目的 对比观察23G、20G玻璃体切割手术治疗糖尿病视网膜病变(DR)的有效性和安全性.方法 接受玻璃体切割手术治疗的DR患者33例38只眼纳入研究.按其所接受的手术方式分为23G微 创玻璃体切割手术组(23G组)和20G玻璃体切割手术组(20G组),分别为18例20只眼和15例18只眼. 手术后随访6～12个月,对比分析两组患眼的玻璃体手术时间,手术中发生的医源性裂孔数目,手术中出血需电凝的次数,手术中需更换显微器械的情况,手术后连续1～3 d的眼压,手术后并发症的情况,手术成功率和最佳矫正视力(BCVA)等指标.结果 23G组手术时间为35～110 min,平均手术时间为(63.5±21.7) min；20G组手术时间为40～150 min,平均手术时间为(83.9±27.5) min,两组比较,差异有统计学意义(t=2.55,P=0.02).23G组和20G组手术中发生医源性视网膜裂孔数平均分别为6、14个.23G组和20G组手术中视网膜或增生膜表面出血影响继续操作需电凝止血的次数平均分别为71、102次.23G组和20G组手术中进行反复显微器械更换操作的患眼分别为3、12只眼,两组比较,差异有统计学意义(x2 =10.58,P=0.001).23G组和20G组手术后第1、2、3天的平均眼压分别为(10.2±2.0)、(13.4±2.5)、(14.9±2.3) mm Hg(1 mm Hg=0.133 kPa)和(16.5±2.9)、(19.3±2.4)、(20.1±2.9) mm Hg,两组比较,差异有统计学意义(t=7.71,7.41,6.18；P＜0.01).23G组手术后出现多量的眼内出血1只眼,牵引性视网膜脱离硅油填充眼出现新生血管性青光眼(NVG)1只眼,再次发生视网膜脱离未再次接受手术1只眼.20G组手术后出现多量的眼内出血2只眼,其中1只眼为玻璃体积血未予眼内填充的患眼,1只眼为牵引性视网膜脱离硅油填充眼,手术后2只眼硅油填充眼出现NVG,1只眼再次发生视网膜脱离未再次接受手术,两组比较,差异无统计学意义(x2 =0.49,0.49,0.01;P＞0.05).23G组和20G组最终手术分别成功19、17只眼,成功率为95.0％、94.4％,两组比较,差异无统计学意义(x2=0.01,P=0.94).两组患眼均未发生眼内炎、明显脉络膜脱离等并发症.23G组BCVA＜0.05者1只眼；0.05～0.09者5只眼；0.1～0.2者10只眼；≥0.3者4只眼；20G组BCVA＜ 0.05者1只眼；0.05～0.09者9只眼；0.1～0.2者6只眼；≥0.3者2只眼,两组比较,差异无统计学意义(x2=2.70,P＞0.05).结论 23G微创玻璃体手术较20G手术减少了器械更换,缩短了手术时间,并减少了手术中出血、医源性裂孔等并发症发生.
