目的 对比观察20G和23G玻璃体手术治疗增生型糖尿病视网膜病变(PDR)的临床效果.方法 前瞻性随机对照研究.具有玻璃体手术指征的PDR患者126例142只眼纳入研究.所有患者均行视力、眼压、间接检眼镜、眼B型超声、泪膜破裂时间(BUT)、基础泪液分泌试验(SIT)以及角膜前后表面6 mm区域散光度、散光轴向检查.采用随机数字表法,将患者分为20G手术组和23G手术组,分别为66例74只眼和60例68只眼.手术后平均随访时间,20G手术组15.0个月,23G手术组12.5个月；以手术后6个月为评价两组疗效的时间点.对比分析两组患者手术中并发症、手术时间以及手术后视力、眼压、并发症及BUT、SIT、角膜前后表面散光度和散光轴向变化.结果 手术后6个月随访时,20G手术组74只眼中,视力≥0.05者49只眼,占本组患眼的66.2％；23G手术组68只眼中,视力≥0.05者47只眼,占本组患眼的69.1％.两组间视力≥0.05者比较,差异无统计学意义(x2=0.14,P＞0.05).20G手术组、23G手术组,手术中发生医源损伤18、7只眼,分别占本组患眼的24.3％、10.3％.两组间手术中医源性损伤发生率比较,差异有统计学意义(x2=4.81,P＜0.05).20G手术组、23G手术组平均手术时间分别为(69.0±8.2)、(51.0±6.3)min.两组间平均手术时间比较,差异有统计学意义(t=3.65,P＜0.05).手术后3d,20G手术组、23G手术组发生低眼压3、11只眼,分别占本组患眼的4.1％、14.7％.两组间低眼压发生率比较,差异有统计学意义(x2=5.85,P＜0.05).20G手术组、23G手术组发生高眼压或继发性青光眼24、14只眼,分别占本组患眼的32.4％、20.6％,两组间手术后高眼压或继发性青光眼发生率比较,差异无统计学意义(x2=2.54,P＞0.05).手术后1个月,20G手术组BUT、SIT长度、角膜前后表面散光度、散光轴向与手术前相应检测指标比较,差异均有统计学意义(t=3.35,4.12,-3.12,-3.22；P＜0.05)；手术后3、6个月BUT、SIT长度、角膜前后表面散光度、散光轴向与手术前相应检测指标比较,差异均无统计学意义(3个月:t=0.45、0.98、-2.12、-1.02,P＞0.05;6个月:t=0.95、1.48、-1.02、-2.11,P＞0.05).手术后1、3、6个月,23G手术组BUT、SIT长度、角膜前后表面散光度、散光轴向与手术前相应检测指标比较,差异均无统计学意义(1个月:t=1.21、1.46、-2.32、-1.61,P＞0.05;3个月:t=1.45、2.21、-2.19、-1.89,P＞0.05;6个月:t=1.92、1.25、-1.75、-2.35,P＞0.05).结论 23G微创玻璃体手术治疗PDR安全有效,可缩短手术时间,减少手术并发症,减轻手术后眼表改变.
