CAJ | 학술논문

目的观察23-G微创玻璃体切割联合超声乳化白内障吸除及人工晶状体植入术治疗增殖性糖尿病性视网膜病变(PDR)合并白内障的效果,并与20-G玻璃体切割术效果进行比较.方法回顾性病例对照研究.PDR合并白内障患者91例(91眼),A组41例,接受了23-G微创玻璃体切割联合超声乳化白内障吸除及人工晶状体植人术;B组50例,接受20-G玻璃体切割联合超声乳化白内障吸除及人工晶状体植入术,术后1 d、1周、2周、1个月、3个月观察视力及并发症情况.数据采用独立样本t检验、配对t检验和卡方检验进行分析.结果平均随访17个月.A组logMAR视力从1.569±0.342提高到0.821±0.421,差异有统计学意义(t=8.99,P＜0.01);B组logMAR视力从1.658±0.312提高到0.834±0.399,差异有统计学意义(t=11.47,P＜0.01).术后并发症:A组中33眼(80%)术后无明显不适及水肿,B组中所有眼(100%)均有明显充血、水肿、异物感及眼部不适.另外,A组和B组分别发现3眼(7%)和1眼(2%)发生短暂性低眼压,两组差异无统计学意义;4眼(10%)和14眼(28%)发生前房纤维蛋白渗出,两组差异有统计学意义(x2=4.75,P＜0.05).结论 23-G微创玻璃体切割联合超声乳化向内障吸除及人工晶状体植入术治疗PDR合并白内障安全有效,同20-G微创玻璃体切割手术比较,其术后恢复较快且不适感较少.
목적 관찰23-G미창파리체절할연합초성유화백내장흡제급인공정상체식입술치료증식성당뇨병성시망막병변(PDR)합병백내장적효과,병여20-G파리체절할술효과진행비교.방법 회고성병례대조연구.PDR합병백내장환자91례(91안),A조41례,접수료23-G미창파리체절할연합초성유화백내장흡제급인공정상체식인술;B조50례,접수20-G파리체절할연합초성유화백내장흡제급인공정상체식입술,술후1 d、1주、2주、1개월、3개월관찰시력급병발증정황.수거채용독립양본t검험、배대t검험화잡방검험진행분석.결과 평균수방17개월.A조logMAR시력종1.569±0.342제고도0.821±0.421,차이유통계학의의(t=8.99,P＜0.01);B조logMAR시력종1.658±0.312제고도0.834±0.399,차이유통계학의의(t=11.47,P＜0.01).술후병발증:A조중33안(80%)술후무명현불괄급수종,B조중소유안(100%)균유명현충혈、수종、이물감급안부불괄.령외,A조화B조분별발현3안(7%)화1안(2%)발생단잠성저안압,량조차이무통계학의의;4안(10%)화14안(28%)발생전방섬유단백삼출,량조차이유통계학의의(x2=4.75,P＜0.05).결론 23-G미창파리체절할연합초성유화향내장흡제급인공정상체식입술치료PDR합병백내장안전유효,동20-G미창파리체절할수술비교,기술후회복교쾌차불괄감교소.
Objective To compare the outcomes of 23-gauge (23-G) and 20-G vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation for proliferative diabetic retinopathy (PDR) with coexisting cataract. Methods Retrospective case-controlled study. Ninety-one patients (91 eyes) with PDR and coexisting cataract underwent 23-G (group A, 41 eyes) or 20-G (group B, 50 eyes) vitrectomy combined with phacoemulsification and IOL implantation were studied.One day, 1 week, 2 weeks, 1 month, and 3 months after surgery, the main outcome visual acuity (VA) and postoperative complications were measured. Statistical analysis was performed using an independent samples t test, a paired t test and a chi-square test. Results After the mean follow-up period of 17 months, VA improved significantly from 1.569±0.342 to 0.821±0.421 (t=8.99, P＜0.01)and from 1.658±0.312 to 0.834±0.399 (t=11.47, P＜0.01) in group A and group B, respectively. Postoperatively, 33 eyes (80%) were quiet with no chemosis in group A; in contrast, all eyes (100%) in group B showed marked congestion, chemosis, foreign body sensations and overall discomfort.Postoperative transient hypotony occurred in 3 eyes(7%)and 1 eye(2%),and inflammation in the fibrin anterior chamber was seen in 4 eyes(10%)and 14 eyes(28%)in group A and group B,respectively.The difference for the latter was significant(x2=4.75,P＜0.05).Conclusion For the management of PDR with coexisting cataract,23-G vitrectomy combined with phacoemulsification and IOL implantation is safe and effective with a faster recovery and greater comfort than in the combined 20-G vitrectomy.