经睫状体平坦部23G免缝合切口硅油取出术的临床研究

Clinical study of silicone removal by sutureless 23G pars plana surgery

目的比较经睫状体平坦部23G免缝合切口硅油取出术与传统20G缝合切口硅油取出术的临床效果。方法回顾性分析行单纯硅油取出术的临床连续病例(硅油填充术前均为孔源性视网膜脱离)共174例(174眼),分为经睫状体平坦部23G免缝合切口(主动式)硅油取出术组(简称23G组,79眼)和经睫状体平坦部常规20G缝合切口(主动式)硅油取出术组(简称20G组,95眼)。记录并分析两组的手术时间、术后视力恢复、眼压变化和并发症情况。结果术后平均随访时间为(11.5±5.5)个月(6～18个月)。23G组平均取油时间为(16.5±4.2)min,20G组为(35.2±7.4)min,两组差异有统计学意义(P<0.01)。两组术后最佳矫正视力比较,差异无统计学意义(P>0.05)。术后1 d和3 d,23G组的眼压均显著低于20G组(P<0.05)。随访期间,23G组结膜炎症的发生率显著低于20G组(P<0.05)。两组术后脉络膜脱离、网膜脱离复发、玻璃体腔混浊和玻璃体积血的发生率比较,差异均无统计学意义(P>0.05)。结论经睫状体平坦部23G免缝合切口硅油取出术与常规20G缝合切口硅油取出术比较,手术时间短,术后反应轻,且术后并发症的发生率无明显差异,具有一定的临床应用前景。

Objective To compare the clinical effects of silicone removal by sutureless 23G pars plana surgery and routine 20G pars plana surgery.Methods One hundred and seventy-four consecutive patients（174 eyes） with rhegmatogenous retinal detachment undergoing single silicone removal were selected,and were divided into sutureless 23G pars plana surgery group（23G group,79 eyes） and routine 20G pars plana surgery group（20G group,95 eyes）.The duration of surgery,visual acuity,intraocular pressure and complications after surgery were recorded and analysed.Results The mean duration of follow-up was（11.5±5.5） months（6 to 18 months）.The mean duration of silicone removal in 23G group was（16.5±4.2） min,while that in 20G group was（35.2±7.4） min,and there were significant differences between two groups（P0.01）.There was no significant difference in best corrected visual acuity between two groups（P0.05）.Intraocular pressure in 23G group was significantly lower than that in 20G group 1 d and 3 d after surgery（P0.05）.The incidence of conjunctival inflammation in 23G group was significantly lower than that in 20G group（P0.05） during follow-up.There was no significant difference in incidences of choroidal detachment,recurrent retinal detachment,vitreous opacity and vitreous hemorrhage between two groups after surgery（P0.05）.Conclusion Compared with routine 20G pars plana surgery,silicone removal by sutureless 23G pars plana surgery is time-saving,with less complications after surgery,which may have definite prospects in clinical application.