目的 對比觀察23G、20G玻璃體切割手術治療糖尿病視網膜病變(DR)的有效性和安全性.方法 接受玻璃體切割手術治療的DR患者33例38隻眼納入研究.按其所接受的手術方式分為23G微 創玻璃體切割手術組(23G組)和20G玻璃體切割手術組(20G組),分彆為18例20隻眼和15例18隻眼. 手術後隨訪6～12箇月,對比分析兩組患眼的玻璃體手術時間,手術中髮生的醫源性裂孔數目,手術中齣血需電凝的次數,手術中需更換顯微器械的情況,手術後連續1～3 d的眼壓,手術後併髮癥的情況,手術成功率和最佳矯正視力(BCVA)等指標.結果 23G組手術時間為35～110 min,平均手術時間為(63.5±21.7) min；20G組手術時間為40～150 min,平均手術時間為(83.9±27.5) min,兩組比較,差異有統計學意義(t=2.55,P=0.02).23G組和20G組手術中髮生醫源性視網膜裂孔數平均分彆為6、14箇.23G組和20G組手術中視網膜或增生膜錶麵齣血影響繼續操作需電凝止血的次數平均分彆為71、102次.23G組和20G組手術中進行反複顯微器械更換操作的患眼分彆為3、12隻眼,兩組比較,差異有統計學意義(x2 =10.58,P=0.001).23G組和20G組手術後第1、2、3天的平均眼壓分彆為(10.2±2.0)、(13.4±2.5)、(14.9±2.3) mm Hg(1 mm Hg=0.133 kPa)和(16.5±2.9)、(19.3±2.4)、(20.1±2.9) mm Hg,兩組比較,差異有統計學意義(t=7.71,7.41,6.18；P＜0.01).23G組手術後齣現多量的眼內齣血1隻眼,牽引性視網膜脫離硅油填充眼齣現新生血管性青光眼(NVG)1隻眼,再次髮生視網膜脫離未再次接受手術1隻眼.20G組手術後齣現多量的眼內齣血2隻眼,其中1隻眼為玻璃體積血未予眼內填充的患眼,1隻眼為牽引性視網膜脫離硅油填充眼,手術後2隻眼硅油填充眼齣現NVG,1隻眼再次髮生視網膜脫離未再次接受手術,兩組比較,差異無統計學意義(x2 =0.49,0.49,0.01;P＞0.05).23G組和20G組最終手術分彆成功19、17隻眼,成功率為95.0％、94.4％,兩組比較,差異無統計學意義(x2=0.01,P=0.94).兩組患眼均未髮生眼內炎、明顯脈絡膜脫離等併髮癥.23G組BCVA＜0.05者1隻眼；0.05～0.09者5隻眼；0.1～0.2者10隻眼；≥0.3者4隻眼；20G組BCVA＜ 0.05者1隻眼；0.05～0.09者9隻眼；0.1～0.2者6隻眼；≥0.3者2隻眼,兩組比較,差異無統計學意義(x2=2.70,P＞0.05).結論 23G微創玻璃體手術較20G手術減少瞭器械更換,縮短瞭手術時間,併減少瞭手術中齣血、醫源性裂孔等併髮癥髮生.
목적 대비관찰23G、20G파리체절할수술치료당뇨병시망막병변(DR)적유효성화안전성.방법 접수파리체절할수술치료적DR환자33례38지안납입연구.안기소접수적수술방식분위23G미 창파리체절할수술조(23G조)화20G파리체절할수술조(20G조),분별위18례20지안화15례18지안. 수술후수방6～12개월,대비분석량조환안적파리체수술시간,수술중발생적의원성렬공수목,수술중출혈수전응적차수,수술중수경환현미기계적정황,수술후련속1～3 d적안압,수술후병발증적정황,수술성공솔화최가교정시력(BCVA)등지표.결과 23G조수술시간위35～110 min,평균수술시간위(63.5±21.7) min；20G조수술시간위40～150 min,평균수술시간위(83.9±27.5) min,량조비교,차이유통계학의의(t=2.55,P=0.02).23G조화20G조수술중발생의원성시망막렬공수평균분별위6、14개.23G조화20G조수술중시망막혹증생막표면출혈영향계속조작수전응지혈적차수평균분별위71、102차.23G조화20G조수술중진행반복현미기계경환조작적환안분별위3、12지안,량조비교,차이유통계학의의(x2 =10.58,P=0.001).23G조화20G조수술후제1、2、3천적평균안압분별위(10.2±2.0)、(13.4±2.5)、(14.9±2.3) mm Hg(1 mm Hg=0.133 kPa)화(16.5±2.9)、(19.3±2.4)、(20.1±2.9) mm Hg,량조비교,차이유통계학의의(t=7.71,7.41,6.18；P＜0.01).23G조수술후출현다량적안내출혈1지안,견인성시망막탈리규유전충안출현신생혈관성청광안(NVG)1지안,재차발생시망막탈리미재차접수수술1지안.20G조수술후출현다량적안내출혈2지안,기중1지안위파리체적혈미여안내전충적환안,1지안위견인성시망막탈리규유전충안,수술후2지안규유전충안출현NVG,1지안재차발생시망막탈리미재차접수수술,량조비교,차이무통계학의의(x2 =0.49,0.49,0.01;P＞0.05).23G조화20G조최종수술분별성공19、17지안,성공솔위95.0％、94.4％,량조비교,차이무통계학의의(x2=0.01,P=0.94).량조환안균미발생안내염、명현맥락막탈리등병발증.23G조BCVA＜0.05자1지안；0.05～0.09자5지안；0.1～0.2자10지안；≥0.3자4지안；20G조BCVA＜ 0.05자1지안；0.05～0.09자9지안；0.1～0.2자6지안；≥0.3자2지안,량조비교,차이무통계학의의(x2=2.70,P＞0.05).결론 23G미창파리체수술교20G수술감소료기계경환,축단료수술시간,병감소료수술중출혈、의원성렬공등병발증발생.
