Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands.
Am J Ophthalmol. 2011 Jan;151(1):156-60. doi: 10.1016/j.ajo.2010.06.042. Epub 2010 Oct 20.
To describe the incidence of hypotony after 25-gauge vitrectomy and to identify preoperative and intraoperative factors that influence the occurrence of hypotony.
Retrospective, nonrandomized, interventional case series.
We reviewed 122 consecutive cases of 25-gauge vitrectomy for all surgical indications. The primary outcome measure was intraocular pressure (IOP) at postoperative day 1, measured with Goldmann tonometry. Secondary outcome measures were clinical signs of hypotony and other complications.
Hypotony, defined as an IOP of 5 mm Hg or less, was found in 13.1% of cases on postoperative day 1. Clinical signs of hypotony were encountered in 7 eyes (5.7%). The risk of hypotony was significantly lower in cases with air or gas tamponade (3.3%) than in cases without tamponade (22.4%). Hypotony was encountered more often in reoperations (29.9%) than in primary operations (9.2%; statistically significant difference). In cases in which intravitreal triamcinolone was used, the risk of hypotony was significantly higher (35.3%) than in cases without triamcinolone (10.3%). Phakic eyes had significantly less chance of hypotony (6.7%) than pseudophakic eyes (15.6%) and eyes undergoing combined phacoemulsification and vitrectomy (25.0%). At postoperative day 7, all cases of hypotony recovered spontaneously. None of our cases developed endophthalmitis.
Our results show that a transient hypotony occurs commonly after 25-gauge vitrectomy. Hypotony was significantly influenced by tamponade, reoperation, intraoperative lens status, and use of intravitreal triamcinolone. Although all cases of hypotony recovered spontaneously without permanent damage, the high frequency of hypotony does impose potential risks. Increased vigilance with focus on perioperative antisepsis and low tolerance of sclerotomy leakage are important for the prevention of endophthalmitis. Strategies aimed at lowering the risk of hypotony are needed to improve the safety of this promising technique.
描述 25G 玻璃体切割术后低眼压的发生率，并确定影响低眼压发生的术前和术中因素。
回顾性、非随机、干预性病例系列。
我们回顾了 122 例因各种手术适应证接受 25G 玻璃体切割术的连续病例。主要观察指标是术后第 1 天用 Goldmann 眼压计测量的眼压（IOP）。次要观察指标为低眼压的临床征象和其他并发症。
术后第 1 天，13.1%的病例出现低眼压，定义为眼压 5mmHg 或更低。7 只眼（5.7%）出现低眼压的临床征象。气/硅油眼内填充（3.3%）的低眼压风险明显低于无填充（22.4%）。再手术（29.9%）比初次手术（9.2%）更常发生低眼压（差异有统计学意义）。术中使用曲安奈德的病例发生低眼压的风险明显高于未用曲安奈德的病例（35.3%比 10.3%）。有晶状体眼发生低眼压的几率（6.7%）明显低于无晶状体眼（15.6%）和联合白内障超声乳化与玻璃体切割术的眼（25.0%）。术后第 7 天，所有低眼压病例均自发恢复。我们的病例均未发生眼内炎。
我们的结果表明，25G 玻璃体切割术后常出现短暂的低眼压。眼压明显受眼内填充、再手术、术中晶状体状态和玻璃体腔曲安奈德应用的影响。尽管所有低眼压病例均自发恢复，无永久性损害，但高频率的低眼压确实存在潜在风险。增加围手术期的抗感染意识和降低对巩膜切口渗漏的容忍度对于预防眼内炎非常重要。需要采取降低低眼压风险的策略，以提高这项有前途技术的安全性。
