| Objective:To investigate the causes of secondary ocular hypertension after the vitrectomy and its combined surgery by comparing and analyzing the structural influencing factors that may affect intraocular pressure(IOP).Methods:A retrospective study on whether the different diseases,surgical procedures,vitreous tamponades and amounts,postoperative lens condition and axial length are associated with secondary ocular hypertension after the vitrectomy and its combined surgery in the First Affiliated Hospital of Kunming Medical University.A total of 134 eyes in 130 patients,from December 2017 to June 2018,and from November 2018 to February 2019 were collected.Ultrasound microscope(UBM)was used to measure the indices,including anterior chamber depth(ACD),temporal anterior scleral thickness(AST),angle of open distance 500(AOD500),trabecular iris angle(TIA),iris lens contact distance(ILCD),which were used to analyze the mechanical influencing factors on the aqueous outflow process.Results:1.Relationship between the general information and the secondary ocular hypertension1.1 Visiting diseasesIn this study,a total of 46 eyes developed secondary ocular hypertension,26 eyes of retinal detachment(accounting for 56.52%),2 eyes of vitreous hemorrhage(4.53%),no eye of macular epiretinal membrane(0.00%),5 eyes of macular hole(10.87%),and 13 eyes of vitreous with silicone oil(28.26%).There were significant differences among the 5 cases of treatment(P<0.05).1.2 Different surgical proceduresAmong the 46 eyes with secondary ocular hypertension,1 eye after simple PPV(accounting for 2.17%),3 eyes after Phaco+PPV+SOT(6.52%),1 eye after Phaco+PPV+SOT+IOL(2.17%),2 eyes after Phaco+PPV(4.35%),4 eyes after Phaco+PPV+IOL(8.70%),23 eyes after PPV+SOT(50.00%),and 12 eyes which were planned to undergo the silicone oil extraction(26.09%).The difference among the different procedures was statistically significant(P<0.05).1.3 Lens conditions after the surgeriesAmong the 46 eyes with secondary ocular hypertension,12 pseudo-phakic eyes(accounting for 26.09%),10 aphakic eyes(27.74%),and 24 phakic eyes(52.17%).There was no significant difference between these groups(P>0.05).1.4 Different vitreous tamponadesAmong the 46 eyes with secondary ocular hypertension,2 eyes filled with sterile air+C3F8(accounting for 4.35%),38 eyes with silicone oil(82.60%),2 eyes with sterile air(4.35%),and 4 eyes with intraocular perfusion fluid(8.70%).The differences among the different vitreous tamponades were statistically significant(P<0.05).1.5 Preoperative axial lengths and silicone oil filling amountsThere was a statistically significant difference in the preoperative axial length between the postoperative normal intraocular pressure group and the postoperative ocular hypertension group(P<0.05).The ROC curve was used to find the optimal threshold value of the axial length for determining the secondary ocular hypertension,which was 25.725 mm with the sensitivity of 0.622 and the specificity of 0.693.The stratified analysis of the axial length revealed that there was no any relationship between the silicone oil filling amount and the secondary ocular hypertension(P>0.05).1.6 Multivariate regression analysis on those factors related to the secondary ocular hypertensionMultivariate two-class logistic regression analysis found that only the surgical procedures and axial length were statistically significant for secondary ocular hypertension.The surgical procedures,including Phaco+PPV+IOL,Phaco+PPV+SOT,Phaco+PPV+SOT+IOL,PPV+SOT and silicone oil extraction were more likely to occur secondary ocular hypertension than PPV.The longer the axial length,the more likely the secondary ocular hypertension.2.Ultrasound biomicroscopy(UBM)analysis on the relationship between the anterior chamber parameters(AOD500,TIA,ACD,ILCD)and the secondary ocular hypertension2.1 Relationship between the normal anterior chamber parameters and axial lengthThere were positive correlations between normal axial length and superior AOD500,temporal AOD500,inferior AOD500,superior TIA,temporal TIA,inferior TIA,ACD(P<0.05).There was no statistical significant difference between those 4 position parameters in normal patients(P>0.05).2.2 There was no significant difference in the anterior chamber parameters between the secondary ocular hypertension and the normal one(P>0.05).2.3 Relationship of the anterior chamber parameters between the postoperative secondary ocular hypertension and the normal oneThe difference of superior AOD500,inferior AOD500,superior TIA,temporal TIA,inferior TIA between the secondary ocular hypertension and normal eyes was statistically significant(P<0.05),the parameters of the angle in the secondary ocular hypertension were larger than those in the normal eyes(P<0.05),but other parameters were not statistically significant(P>0.05)2.4 Relationship of the anterior chamber parameters between the postoperative secondary ocular hypertension with different tamponades and the normal one2.4.1 There was a statistically significant difference of the superior AOD500,temporal AOD500,inferior AOD500,nasal AOD500,superior TIA,temporal TIA,inferior TIA between the normal eyes and the secondary ocular hypertension eyes filled with silicone oil(P<0.05),the parameters of the angle in the secondary ocular hypertension were larger than those in the normal eyes(P<0.05),but other parameters were not statistically significant(P>0.05).2.4.2 In the secondary ocular hypertension eyes filled with intraocular perfusion fluid,nasal ILCD and ACD was significantly different from the normal ones(P<0.05),nasal ILCD in the secondary ocular hypertension was smaller than the normal one(P<0.05),and ACD was deeper than the normal one(P<0.05),and the others were not statistically significant(P>0.05).2.5 Relationship of the anterior chamber parameters between the secondary ocular hypertension with the different postoperative lens condition and the normal one2.5.1 There were statistically significant differences in the parameters of superior AOD500,temporal AOD500,inferior AOD500,nasal AOD500,superior TIA,temporal TIA and inferior TIA,between the secondary ocular hypertension with lens after surgery and the normal one(P<0.05),the parameters of the angle in the secondary ocular hypertension were larger than the normal one(P<0.05),and other statistics were not statistically significant(P>0.05).2.5.2 There were statistically significant differences in the parameters of inferior TIA,temporal ILCD,nasal ILCD and ACD,between the secondary ocular hypertension with IOL and the normal one(P<0.05).Inferior TIA and ACD of secondary ocular hypertension were greater than those of the normal one(P<0.05),while temporal ILCD and nasal ILCD smaller than the normal one(P<0.05),and the others were not statistically significant(P>0.05)Conclusions:1.Visiting diseases,surgical procedures,vitreous tamponades and axial length are associated with the secondary ocular hypertension after the vitrectomy.2.Surgical procedure and axial length are the risk factors for the secondary ocular hypertension after the vitrectomy.The optimal threshold value of the axial length for secondary ocular hypertension may be 25.725 mm3.As the axial length increases,the amount of filled silicone oil is increased,but it is not related to secondary ocular hypertension.4.In IOL and phakic eyes,pupil block and angle stenosis are not the structural influencing factors for the secondary ocular hypertension after the vitrectomy.5.Primary open angle glaucoma that is not clearly diagnosed before surgery,and changing of scleral elastic bearing capacity,may be the cause of the secondary ocular hypertension. |
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