单眼小梁消融术后对侧眼的眼压同感反应

doi:10.6040/j.issn.1673-3770.0.2023.141

摘要/Abstract

摘要： 目的观察开角型青光眼患者单眼小梁消融术后对侧眼的眼压波动趋势、眼压同感反应(ophthalmotonic consensual reaction, OCR)现象并探究其影响因素。方法单中心回顾性观察性研究。纳入2016年1月至2022年9月于北京大学第三医院眼科就诊并接受单眼小梁消融术的开角型青光眼(Open-angle glaucoma, OAG)患者97例(97只眼),收集所有病例的人口学资料、双眼既往眼部疾病史及抗青光眼手术史、双眼局部所用的降眼压药种类及数目及包括双眼基线眼压和术后1 d、1周、1个月、3个月、6个月眼压在内的眼科检查资料。将对侧眼的眼压相较基线水平升高 ≥ 4 mm Hg或较基线水平相对升高≥20%定义为对侧眼发生OCR现象。采用秩和检验比较在术后各随访时间点对侧眼眼压较基线的变化,采用秩和检验、Fisher精确检验以及logistic回归探究术后1 d对侧眼发生OCR现象的影响因素,采用秩和检验和Spearman相关性分析探究术后1 d对侧眼眼压升高幅度的影响因素。结果在手术眼接受小梁消融术后,相比于基线眼压(17.3±6.5)mm Hg,对侧眼眼压仅在术后1 d升高至(18.1±7.8)mm Hg(P=0.008),但在其他术后随访时间点较基线无显著变化(P>0.05);术后1 d对侧眼OCR现象的发生率为34.0%,高于其他术后随访时间点;健康的对侧眼是单眼小梁消融术后1 d对侧眼发生OCR现象的独立危险因素;当术前手术眼基线眼压越高或术后1 d手术眼眼压下降幅度越大时,术后1 d对侧眼眼压升高幅度越大。结论单眼小梁消融术术后早期会引起对侧眼的眼压升高,在术后早期需要监测对侧眼的眼压波动。

关键词: 对侧眼, 开角型青光眼, 眼压同感反应, 小梁消融术, 眼压波动

Abstract: Objective To observe the intraocular pressure(IOP)fluctuations and the phenomenon of ophthalmotonic consensual reaction(OCR)in the fellow eye following trabectome in one eye and to investigate its correlative influencing factors in patients with open-angle glaucoma(OAG). Methods In this single-center retrospective observational study, the eyes of 97 individuals with OAG undergoing unilateral trabectome from January 2016 to September 2022 were evaluated. Data were collected on demographics, past ocular disease and surgical history, the kind and number of preoperative anti-glaucoma medications, ophthalmic examination data, including baseline IOP in both eyes, and the IOP of both eyes at one day, one week, one month, three months, and six months postoperatively. An IOP change(ΔIOP)≥ 4 mm Hg or a 20% increase from the baseline values was defined as OCR in the fellow eye. Paired rank sum test was used to compare the difference between baseline IOP values and IOP at different time points postoperatively, and the influencing factors of OCR phenomenon in the fellow eye on postoperative day 1 were investigated using rank sum test, Fisher’s exact test, and logistic regression, while the influencing factors of the magnitude of ΔIOP in the fellow eye at postoperative day 1 were investigated using rank sum test and Spearman correlation analysis. Results The baseline IOP of all fellow eyes was 17.3±6.5 mm Hg, significantly increasing to 18.1±7.8 mm Hg at postoperative day 1(P=0.008), while IOP in the fellow at other postoperative time points did not significantly change from the baseline level(P>0.05). The incidence of OCR in fellow eyes at postoperative day 1 was 34.0%, which was higher than those of other postoperative time points. Healthy fellow eye was an independent risk factor of OCR in the fellow eye following trabectome in the surgical eye at postoperative day 1. At postoperative day 1, ΔIOP in fellow eyes was positively correlated with the magnitude of IOP reduction and the baseline IOP level in surgical eyes. Conclusion A consensual IOP rise in fellow eyes was observed after trabectome in one eye in the early postoperative period. These findings highlight the explicit need to monitor IOP in fellow eyes carefully.