目的 對比觀察20G和23G玻璃體手術治療增生型糖尿病視網膜病變(PDR)的臨床效果.方法 前瞻性隨機對照研究.具有玻璃體手術指徵的PDR患者126例142隻眼納入研究.所有患者均行視力、眼壓、間接檢眼鏡、眼B型超聲、淚膜破裂時間(BUT)、基礎淚液分泌試驗(SIT)以及角膜前後錶麵6 mm區域散光度、散光軸嚮檢查.採用隨機數字錶法,將患者分為20G手術組和23G手術組,分彆為66例74隻眼和60例68隻眼.手術後平均隨訪時間,20G手術組15.0箇月,23G手術組12.5箇月；以手術後6箇月為評價兩組療效的時間點.對比分析兩組患者手術中併髮癥、手術時間以及手術後視力、眼壓、併髮癥及BUT、SIT、角膜前後錶麵散光度和散光軸嚮變化.結果 手術後6箇月隨訪時,20G手術組74隻眼中,視力≥0.05者49隻眼,佔本組患眼的66.2％；23G手術組68隻眼中,視力≥0.05者47隻眼,佔本組患眼的69.1％.兩組間視力≥0.05者比較,差異無統計學意義(x2=0.14,P＞0.05).20G手術組、23G手術組,手術中髮生醫源損傷18、7隻眼,分彆佔本組患眼的24.3％、10.3％.兩組間手術中醫源性損傷髮生率比較,差異有統計學意義(x2=4.81,P＜0.05).20G手術組、23G手術組平均手術時間分彆為(69.0±8.2)、(51.0±6.3)min.兩組間平均手術時間比較,差異有統計學意義(t=3.65,P＜0.05).手術後3d,20G手術組、23G手術組髮生低眼壓3、11隻眼,分彆佔本組患眼的4.1％、14.7％.兩組間低眼壓髮生率比較,差異有統計學意義(x2=5.85,P＜0.05).20G手術組、23G手術組髮生高眼壓或繼髮性青光眼24、14隻眼,分彆佔本組患眼的32.4％、20.6％,兩組間手術後高眼壓或繼髮性青光眼髮生率比較,差異無統計學意義(x2=2.54,P＞0.05).手術後1箇月,20G手術組BUT、SIT長度、角膜前後錶麵散光度、散光軸嚮與手術前相應檢測指標比較,差異均有統計學意義(t=3.35,4.12,-3.12,-3.22；P＜0.05)；手術後3、6箇月BUT、SIT長度、角膜前後錶麵散光度、散光軸嚮與手術前相應檢測指標比較,差異均無統計學意義(3箇月:t=0.45、0.98、-2.12、-1.02,P＞0.05;6箇月:t=0.95、1.48、-1.02、-2.11,P＞0.05).手術後1、3、6箇月,23G手術組BUT、SIT長度、角膜前後錶麵散光度、散光軸嚮與手術前相應檢測指標比較,差異均無統計學意義(1箇月:t=1.21、1.46、-2.32、-1.61,P＞0.05;3箇月:t=1.45、2.21、-2.19、-1.89,P＞0.05;6箇月:t=1.92、1.25、-1.75、-2.35,P＞0.05).結論 23G微創玻璃體手術治療PDR安全有效,可縮短手術時間,減少手術併髮癥,減輕手術後眼錶改變.
목적 대비관찰20G화23G파리체수술치료증생형당뇨병시망막병변(PDR)적림상효과.방법 전첨성수궤대조연구.구유파리체수술지정적PDR환자126례142지안납입연구.소유환자균행시력、안압、간접검안경、안B형초성、루막파렬시간(BUT)、기출루액분비시험(SIT)이급각막전후표면6 mm구역산광도、산광축향검사.채용수궤수자표법,장환자분위20G수술조화23G수술조,분별위66례74지안화60례68지안.수술후평균수방시간,20G수술조15.0개월,23G수술조12.5개월；이수술후6개월위평개량조료효적시간점.대비분석량조환자수술중병발증、수술시간이급수술후시력、안압、병발증급BUT、SIT、각막전후표면산광도화산광축향변화.결과 수술후6개월수방시,20G수술조74지안중,시력≥0.05자49지안,점본조환안적66.2％；23G수술조68지안중,시력≥0.05자47지안,점본조환안적69.1％.량조간시력≥0.05자비교,차이무통계학의의(x2=0.14,P＞0.05).20G수술조、23G수술조,수술중발생의원손상18、7지안,분별점본조환안적24.3％、10.3％.량조간수술중의원성손상발생솔비교,차이유통계학의의(x2=4.81,P＜0.05).20G수술조、23G수술조평균수술시간분별위(69.0±8.2)、(51.0±6.3)min.량조간평균수술시간비교,차이유통계학의의(t=3.65,P＜0.05).수술후3d,20G수술조、23G수술조발생저안압3、11지안,분별점본조환안적4.1％、14.7％.량조간저안압발생솔비교,차이유통계학의의(x2=5.85,P＜0.05).20G수술조、23G수술조발생고안압혹계발성청광안24、14지안,분별점본조환안적32.4％、20.6％,량조간수술후고안압혹계발성청광안발생솔비교,차이무통계학의의(x2=2.54,P＞0.05).수술후1개월,20G수술조BUT、SIT장도、각막전후표면산광도、산광축향여수술전상응검측지표비교,차이균유통계학의의(t=3.35,4.12,-3.12,-3.22；P＜0.05)；수술후3、6개월BUT、SIT장도、각막전후표면산광도、산광축향여수술전상응검측지표비교,차이균무통계학의의(3개월:t=0.45、0.98、-2.12、-1.02,P＞0.05;6개월:t=0.95、1.48、-1.02、-2.11,P＞0.05).수술후1、3、6개월,23G수술조BUT、SIT장도、각막전후표면산광도、산광축향여수술전상응검측지표비교,차이균무통계학의의(1개월:t=1.21、1.46、-2.32、-1.61,P＞0.05;3개월:t=1.45、2.21、-2.19、-1.89,P＞0.05;6개월:t=1.92、1.25、-1.75、-2.35,P＞0.05).결론 23G미창파리체수술치료PDR안전유효,가축단수술시간,감소수술병발증,감경수술후안표개변.
