Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York, USA.
Retina. 2012 Jan;32(1):160-7. doi: 10.1097/IAE.0b013e318217fffb.
To estimate the incidence of and identify the risk factors for late-onset open-angle glaucoma (OAG) after uncomplicated pars plana vitrectomy (PPV).
All patients who underwent PPV at the Edward Harkness Eye Institute between January 1998 and January 2004 had at least 6 months of follow-up and did not have preexisting glaucoma or reason for secondary development of glaucoma were included. Retrospective cohort and matched case-control study designs were used.
Of 285 vitrectomized eyes that met enrollment criteria, 11.6% (n = 33) developed glaucoma after vitrectomy. In the matched case-control analysis, the only variable that had a statistically significant association with the development of OAG was cataract extraction (CE), as compared with phakic status at the last follow-up (odds ratio = 16.4; 95% confidence interval, 2.1-127.4; P = 0.007). There was no difference in OAG development between eyes that had CE before or at the time of PPV and those that had it after PPV. The overall incidence of OAG development after PPV among all eyes, phakic eyes, and nonphakic eyes was 11.6%, 1.4%, and 15.0%, respectively. The difference in incidence between phakic and nonphakic eyes was statistically significant (P = 0.001).
Lens extraction is a strong risk factor for the development of late-onset OAG after uncomplicated PPV. While the overall incidence of OAG development after PPV is substantial, it is more so among eyes that have had CE. The absence of substantial OAG incidence in phakic patients points toward a combined mechanism for late-onset post-PPV OAG involving PPV and CE at any time. Preoperative PPV counseling should include the risk of glaucoma development in addition to cataract development and the connection between the two. Patients who have undergone PPV, and especially those who also had CE in the same eye, should be carefully monitored for glaucoma.
评估单纯性平板层玻璃体切除术（PPV）后迟发性开角型青光眼（OAG）的发病情况并确定其危险因素。
所有于 1998 年 1 月至 2004 年 1 月期间在爱德华哈克尼斯眼科研究所接受 PPV 的患者，均至少随访 6 个月，且术前无青光眼或继发性青光眼的发病原因。本研究采用回顾性队列和匹配病例对照研究设计。
符合入组标准的 285 只接受玻璃体切除术的眼中，有 11.6%（n = 33）在手术后发生青光眼。在匹配病例对照分析中，唯一与 OAG 发生具有统计学显著关联的变量是白内障摘除术（CE），与最后一次随访时的晶状体状态相比（比值比 = 16.4；95%置信区间，2.1-127.4；P = 0.007）。PPV 前或同时进行的 CE 与 PPV 后进行的 CE 相比，对 OAG 发生无影响。所有接受 PPV 的眼、晶状体眼和非晶状体眼中 OAG 的总体发生率分别为 11.6%、1.4%和 15.0%。晶状体眼和非晶状体眼之间的发病率差异具有统计学显著性（P = 0.001）。
晶状体摘除是单纯性 PPV 后迟发性 OAG 发生的一个重要危险因素。尽管 PPV 后 OAG 发生率很高，但在已经进行过 CE 的眼中发生率更高。晶状体眼患者中未出现大量 OAG 发生率，这表明在任何时候，PPV 和 CE 联合作用于眼球可能是导致迟发性术后青光眼的机制之一。术前 PPV 咨询应包括除白内障形成以外的青光眼发病风险，以及两者之间的联系。已接受 PPV 治疗的患者，尤其是同一眼还进行过 CE 的患者，应密切监测青光眼的发生。