Objective To compare the efficacy of 23G and 20G vitrectomy for diabetic retinopathy.Methods Thirty-eight eyes of 33 patients with diabetic retinopathy who underwent primary vitrectomy were enrolled in this study.Twenty eyes of 18 patients underwent 23G microincision vitrectomy (23G group).Eighteen eyes of 15 patients underwent 20G vitrectomy (20G group).The follow-up ranged from 6 to 12months.The surgical time,number of iatrogenic retinal tears,times of coagulation for hemorhage,instrumental change for fibromembrane removal,intraocular pressure (IOP) at 1st,2nd and 3rd days after surgery,postoperative complications,anatomic success rate,and best corrected visual acuity (BCVA) were observed.Results The mean surgical times were (63.5±21.7) and (83.9±27.5) minutes in 23G and 20Ggroup which was a significant difference (t=2.55,P=0.02).The numbers of iatrogenic retinal tears were six and 14,while the mean times of coagulation were 71 and 104 in 23G and 20G group respectively.There were three and 12 eyes needing instrumental change for fibromembrane removal in 23G and 20G group with significant difference (x2=10.58,P=0.001). At the 1st,2nd and 3rd days after surgery,IOP were (10.2±2.0),(13.4±2.5),and (14.9±2.3) mm Hg (1 mm Hg=0.133 kPa) in 23G group,(16.5± 2.9),(19.3±2.4),and (20.1±2.9) mm Hg in 20G group.Compared with each other,the differences were statistically significant (t =7.71,7.41,6.18; P ＜ 0.01). There was one eye with intraocular hemorrhage,one eye with neovascular glaucoma (NVG),and one eye with retinal detachment (RD) in 23G group.There were two eyes with intraocular hemorrhage,two eyes with NVG,and one eye with RD in 20G group.Compared with each other,the differences were not statistically significant (x2 =0.49,0.49,0.01; P＞0.05).The anatomic success rates were 95.0％ and 94.4％ in 23G and 20G group without significant difference (x2=0.01,P =0.94). There were no complications such as endophthalmitis or choroidal detachment.In 23G group,BCVA was ＜0.05 in one eye,0.05 - 0.09 in five eyes,0.1 - 0.2 in 10 eyes,≥0.3 in two eyes.In 20G group,BCVA was ＜0.05 in one eye,0.05 - 0.09 in nine eyes,0.1 - 0.2 in six eyes,≥0.3 in two eyes.Compared with each other,the differences were not statistically significant (x2=2.70,P＞0.05).Conclusion 23G microincision vitrectomy is beneficial to shorten the operation time,reduce instrumental changes,decrease intraoperative complications,and enhance visual rehabilitation.
