*Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine †Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD ‡Department of Pathology, Massachusetts General Hospital, Boston, MA and Glaucoma Center of Excellence, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
J Glaucoma. 2014 Jan;23(1):e60-8. doi: 10.1097/IJG.0000000000000008.
To determine the risk factors for low intraocular pressure (IOP) and its detrimental consequences after trabeculectomy.
We performed a retrospective chart review of consecutive patients aged 12 years and above undergoing trabeculectomy alone by 1 of 2 surgeons between May 2000 and October 2008 at the Wilmer Institute.
Among 753 eyes of 596 patients, 112 eyes (14.9%) of 103 patients had an IOP of ≤5 mm Hg at ≥3 months postoperatively (late low IOP). Physical signs related to low IOP occurred in 61 eyes of 58 patients, and 40 eyes of 37 patients had revision surgery for low IOP. Physical signs of low IOP included 34 eyes with choroidal detachment or shallow anterior chamber, 10 with hypotony maculopathy, and 7 with both. Compared with 187 control eyes of 165 patients, risk factors for late low IOP included: surgeon 2 (P=0.0003), left eyes (P=0.03), and secondary glaucoma (P=0.05). Physical signs of low IOP were more common in phakic eyes (P=0.03), whereas need for revision surgery was associated with younger age (P=0.01). The presence of hypotony maculopathy significantly decreased the risk of choroidal detachment/shallow anterior chamber (P=0.003). Hypotony maculopathy was associated with younger age (P=0.02).
Late low IOP was more common with techniques used by 1 of 2 surgeons and in eyes with secondary glaucoma. Clinical signs of low IOP were more common in phakic eyes. Younger age was a risk factor for hypotony maculopathy. Hypotony maculopathy and choroidal detachment tend to occur in different eyes.
确定小梁切除术治疗后低眼压（IOP）及其不良后果的危险因素。
我们对 2000 年 5 月至 2008 年 10 月期间，2 位医生中的 1 位为 12 岁及以上患者行单纯小梁切除术的连续患者进行了回顾性图表审查。
在 596 例患者的 753 只眼中，103 例患者中有 112 只眼（14.9%）术后≥3 个月时 IOP≤5mmHg（迟发性低眼压）。61 只眼（58 例患者）出现低眼压的体征，40 只眼（37 例患者）因低眼压行手术修复。低眼压的体征包括 34 只眼伴有脉络膜脱离或浅前房、10 只眼伴有低眼压性黄斑病变、7 只眼伴有上述两种情况。与 165 例患者的 187 只对照眼相比，迟发性低眼压的危险因素包括：医生 2（P=0.0003）、左眼（P=0.03）和继发性青光眼（P=0.05）。在有晶状体眼中，低眼压的体征更为常见（P=0.03），而需要手术修复与年龄较小有关（P=0.01）。低眼压性黄斑病变的存在显著降低脉络膜脱离/浅前房的风险（P=0.003）。低眼压性黄斑病变与年龄较小有关（P=0.02）。
迟发性低眼压更常见于 2 位医生中的 1 位使用的技术，以及继发青光眼的眼中。有晶状体眼的低眼压体征更为常见。年龄较小是低眼压性黄斑病变的危险因素。低眼压性黄斑病变和脉络膜脱离倾向于发生在不同的眼中。