Key words: Fellow eye, Open-angle glaucoma, Ophthalmotonic consensual reaction, Trabectome, Fluctuations of IOP

中图分类号:

R775

杨臻,孟素坤,张纯. 单眼小梁消融术后对侧眼的眼压同感反应[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 43-51.

YANG Zhen, MENG Sukun, ZHANG Chun. Ophthalmotonic consensual reaction in the fellow eye following unilateral trabectome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(5): 43-51.

参考文献

[1] Weekers L. Modification experimentales de l’ophtalmotonous. Reaction ophtalmotonique consenuelle [J]. Arch Ophthalmol, 1924, 41: 641-658
[2] Piltz J, Gross R, Shin DH, et al. Contralateral effect of topical beta-adrenergic antagonists in initial one-eyed trials in the ocular hypertension treatment study[J]. Am J Ophthalmol, 2000, 130(4): 441-453. doi:10.1016/s0002-9394(00)00527-4
[3] Rao HL, Senthil S, Garudadri CS. Contralateral intraocular pressure lowering effect of prostaglandin analogues[J]. Indian J Ophthalmol, 2014, 62(5): 575-579. doi:10.4103/0301-4738.129783
[4] Liu Y, Fan X, Wu LL. Selective laser trabeculoplasty lowered the untreated fellow eye long-term intraocular pressure: a 3-year observational study[J]. Lasers Med Sci, 2022, 37(3): 1487-1493. doi:10.1007/s10103-021-03253-w
[5] Nassiri N, Mei F, Tokko H, et al. Consensual ophthalmotonic reaction following selective laser trabeculoplasty[J]. J Curr Glaucoma Pract, 2022, 16(1): 36-40. doi:10.5005/jp-journals-10078-1361
[6] Yarangümeli A, Köz OG, Kural G. The effect of trabeculectomy on the intraocular pressure of the unoperated fellow eye[J]. J Glaucoma, 2003, 12(2): 108-113. doi:10.1097/00061198-200304000-00004 [PubMed]
[7] Kaushik S, Agarwal A, Kaur S, et al. Change in intraocular pressure in the fellow eye after glaucoma surgery in 1 eye[J]. J Glaucoma, 2016, 25(3): 324-329. doi:10.1097/IJG.0000000000000217
[8] 张倩雯, 赵灿, 裴力, 等. 原发性开角型青光眼患者单侧小梁切除术后对侧眼眼压变化[J]. 眼科新进展, 2021, 41(9): 848-852. doi:10.13389/j.cnki.rao.2021.0177 ZHANG Qianwen, ZHAO Can, PEI Li, et al. Intraocular pressure changes in the contralateral eye after unilateral trabeculectomy for primary open angle glaucoma[J]. Recent Advances in Ophthalmology, 2021, 41(9): 848-852. doi:10.13389/j.cnki.rao.2021.0177
[9] Shum JWH, Choy BNK, Ho WL, et al. Consensual ophthalmotonic reaction in Chinese patients following augmented trabeculectomy or ExPRESS shunt implantation[J]. Medicine, 2016, 95(29): e4190. doi:10.1097/MD.0000000000004190
[10] Meshksar A, Hajizadeh M, Sharifipour F, et al. Intraocular pressure changes in the contralateral eye after glaucoma surgery[J]. J Glaucoma, 2021, 30(12): 1074-1081. doi:10.1097/IJG.0000000000001950
[11] Vysniauskiene I, Shaarawy T, Flammer J, et al. Intraocular pressure changes in the contralateral eye after trabeculectomy with mitomycin C[J]. Br J Ophthalmol, 2005, 89(7): 809-811. doi:10.1136/bjo.2004.050294
[12] Radcliffe NM, Musch DC, Niziol LM, et al. The effect of trabeculectomy on intraocular pressure of the untreated fellow eye in the collaborative initial glaucoma treatment study[J]. Ophthalmology, 2010, 117(11): 2055-2060. doi:10.1016/j.ophtha.2010.02.016
