| Objective:To analyze the possible factors which could lead to or influence the secondary intraocular pressure (IOP) elevation after vitrectomy combined with silicone oil tamponade, compare these factors in patients of both secondary elevated and normal intraocular pressure after the surgery, and discuss the high risk factors and corresponding treatment method.Methods:The follow-up results of156in-patients with silicone oil removal surgery in the First Affiliated Hospital of Kunming Medical University from January2011to January2013were collected and studied retrospectively.Results:1. There were57eyes with secondary high intraocular pressure in156patients (156eyes) of vitrectomy and silicone oil tamponade (the incidence was57/156,36.5%). According to the time of onset, the incidence were9.6%(1week),6.4%(1week-1month),4.5%(1month-3months),5.1%(3months-6months),6.4%(6months-1year), and10.9%(1year later), respectively. That is to say, itthe intraocular pressure increased significantly in one week after sugery, and then decreased steadily, and gradually rised after3months. The incidence of secondary intraocular pressure elevation rised along with the extension of silicone oil filling time significantly (P<0.05). There were8eyes with secondary high intraocular pressure twise at1week and1year after the surgery, and2eyes at3 months and1year.2. The incidence of secondary high intraocular pressure were35/104(33.65%) in male, and22/52(42.31%) in female. The difference was not statistically significant (X2=1.120, P=0.29).3. The incidence of secondary high intraocular pressure according to age were1/6(16.7%) in10to19years,12/39(30.8%) in20to39years,30/81(37.0%) in40-59years, and14/30(46.7%) over60years, respectively. The difference was not statistically significant (X2=2.706, P=0.454).4. The incidence of secondary high intraocular pressure were15/38(39.5%) with a history of diabetes, and42/118(5.6%) without diabetes. The difference was not statistically significant (X2=0.187, P=0.666).5. The incidence of secondary high intraocular pressure were6/22(27.3%) with a history of ocular trauma, and51/134(38.1%) without trauma. The difference was not statistically significant (X2=0.948, P=0.330).6. The incidence of secondary high intraocular pressure were7/32(21.9%) with a history of previous intraocular surgery, and50/124(40.3%) without surgery. The difference was not statistically significance (X2=0.246, P=0.620).7. The incidence of secondary high intraocular pressure were11/19(57.9%) with the scleral buckling or cerclage surgery, and46/137(33.6%) without the scleral surgery. The former was higher than the latter significantly (X2=4.255, P=0.039).8. The incidence of secondary high intraocular pressure were22/72(30.6%) with autologous lens,28/52(53.8%) without lens, and7/32(21.9%) with artificial lens respectively. The difference had statistical significance (X2=10.796, P=0.005).9. The incidence of secondary high intraocular pressure were31/37(83.8%) with the axial length longer than24mm, and26/119(21.8%) with normal length. The difference had statistical significance (X2=46.691, P<0.01).10. The incidence of secondary high intraocular pressure were10/15(66.7%) with emulsified silicone oil, and47/141(33.3%) without emulsified one. The difference hadstatistical significance (X2=6.497, P=0.011). 11. The incidence of secondary high intraocular pressure were7/9(77.8%) with the silicone oil into the anterior chamber, and50/147(34.0%) without into anerior chamber. The difference hadstatistical significance (X2=5.245, P=0.022).12. The longer silicone oil tamponade duration, the easier occurrence of the secondary high intraocular pressure. According to the duration, the incidence were29/110(26.4%) within6months,3/13(23.1%) from6months to1year,8/15(53.3%) from1year to1.5years, and17/18(94.4%) from1.5years to2years, respectively. The difference had statistical significance (X2=33.781, P<0.01).13. The morphological imaging of UBM:There was tiny and highly reflective echo with clear outline which sticked closely to the cornea endothelium in the anterior chamber of10eyes; the silicone oil occupied1/2of the anterior chamber in7eyes, and1/5in3eyes. There were obvious silicone oil bubbles in the anterior chamber of7eyes, visible anterior synechia in6eyes, and open iridectomy cuts in13eyes.14. The analysis results of AS-OCT:1) Compared the pre-and post-operative anterior chamber angle degrees of0°and180°in the eyes with normal autologous lens whose intraocular pressure raised after the vitrectomy combined with silicone oil tamponade, the degree of the pre-operative angle was bigger than the post-operative one, and the chamber depth was also deeper (P<0.05). The possible reason might be relative to the inflammation and the forward movement of lens-iris diaphragm after the surgery.2) Compared the anterior chamber angle degrees of0°and180°in the eyes with silicone oil into the anterior chamber and without into chamber whose intraocular pressure raised after the vitrectomy combined with silicone oil tamponade, there’s a significant difference (P<0.05). The degree of the former was bigger than the latter, and the chamber depth of the former was deeper than the latter.3) Compared the anterior chamber angle degrees of0°and180°in the eyes without lens whose intraocular pressure raised after the vitrectomy combined with silicone oil tamponade, before and after removal of silicone oil, the degree of the pre-operative angle was smaller than the post-operative one, and the chamber depth was also shallower (P<0.05).4) Compared the anterior chamber angle degrees of0°and180°and the chamber depths in the eyes without lens and with artificial lens whose intraocular pressure were normal after the vitrectomy combined with silicone oil tamponade, there’s no difference (P>0.05).15. Logistic regression analysis:axial length longer than24mm, silicone oil emulsion, silicone oil into the anterior chamber, the scleral buckling or cerclage surgery, the long duration of silicone oil tamponade, and aphakia were the high risk factors for the occurrence of secondary intraocular pressure elevation after the vitrectomy combined with silicone oil tamponade (OR values were1.851,4.565,3.886,5.482,3.385, and5.924, respectivle).16. Treatment and outcome:Given the corresponding treatment such as peripheral iridectomy, intraocular lens implantation, or the postoperative timely medication and operation in lowering intraocular pressure to the patients according to the above-mentioned high risk factors, and removed the silicone oil after the retina recovered in time, the incidence of of the secondary intraocular pressure elevation after the vitrectomy combined with silicone oil tamponade would be decreased tremendously and effectively.Conclusions:Intraocular pressure elevation after the vitrectomy combined with silicone oil tamponade is a common postoperative complications, the incidence is relative to the factors of long axial length, aphakia, long duration of silicone oil tamponade, silicone oil into the anterior chamber, silicone oil emulsiion, and combined operation of scleral buckling or cerclage, and so on. The analysis of morphological imaging showed that the secondary increased intraocular pressure had nothing to do with the anterior chamber angle, but might be relative to the pupillary block caused by forward movement of the lens-iris diaphragm or the silicone interface in aphakic eyes. The management according to the high risk factors could control the secondary high intraocular pressure. |
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