Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2012 Nov;119(11):2377-85. doi: 10.1016/j.ophtha.2012.05.032. Epub 2012 Jul 13.
We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort.
Retrospective cohort study.
Patients with noninfectious uveitis seen between 1979 and 2007 at 4 academic ocular inflammation specialty clinics.
Data were collected from medical records by trained, certified, expert reviewers.
Hypotony (<5 mmHg) and low intraocular pressure (<8 mmHg), each sustained for ≥ 2 visits spanning ≥ 30 days.
During follow-up, 126 of 6785 patients (1.86%) developed hypotony at the rate of 0.61% (95% confidence interval [CI], 0.50-0.75%) per eye-year. Cataract surgery was associated with a 7.5-fold risk (adjusted hazard ratio [aHR], 7.51; 95% CI, 3.97-14.23) of incident hypotony. Phacoemulsification, the type of cataract surgery associated with the least hypotony risk still was associated with nearly 5-fold higher hypotony incidence (aHR, 4.87; 95% CI, 2.25-10.55). Increased risk was observed in children (aHR, 2.92; 95% CI, 1.20-7.10) with respect to young adults, and duration of uveitis of >5 years (aHR, 3.08; 95% CI, 1.30-7.31) with respect to uveitis of <6 month duration. Band keratopathy, ≥ 3+ vitreous cells, exudative retinal detachment, posterior synechia, and a history of pars plana vitrectomy also were associated with greater hypotony incidence. With respect to anterior uveitis, intermediate uveitis (aHR, 0.17; 95% CI, 0.05-0.56) and posterior uveitis (aHR, 0.11; 95% CI, 0.03-0.45) were associated with lower hypotony risk, whereas panuveitis (aHR, 1.25; 95% CI, 0.67-2.35) was similar. Approximately five-sixths (84.1%) of eyes presenting with hypotony had a visual acuity of ≤ 20/200 (aOR for visual acuity ≤ 20/200, 13.85; 95% CI, 7.23-26.53). Risk factors for prevalent hypotony were similar.
The risk of hypotony is low among eyes with noninfectious uveitis, but is more frequently observed in cases with anterior segment inflammation. Signs of present or past inflammation were associated with greater risk, suggesting excellent inflammatory control may reduce the risk of hypotony. Prior ocular surgery also was associated with higher risk; cataract surgery in particular was associated with much higher risk of hypotony. Lower risk of hypotony with phacoemulsification than with alternative cataract surgery approaches suggests the phacoemulsification approach is preferable.
我们旨在描述非感染性葡萄膜炎患者中出现低眼压的风险和风险因素。
回顾性队列研究。
1979 年至 2007 年间在 4 个学术眼科炎症专科诊所就诊的非感染性葡萄膜炎患者。
由经过培训、认证的专家评审员从病历中收集数据。
眼压持续<5mmHg（<8mmHg），持续≥2 次就诊，间隔≥30 天。
在随访期间，6785 例患者中有 126 例（1.86%）出现低眼压，其发生率为 0.61%（95%置信区间[CI]，0.50-0.75%）/眼年。白内障手术与新发低眼压风险增加 7.5 倍相关（校正后的危险比[aHR]，7.51；95%CI，3.97-14.23）。虽然白内障超声乳化术是与低眼压风险最低相关的白内障手术类型，但仍与近 5 倍更高的低眼压发生率相关（aHR，4.87；95%CI，2.25-10.55）。与年轻成年人相比，儿童（aHR，2.92；95%CI，1.20-7.10）发生低眼压的风险增加，与葡萄膜炎持续时间<6 个月相比，葡萄膜炎持续时间>5 年（aHR，3.08；95%CI，1.30-7.31）发生低眼压的风险增加。角膜带状变性、≥3+玻璃体细胞、渗出性视网膜脱离、后粘连以及玻璃体切除术病史也与更高的低眼压发生率相关。与前葡萄膜炎相比，中间葡萄膜炎（aHR，0.17；95%CI，0.05-0.56）和后葡萄膜炎（aHR，0.11；95%CI，0.03-0.45）的低眼压风险降低，而全葡萄膜炎（aHR，1.25；95%CI，0.67-2.35）相似。约五分之六（84.1%）出现低眼压的眼视力≤20/200（视力≤20/200 的比值比[aOR]，13.85；95%CI，7.23-26.53）。低眼压的现患风险因素与上述因素相似。
非感染性葡萄膜炎患者的低眼压风险较低，但在伴有前段炎症的病例中更常见。当前或既往炎症的迹象与更高的风险相关，表明良好的炎症控制可能降低低眼压的风险。先前的眼部手术也与更高的风险相关；白内障手术特别是与更高的低眼压风险相关。与替代白内障手术方法相比，白内障超声乳化术发生低眼压的风险较低，提示白内障超声乳化术是首选方法。
