摘要目的 对比观察23G和25G+玻璃体切割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.行玻璃体切割手术治疗的PDR患者57例75只眼纳入研究.所有患者均行视力、眼压、前置镜、眼B型超声等检查.采用随机数字表法将患者分为23G手术组和25G+手术组,前者30例39只眼,后者27例36只眼.分别行23G玻璃体切割手术和25G+玻璃体切割手术.记录手术时间,并观察手术中医源性损伤的发生情况.23G手术组、25G+手术组手术后平均随访时间分别为10.0、8.5个月.以手术后3个月为疗效判定时间点,观察视力、眼压及并发症的发生情况.结果 23G手术组、25G+手术组平均手术时间分别为(53.35±7.42)、(49.16±5.17) min,两组平均手术时间比较,差异有统计学意义(t=4.37,P＜0.05).23G手术组、25G+手术组手术中发生医源性损伤者分别为11、5只眼,两组手术中发生医源性损伤的眼数比较,差异有统计学意义(x2=4.93,P＜0.05).23G手术组、25G+手术组手术后视力均较手术前明显提高,两组手术前后视力比较,差异均有统计学意义(x2=16.81、18.29,P＜0.05).两组手术后视力≥0.05的眼数比较,差异无统计学意义(x2=0.13,P＞0.05).23G手术组、25G+手术组发生早期低眼压分别为7、3只眼,两组发生早期低眼压的眼数比较,差异有统计学意义(x2=5.67,P＜0.05).结论 与23G玻璃体切割手术比较,25G+玻璃体切割手术治疗PDR可缩短手术时间,减少手术中医源性损伤的发生,降低手术后早期低眼压发生率.

abstractsObjective To compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR).Methods This is a prospective randomized study.Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients,39 eyes) and 25G+ vitrectomy group (27 patients,36 eyes).Visual acuity,intraocular pressures,ophthalmoscopy,B-scan ultrasound was examined before surgery.The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively.Intraoperative complications,operation time,postoperative visual acuity,intraocular pressure,postoperative complications and postoperative ocular conditions were analyzed.Results The mean surgical times were (53.35± 7.42)minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively,and the difference was significant (t=4.37,P＜0.05).Iatrogenic injuries occurred in 11 eyes (28.21％) and 5 (13.89％) eyes in 23G and 25G + group respectively,and the difference was significant (x2 =4.93,P＜0.05).The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (x2=16.81,18.29; P＜0.05).At last follow-up,there was 25 eyes and 24 eyes with visual acuity ≥ 0.05 in 23G and 25G+ groups respectively,and the difference was not significant (x2 =0.13,P＞0.05).Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively,and the difference was significant (x2 =5.67,P＜0.05).Conclusion 25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications.