Matić Suzana, Suić Smiljka Popović, Biuk Dubravka, Matić Mate, Barać Josip, Vinković Maja
J. J. Strossmayer University, Osijek University Hospital Centre, Department of Ophthalmology, Osijek, Croatia.
Coll Antropol. 2013 Apr;37 Suppl 1:227-35.
The aim of this prospective study was to determine the possible influence of the silicone oil tamponade after vitrectomy on the early intraocular pressure (IOP) elevation, which is a major risk factor for developing secondary glaucoma in patients with vitreal and retinal proliferative changes. The research included 110 patients which were allocated in three groups according to the medical history data. The surgical procedures were performed at the Eye Clinic, University of Zagreb School of Medicine. The control group comprised 40 patients who underwent vitrectomy with air or saline solution tamponade. The second group consisted of 40 patients with retinal detachment and proliferative retinopathy who had vitrectomy with silicone oil tamponade and the third group were 30 patients with diabetic retinopathy who underwent vitrectomy and tamponade with silicone oil. The intraocular pressure was measured and gonioscopy was performed in all patients one month before and after vitrectomy. The results showed that there is no statistically significant difference among IOP values before and after vitrectomy in the control group (p = 0.104) as well as in the preoperative IOP values among all three groups of patients. The data analysis determined that in both groups of patients with silicone oil tamponade after vitrectomy, there is a statistically significant difference in IOP values one month after the surgical procedure (p = 0.000). The mean IOP values in those patients a month after vitrectomy were significantly higher compared to the control group (p < 0.05). Comparison of the IOP one month after vitrectomy between the patients with retinal detachment and those with diabetic retinopathy showed no statistically significant difference (p = 0.331) but the qualitative analysis showed that the IOP one month after vitrectomy was 2 mmHg higher in the diabetic retinopathy group. The results suggest that there is no difference in angle width before and after vitrectomy among different groups of patients. Emulsified silicone oil was confirmed in 18% of patients in the retinal detachment group. In 17% of patients in the diabetic retinopathy group the emulsified oil was found in the angle, whereas a 10% of patients had neovascularization of the angle one month after vitrectomy. The IOP elevation in the early postoperative course may be caused by intravitreal instillation of the silicone oil after vitrectomy. Emulsification of the silicone oil may lead to the early IOP rise; especially in the diabetic patients with angle neovascularization which itself can additionally accelerate the development of the secondary glaucoma.
这项前瞻性研究的目的是确定玻璃体切除术后硅油填塞对早期眼压升高的可能影响，而眼压升高是玻璃体和视网膜增殖性病变患者发生继发性青光眼的主要危险因素。该研究纳入了110例患者，根据病史数据将其分为三组。手术操作在萨格勒布大学医学院眼科诊所进行。对照组包括40例行玻璃体切除术并使用空气或生理盐水填塞的患者。第二组由40例视网膜脱离和增殖性视网膜病变患者组成，他们接受了玻璃体切除术并使用硅油填塞，第三组是30例糖尿病视网膜病变患者，他们接受了玻璃体切除术并使用硅油填塞。在玻璃体切除术前和术后1个月对所有患者测量眼压并进行前房角镜检查。结果显示，对照组玻璃体切除术前和术后的眼压值之间（p = 0.104）以及所有三组患者的术前眼压值之间均无统计学显著差异。数据分析确定，在玻璃体切除术后使用硅油填塞的两组患者中，手术后1个月的眼压值存在统计学显著差异（p = 0.000）。玻璃体切除术后1个月这些患者的平均眼压值与对照组相比显著更高（p < 0.05）。视网膜脱离患者和糖尿病视网膜病变患者玻璃体切除术后1个月的眼压比较显示无统计学显著差异（p = 0.331），但定性分析显示糖尿病视网膜病变组玻璃体切除术后1个月的眼压高2 mmHg。结果表明，不同组患者玻璃体切除术前和术后的房角宽度无差异。视网膜脱离组18%的患者证实有乳化硅油。糖尿病视网膜病变组17%的患者在前房角发现乳化油，而10%的患者在玻璃体切除术后1个月有房角新生血管形成。术后早期眼压升高可能是玻璃体切除术后玻璃体内注入硅油所致。硅油乳化可能导致早期眼压升高；尤其是在有房角新生血管形成的糖尿病患者中，这本身可能会加速继发性青光眼的发展。
