Risk factors of postoperatve hormone-induced intraocular hypertension in 792 patients with cataract surgery
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摘要:目的 探讨白内障手术患者术后激素性高眼压的危险因素。方法 回顾性分析792例(792眼)行白内障超声乳化联合人工晶状体植入术治疗患者的临床资料, 根据其术后激素性高眼压发生情况分为激素性高眼压组与非激素性高眼压组。比较2组性别、年龄、白内障晶体核分级、高度近视、高血压、糖尿病、术前合并青光眼、术前合并色素膜炎、术前合并眼外伤、术中并发症等情况差异，并采用多因素Logistic回归分析评估白内障超声乳化联合人工晶状体植入术后激素性高眼压的危险因素。结果 792例患者出现激素性高眼压者29例(3.66%), 纳入激素性高眼压组; 未出现激素性高眼压者763例(96.34%), 纳入非激素性高眼压组。2组性别、白内障晶体核分级、高血压、术前合并青光眼情况比较，差异无统计学意义(P>0.05); 激素性高眼压组患者年龄显著小于非激素性高眼压组(P < 0.01), 高度近视、糖尿病、术前合并色素膜炎、术前合并眼外伤及术中并发症的发生率均显著高于非激素性高眼压组(P < 0.05或P < 0.01)。经Logistic回归分析，发现高龄是影响白内障超声乳化联合人工晶状体植入术后激素性高眼压的独立保护因素(OR=0.660, P < 0.05), 而高度近视、糖尿病、术前合并色素膜炎、术前合并眼外伤及术中并发症是其独立危险因素(OR=1.893、1.669、2.487、2.069、2.568, P < 0.05或P < 0.01)。结论 年龄较小及合并高度近视、糖尿病、色素膜炎、眼外伤、术中并发症的白内障手术患者易发生术后激素性高眼压，临床应予以针对性防控措施，以改善白内障患者的预后。Abstract:Objective To analyze the risk factors of postoperative hormone-induced intraocular hypertension in patients with cataract surgery.Methods A retrospective analysis was performed on clinical data of 792 cases (792 eyes) who underwent phacoemulsification combined with intraocular lens implantation in our hospital. According to the occurrence of postoperative hormone-induced intraocular hypertension, they were divided into hormone-induced intraocular hypertension group and non-hormone-induced intraocular hypertension group. The gender, age, cataract crystal nucleus classification, high myopia, hypertension, diabetes mellitus, preoperative complicating with glaucoma, preoperative complicating with uveitis, preoperative ocular trauma and intraoperative complications were compared between the two groups. Multivariate Logistic regression analysis was used to evaluate the risk factors for steroid-induced intraocular hypertension after phacoemulsification and intraocular lens implantation.Results Out of 792 patients, 29 cases (3.66%) with hormone-induced intraocular hypertension were included in hormone-induced intraocular hypertension group, and 763 cases (96.34%) without hormone-induced intraocular hypertension were included in non-hormone-induced intraocular hypertension group. There were no significant differences in the gender, cataract crystal nucleus classification, hypertension, preoperative complicating with glaucoma between the two groups (P>0.05). The age in hormone-induced intraocular hypertension group was lower than that in non-hormone-induced intraocular hypertension group (P < 0.05), and the incidence of high myopia, diabetes mellitus, preoperative complicating with uveitis, preoperative complicating with ocular trauma and intraoperative complications in hormone-induced intraocular hypertension group were higher than those in non-hormone-induced intraocular hypertension group (P < 0.05 or P < 0.01). Logistic regression analysis showed that elder age was an independent protective factor affecting hormone-induced intraocular hypertension group after phacoemulsification combined with intraocular lens implantation (OR=0.660, P < 0.05), and high myopia, diabetes mellitus, preoperative complicating with uveitis, preoperative complicating with ocular trauma and intraoperative complications were independent risk factors (OR=1.893, 1.669, 2.487, 2.069, 2.568, P < 0.05 or P < 0.01).Conclusion The young patients with cataract surgery and those with high myopia, diabetes mellitus, uveitis, ocular trauma and intraoperative complications are prone to occurring postoperative hormone-induced intraocular hypertension. Clinically, targeted prevention and control measures should be taken to improve the prognosis of cataract patients.
