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2.4 硅油和惰性气体充填术后低眼压的发病率〔21，22〕
C3F8充填术后持续低眼压占42%，硅油充填占22%。有黄斑脱离者低眼压更多见。二次玻璃体切除比第一次玻璃体切除低眼压发生率高，视网膜切开的比未切开的低眼压发生率高，以前作过玻璃体切除者低眼压的发生率与作过或未作过视网膜切开的相似。硅油充填发生低眼压者比C3F8充填者少。
3 中医学对玻璃体视网膜术后低眼压的认识
目前尚无中医药治疗玻璃体视网膜术后低眼压的报道，但中医对虹膜、房水、前房角、睫状体、玻璃体及视网膜的组织解剖、病理生理已积累了一定的认识。玻璃体相当于中医的“神膏”，《张氏医通》在金针拨内障中记载有“年高卫气不足，针时神膏微出”〔23〕。《证治准绳》谓“神膏者，目内包含膏液，如破则黑稠水出是也，此膏由胆中渗润精汁而成”〔24〕。陈达夫在50年代根据传统中医理论，创立了眼内组织的脏腑分属学说〔25〕，虹膜、睫状体、睫状小带、前房角及视网膜皆属于足厥阴肝经。玻璃体视网膜、脉络膜及睫状体均属瞳神后组织，五论辨证属水轮，为肾所主。由上可知，神膏(玻璃体)、神水(房水)的生成有赖于精汁、真气的濡养，而瞳孔后组织的正常生理功能又有赖于气血的濡养。因此真气、真血、真精对于眼压的生成和维持具有重要意义。中医学认为手术损伤乃为物损伤，有风邪夹杂，打动珠内真气、耗损真气、真血、郁遇脉络，阻滞气血而致。故玻璃体视网膜手术后低眼压的立法原则应是：补肾益精，益气养血，祛风活血。文献报道以补肝四物汤加减，补益气血、理气健脾、活血化瘀立法治疗术后和挫伤后低眼压症51例(51眼)，治愈率达86.27%〔26〕。用加味四物汤联合西药，以活血化瘀、益气生新、滋补肝肾、生精增液、祛风明目为法治疗眼挫伤术后低眼压9例(有效9只眼)，有效率达88.9%〔27〕。
综上所述，低眼压与玻璃体视网膜手术非常密切。术前低眼压是预后差的标志，术后有症状的低眼压特别是眼球痨均标志着手术的失败。随着期望更高的视网膜复位率，近年来术后低眼压已受到广大学者的关注。术后低眼压病理机制相当复杂，临床治疗又不理想。但可相信，通过应用先进的无创伤的外科技巧和中西医结合的治疗，可使玻璃体视网膜术后低眼压减至最低限度，提高手术治愈率。
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