[13] Aghayeva FA, Chronopoulos P, Schuster AK, et al. Inter-eye relationship of intraocular pressure change after unilateral trabeculectomy, filtering canaloplasty, or PreserFlo^TM microshunt implantation[J]. Graefes Arch Clin Exp Ophthalmol, 2021, 259(10): 3045-3053. doi:10.1007/s00417-021-05188-y
[14] Bicket AK, Le JT, Azuara-Blanco A, et al. Minimally invasive glaucoma surgical techniques for open-angle glaucoma: an overview of cochrane systematic reviews and network meta-analysis[J]. JAMA Ophthalmol, 2021, 139(9): 983-989. doi:10.1001/jamaophthalmol.2021.2351
[15] Mathew DJ, Buys YM. Minimally invasive glaucoma surgery: a critical appraisal of the literature[J]. Annu Rev Vis Sci, 2020, 6: 47-89. doi:10.1146/annurev-vision-121219-081737
[16] 钟煜, 廖智敏, 段宣初. XEN微支架在青光眼手术中的应用进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 145-151. doi:10.6040/j.issn.1673-3770.0.2021.468 ZHONG Yu, LIAO Zhimin, DUAN Xuanchu. Progress in the applications of XEN microstent in glaucoma surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(1): 145-151. doi:10.6040/j.issn.1673-3770.0.2021.468
[17] Nichani P, Popovic MM, Schlenker MB, et al. Microinvasive glaucoma surgery: a review of 3476 eyes[J]. Surv Ophthalmol, 2021, 66(5): 714-742. doi:10.1016/j.survophthal.2020.09.005
[18] 中华医学会眼科学分会青光眼学组, 中国医师协会眼科医师分会青光眼学组. 中国青光眼指南(2020年)[J]. 中华眼科杂志, 2020, 56(8): 573-586. doi:10.3760/cma.j.cn112142-20200313-00182
[19] Sunaric Megevand G, Bron AM. Personalising surgical treatments for glaucoma patients[J]. Prog Retin Eye Res, 2021, 81: 100879. doi:10.1016/j.preteyeres.2020.100879
[20] Gibbens MV. Sympathetic influences on the consensual ophthalmotonic reaction[J]. Br J Ophthalmol, 1988, 72(10): 750-753. doi:10.1136/bjo.72.10.750
[21] Diestelhorst M, Krieglstein G. The effect of trabeculectomy on the aqueous humor flow of the unoperated fellow eye[J]. Albrecht Von Graefes Arch Fur Klin Und Exp Ophthalmol, 1991, 229(3): 274-276. doi:10.1007/BF00167883
[22] Yang F, Zhu XT, Liu X, et al. Anatomical evidence for the efferent pathway from the hypothalamus to autonomic innervation in the anterior chamber structures of eyes[J]. Exp Eye Res, 2021, 202: 108367. doi:10.1016/j.exer.2020.108367
[23] Winkler NS, Fautsch MP. Effects of prostaglandin analogues on aqueous humor outflow pathways[J]. J Ocul Pharmacol Ther, 2014, 30(2/3): 102-109. doi:10.1089/jop.2013.0179
[24] Pandit R, George RJ, Lingam V, et al. Incidence of presumed steroid response in contralateral eye of patients who underwent glaucoma filtration surgery[J]. Indian J Ophthalmol, 2021, 69(9): 2481-2483. doi:10.4103/ijo.IJO_3069_20
[25] Kumar H, Thulasidas M. Commentary: Consensual ophthalmotonic reaction[J]. Indian J Ophthalmol, 2023, 71(3): 878-879. doi:10.4103/ijo.IJO_6_23_6
[26] Berchuck S, Jammal A, Mukherjee S, et al. Impact of anxiety and depression on progression to glaucoma among glaucoma suspects[J]. Br J Ophthalmol, 2021, 105(9): 1244-1249. doi:10.1136/bjophthalmol-2020-316617

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed