23G与20G玻璃体切割治疗增殖性糖尿病视网膜病变玻璃体出血对比研究
Comparative study of 23-gauge vitrectomy versus 20-gauge vitrectomy for the treatment of proliferative diabetic retinopathy
目的 对比23G与20G玻璃体切割技术治疗增殖性糖尿病视网膜病变引起的玻璃体出血临床疗效.方法 临床病例对照研究.收集2010年3月至2012年9月在宣武医院眼科诊治的增殖性糖尿病视网膜病变,所致玻璃体出血需行玻璃体切割手术治疗患者,分为23G玻璃体切割组及20G玻璃体切割组,记录患者术前个人资料包括年龄、性别、糖尿病患病时间、玻璃体出血至手术时间、术前糖化血红蛋白以及眼科检查结果视力、眼压、散瞳眼底情况,并行眼B超检查.两组患者分别行23G及20G玻璃体切割,记录每例患者的手术时间及眼内玻璃体切割操作时间,术后患者1周、1、2、3月复查分别记录视力、眼压、眼底检查、黄斑OCT结果,并进行统计分析.结果 23G玻璃体切割组完成31例,男21例,女10例,平均年龄(65.2±23.7)岁,20G玻璃体切割组26例,男12例,女14例,平均年龄(63.6±18.4)岁,两组对比的手术时间:23G组(74.39±15.61) min,20G组(93.96±18.74) min差异有统计学意义(P<0.01),眼内玻璃体手术操作时间:23G组(62.35±13.95) min,20G组(59.35±16.07) min,差异有统计学意义(P>0.05).眼压:术后1d、1周、1、3月复查眼压,23G组分别为(10.46±2.11)、(11.74±2.52)、(14.26±3.11)、(14.85±3.73) mmHg; 20G组(15.20±3.33)、(14.49±3.36)、(14.76±3.50)、(15.62±4.02) mmHg,术后1d、1周眼压两组对比差异有统计学意义.术后黄斑OCT结果:术后1周、1、3个月复查OCT结果,23G组(356.93±88.82)、(313.77±92.21)、(273.74±66.09) μm,20G组(336.50±116.1)、(301.43±100.65)、(283.69±84.39) μm,两组各复查时间点差异无统计学意义(P>0.05).视力结果:术后3个月两组最佳矫正视力(BCVA),23G组BCVA<0.05者2只眼;0.05~0.09者5只眼;0.1~0.2者17只眼;≥0.3者只7眼;20G组BCVA<0.05者2只眼;0.05~0.09者4只眼;0.1~0.2者14只眼;≥0.3者6只眼,两组比较,差异无统计学意义(P>0.05).23G组手术后出现多量的眼内出血3只眼,1只眼需再次冲洗手术,1只眼术后第1天眼压4 mmHg术后5天发现术眼脉络膜脱离,经激素抗炎治疗逐步吸收.20G组手术后出现多量的眼内出血4只眼,2只眼需再次冲洗手术.结论 23G玻璃体切割手术治疗增殖性糖尿病视网膜病变所致玻璃体出血与20G玻璃体切割手术相比同样有效,完成手术所耗时间更短,但存在术后短期低眼压情况.
更多Objective To compare the clinical outcomes and complications between 23-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy.Methods Prospective,randomized,comparative study of 57 eyes underwent 23 and 20 gauge (G) vitrectomy for uncomplicated vitreous hemorrhage due to proliferative diabetic retinopathy.Results The mean surgical times were (74.39±15.61) and (93.96±18.74) minutes in 23-G and 20-G group,which was a significant difference,IOPs in 23-G group 1 day,1 week after surgery were significantly lower than those in 20-G group (P <0.001),there were no significant different macular thickness between 23-G and 20-G group in 1 week,1 month,3 months after surgery.Postoperative visual acuity in 23-G and 20-G group was improved,but there were no significant difference between tow groups.Conclusions The small gauge systems are safe and equally effective than the 20-G system for non-complicated vitreous hemorrhage cases with faster recovery and more comfort for the patient.
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