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表 1 白内障超声乳化联合人工晶状体植入术后激素性高眼压的单因素分析(x±s)[n(%)]
因素 激素性高眼压组(n=29) 非激素性高眼压组(n=763) χ2或t P 性别 男 15(51.72) 371(48.62) 0.108 0.743 女 14(48.28) 392(51.38) 年龄/岁 57.21±11.41 65.49±9.34 4.645 <0.001 白内障晶体核分级 Ⅰ级 3(10.35) 84(11.01) 0.705 0.872 Ⅱ级 9(31.03) 277(36.30) Ⅲ级 10(34.48) 261(34.21) Ⅳ级 7(24.14) 141(18.48) 高度近视 有 5(17.24) 39(5.11) 5.693 0.017 无 24(82.76) 724(94.89) 高血压 有 4(13.79) 79(10.35) 0.081 0.776 无 25(86.21) 684(89.65) 糖尿病 有 4(13.79) 32(4.19) 3.927 0.048 无 25(86.21) 731(95.81) 术前合并青光眼 有 0 35(4.59) - 0.421 无 29(100.00) 728(95.41) 术前合并色素膜炎 有 4(13.79) 7(0.92) 25.070 <0.001 无 25(86.21) 756(99.08) 术前合并眼外伤 有 3(10.35) 6(0.79) 15.009 <0.001 无 26(89.65) 757(99.21) 术中并发症 有 7(24.14) 24(3.15) 27.392 <0.001 无 22(75.86) 739(96.85) 术前合并青光眼情况的比较，采用Fisher精确检验。 
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表 2 白内障超声乳化联合人工晶状体植入术后激素性高眼压的多因素分析
因素 β SE Waldχ2 P OR 95%CI 高龄 -0.415 0.197 4.438 0.035 0.660 0.019~1.214 高度近视 0.638 0.256 6.211 0.013 1.893 0.832~4.024 糖尿病 0.512 0.231 4.913 0.027 1.669 0.661~3.711 术前合并色素膜炎 0.911 0.314 8.417 0.004 2.487 1.257~4.920 术前合并眼外伤 0.727 0.265 7.526 0.006 2.069 0.981~4.364 术中并发症 0.943 0.298 10.014 0.002 2.568 1.373~4.801
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[1] 李庆和, 李岳美, 宋学英, 等. 1 g/L溴芬酸钠水合物滴眼液联合糖皮质激素在高度近视LASEK术后的应用[J]. 国际眼科杂志, 2017, 17(6): 1133-1136. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201706033.htm [2] 张娜娜, 燕振国. 高度近视SMILE术后眼压变化及其相关因素分析[J]. 国际眼科杂志, 2017, 17(9): 1646-1649. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201709012.htm [3] 雷琦峰, 蔡维. LASEK术后激素性高眼压的影响因素及临床治疗[J]. 国际眼科杂志, 2017, 17(2): 379-381. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201702053.htm [4] 吴作红, 张莹. 白内障超声乳化联合房角分离术治疗原发性闭角型青光眼术后高眼压分析[J]. 中国实用眼科杂志, 2017, 35(1): 77-80. doi: 10.3760/cma.j.issn.1006-4443.2017.01.021 [5] 中华医学会眼科学分会白内障与人工晶状体学组. 第12届全国白内障与人工晶状体学术会议纪要[J]. 中华眼科杂志, 2010, 46(8): 767-768. doi: 10.3760/cma.j.issn.0412-4081.2010.08.024 [6] 李俊宁, 何侦. 白内障超声乳化IOL植入术后早期高眼压的临床分析[J]. 国际眼科杂志, 2017, 17(1): 128-130. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201701037.htm [7] 包菁, 吕志刚, 黄文丽. 青光眼滤过术后白内障超声乳化术中突发高眼压的临床观察[J]. 中国眼耳鼻喉科杂志, 2018, 18(3): 211-213. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH201803027.htm [8] 孙雯琦. 两种手术方式治疗白内障继发青光眼持续高眼压状态[J]. 西南国防医药, 2017, 27(8): 873-875. doi: 10.3969/j.issn.1004-0188.2017.08.034 [9] 李杰, 刘三梅, 李芳, 等. 微创玻璃体切割术联合与不联合白内障手术对术后早期眼压波动的影响[J]. 眼科新进展, 2018, 38(8): 732-735, 741. https://www.cnki.com.cn/Article/CJFDTOTAL-XKJZ201808009.htm [10] 纪康康, 张学勇, 廖荣丰. 不同测量工具下FS-LASIK手术前后眼压测量值一致性及测量变化值影响因素分析[J]. 安徽医学, 2018, 39(9): 1039-1043. doi: 10.3969/j.issn.1000-0399.2018.09.003 [11] 王朋, 杜非凡, 韩冰, 等. 原发性闭角型青光眼术后并发恶性青光眼的多因素分析[J]. 军事医学, 2017, 41(3): 227-229. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYX201703015.htm [12] 高天. 高度近视合并年龄相关性白内障超声乳化手术并发症处理及预防[J]. 国际眼科杂志, 2017, 17(1): 118-120. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201701033.htm [13] 王萍, 陈松, 何广辉, 等. 不同联合手术方式治疗增生性糖尿病视网膜病变的有效性及并发症[J]. 国际眼科杂志, 2017, 17(5): 970-973. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201705047.htm [14] van Koeverden A K, He Z, Nguyen C T O, et al. Systemic hypertension is not protective against chronic intraocular pressure elevation in a rodent model[J]. Sci Rep, 2018, 8(1): 7107-7112. doi: 10.1038/s41598-018-25264-4
[15] Luo X Y, Tan N Y Q, Chee M L, et al. Direct and indirect associations between diabetes and intraocular pressure: the Singapore epidemiology of eye diseases study[J]. Invest Ophthalmol Vis Sci, 2018, 59(5): 2205-2211. doi: 10.1167/iovs.17-23013
[16] 李杰, 刘三梅, 李芳, 等. 微创玻璃体切除术后早期高眼压发生的相关因素分析[J]. 实用医院临床杂志, 2018, 15(5): 13-17. doi: 10.3969/j.issn.1672-6170.2018.05.004 [17] Inborr P K, Harju M, Kivelä T T. Intravenous hypertonic saline to lower intraocular pressure in ocular hypertension and primary open-angle and exfoliation glaucoma[J]. J Glaucoma, 2018, 27(7): 638-642. doi: 10.1097/IJG.0000000000000979
[18] 王亚丽, 吴青松, 李家璋, 等. Ahmed青光眼阀植入术与小梁切除术治疗眼外伤继发性青光眼的疗效观察[J]. 广西医科大学学报, 2017, 34(1): 112-114. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD201701030.htm [19] 李璐希, 王雨生, 李曼红, 等. 缝合切口与否对25G玻璃体切割术后患者眼压及相关并发症的影响[J]. 眼科新进展, 2018, 38(7): 664-668. https://www.cnki.com.cn/Article/CJFDTOTAL-XKJZ201807016.htm [20] 蒋丽君, 朱永唯, 郭志丽, 等. 双微创玻璃体手术联合白内障人工晶状体植入的临床效果[J]. 国际眼科杂志, 2016, 16(3): 483-485. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201603021.htm
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