about blood pressure and intraocular pressure in premature infants.
RESULTS
Mean blood pressure in conscious premature infants is low and labile; it falls further under anaesthesia. Pre-operative intraocular pressure in retinopathy of prematurity patients is unknown, but intraocular pressure during vitrectomy is elevated, and likely elevated postoperatively.
CONCLUSIONS
Conditions during and after vitreoretinal surgery for retinopathy of prematurity are conducive to low ocular perfusion pressure and consequent ischaemia of the retina and optic nerve, which can contribute to poor visual results. Improved monitoring and control of ocular perfusion pressure is warranted.
目的
即使解剖学结果良好，针对4期和5期早产儿视网膜病变进行玻璃体视网膜手术后的视觉效果往往也不尽人意。这就引发了一个问题，即手术还是术后护理导致了视神经萎缩。提出了一个假设，即手术期间或术后的眼灌注压（平均血压减去眼压）可能过低，无法提供足够的眼血流量。
方法
本报告分析了已发表的早产儿视网膜病变手术结果、所采用的技术以及有关早产儿血压和眼压的数据。
结果
清醒早产儿的平均血压较低且不稳定；在麻醉状态下会进一步下降。早产儿视网膜病变患者的术前眼压未知，但玻璃体切除术中眼压升高，且术后可能也会升高。
结论
针对早产儿视网膜病变进行玻璃体视网膜手术期间及术后的情况有利于低眼灌注压以及随之而来的视网膜和视神经缺血，这可能导致视觉效果不佳。有必要改进对眼灌注压的监测和控制。
Zotero 插件