Lewis H, Verdaguer J I
Division of Ophthalmology, Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Ophthalmol. 1996 Aug;122(2):228-35. doi: 10.1016/s0002-9394(14)72014-8.
To determine whether vitreoretinal surgery to release anterior traction in eyes with chronic hypotony and attached posterior retinas increases the intraocular pressure and prevents atrophia bulbi.
In this prospective study, we operated on and followed-up postoperatively 17 eyes of 17 consecutive patients with previous vitreoretinal surgeries for retinal detachments and severe proliferative vitreoretinopathy. These eyes had developed chronic hypotony (intraocular pressure < or = 5 mm Hg for at least one month) and anterior proliferative vitreoretinopathy.
After a minimum of six months of postoperative follow-up (mean, 10.6 months), mean intraocular pressure had increased significantly after surgery from 1.7 to 7.2 mm Hg (P < .001), and ten (59%) of the 17 eyes had a final intraocular pressure greater than 5 mm Hg. Visual acuity did not change significantly after surgery (P = .25). In 13 (76%) of the 17 eyes, visual acuity improved or remained the same. Factors associated with higher postoperative intraocular pressure included hypotony of less than three months' duration (P = .007), preoperative visual acuity of 2/200 or more (P = .02), extent of anterior proliferative vitreoretinopathy of less than 90 degrees (P = .003), absence of tissue over the pars plicata (P = .001), and no anterior reproliferation after surgery (P = .04).
Early surgery to release traction over the anterior retina and uveal tissue in eyes with chronic hypotony and anterior proliferative vitreoretinopathy can increase intraocular pressure and stabilize visual acuity.
确定对慢性低眼压且视网膜后极部附着的眼进行玻璃体视网膜手术以解除前部牵引，是否能提高眼压并预防眼球萎缩。
在这项前瞻性研究中，我们对17例连续患者的17只眼进行了手术并术后随访，这些患者既往因视网膜脱离和严重增殖性玻璃体视网膜病变接受过玻璃体视网膜手术。这些眼已出现慢性低眼压（眼压≤5 mmHg至少1个月）和前部增殖性玻璃体视网膜病变。
术后至少随访6个月（平均10.6个月），术后眼压从1.7 mmHg显著升至7.2 mmHg（P <.001），17只眼中有10只（59%）最终眼压大于5 mmHg。术后视力无显著变化（P = 0.25）。17只眼中有13只（76%）视力提高或保持不变。与术后较高眼压相关的因素包括低眼压持续时间少于3个月（P = 0.007）、术前视力为2/200或更好（P = 0.02）、前部增殖性玻璃体视网膜病变范围小于90度（P = 0.003）、睫状体平坦部无组织覆盖（P = 0.001）以及术后无前部再增殖（P = 0.04）。
对慢性低眼压且伴有前部增殖性玻璃体视网膜病变的眼尽早进行手术以解除视网膜前部和葡萄膜组织的牵引，可提高眼压并稳定视力。