Objective To compare the outcomes of 23G and 20G vitrectomy in treatment of proliferative diabetic retinopathy (PDR).Methods This was a prospective randomized study.One hundred twenty six patients (142 eyes) suffering from PDR with symptoms requiring vitrectomy were randomly divided into 20G vitrectomy group (66 patients,74 eyes) and 23G vitrectomy group (60 patients,68 eyes).Visual acuity,intraocular pressures,indirect ophthalmoscopy,B-scan ultrasound,tear film break up time (BUT),Schirmer I test (S I T),astigmatic power and the astigmatic axial at 6 mm area of anterior and posterior corneal surface were observed and measured before surgery.The follow-up period was 15.0 and 12.5 months separately in 20G and 23G groups.Intraoperative complications,operation time,postoperative visual acuity,intraocular pressure,postoperative complications,re-operation,and postoperative ocular conditions including changes of astigmatic power and the astigmatic axial measurements were analyzed.Results At last follow-up,there was 49 eyes (66.2％) and 47 eyes (69.1％) with visual acuity ≥0.05 in 20G and 23G groups.Comparing visual acuity ≥0.05,there was no statistical difference between the groups (x2=0.14,P＞0.05).The eyes suffering from iatrogenic injuries were 18 (24.3％) and seven (10.3％).There was obvious difference in iatrogenic injury between the two groups (x2=4.81,P＜0.05).The mean surgical times were (69.0±8.2) and (51.0±6.3) minutes in 20G and 23G group,which was significantly different (t=3.65,P＜0.05).The postoperative third day,hypotony was detected in three (4.1％) and 11 eyes (14.7％) in 20G and 23G group,which was a significantly different (x2=5.85,P＜0.05).Postoperatively high intraocular pressures were not significantly different between the two groups (x2=2.54,P＞0.05).There were 24 (32.4％) and 14 eyes (20.6％) in 20G and 23G group.There were significant differences in BUT,S I T,astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first month after operation (t=3.35,4.12,-3.12,-3.22; P＜0.05),but no significant differences in them at the third and sixth month after operation (third month:t =0.45,0.98,-2.12,-1.02; P＞0.05,and the sixth month:t=0.95,1.48,-1.02,-2.11; P＞0.05).In 23G group,there were no significant differences in BUT,S I T,astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first,third and sixth month after operation (first month:t=l.21,1.46,-2.32,-1.61; P＞0.05,third month:t=1.45,2.21,-2.19,-1.89; P＞0.05,and sixth month:t=1.92,1.25,-1.76,-2.35; P＞0.05).Conclusion 23G vitrectomy is a safe and effective treatment for PDR with shorter surgery time,fewer surgical complications and postoperative ocular surface changes.
