Ando Takumi, Terashima Hiroko, Fujii Kazuma, Yoshida Hiromitsu, Ueda Eriko, Nozaki Yohei, Shiozaki Naoya, Yaoeda Kiyoshi, Fukuchi Takeo
Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Ueda Eye Clinic, Niigata, Japan.
PLoS One. 2025 Apr 28;20(4):e0321135. doi: 10.1371/journal.pone.0321135. eCollection 2025.
To identify risk factors for unexpected hypotony after transconjunctival sutureless vitrectomy (TSV).
In this retrospective observational study, we defined postoperative hypotony as intraocular pressure (IOP) < 6 mmHg on the day after TSV and performed multivariate analysis after dividing patients into hypotony and non-hypotony groups. Peripheral vitrectomy with scleral compression was performed for all patients and completed with normal IOP and no sutures.
Eight-hundred and forty eyes of 748 consecutive patients who underwent 25-G or 27-G TSV were included. Postoperative hypotony occurred in 139 eyes (16.5%) and was associated with longer axial length (AL) (odds ratio [OR], 0.86; P = 0.001) and no tamponade usage (OR, 0.50; P = 0.001). Postoperative complications occurred more frequently in the hypotony group than in the non-hypotony group (51.1% vs. 11.3%, P < 0.001), especially choroidal fold (47.5%) and hypotony maculopathy (2.2%). On dividing patients without tamponade into 3 AL-based groups, the ≥26-mm group had significantly higher hypotony incidence than the 23-26-mm group (33.3% vs. 18.4%; P = 0.024).
Longer AL and no tamponade usage influenced hypotony post-TSV. In patients with these factors, especially with AL ≥ 26 mm, surgeons may aggressively consider suturing sclerotomy to minimize hypotony-related complications.
确定经结膜无缝线玻璃体切除术（TSV）后意外低眼压的危险因素。
在这项回顾性观察研究中，我们将术后低眼压定义为TSV术后次日眼压（IOP）<6 mmHg，并将患者分为低眼压组和非低眼压组后进行多因素分析。所有患者均行巩膜加压的周边玻璃体切除术，手术结束时眼压正常且无缝线。
纳入748例连续接受25G或27G TSV的患者的840只眼。139只眼（16.5%）发生术后低眼压，与眼轴长度（AL）较长（比值比[OR]，0.86；P = 0.001）和未使用填充剂（OR，0.50；P = 0.001）有关。低眼压组术后并发症的发生率高于非低眼压组（51.1%对11.3%，P < 0.001），尤其是脉络膜皱褶（47.5%）和低眼压性黄斑病变（2.2%）。将未使用填充剂的患者按AL分为3组，≥26 mm组的低眼压发生率显著高于23 - 26 mm组（33.3%对18.4%；P = 0.024）。
较长的AL和未使用填充剂影响TSV术后低眼压。对于有这些因素的患者，尤其是AL≥26 mm的患者，手术医生可积极考虑缝合巩膜切口以尽量减少与低眼压相关的并发症。
