23G玻璃体切割系统硅油取出30例临床观察

Clinical research of 30 patients underwent active removal of silicon oil with a 23-gauge transconjunctival sutureless vitrectomy system

目的:评价23-Gauge(23G)玻璃体切割系统应用于硅油取出术的安全性和有效性。方法:回顾分析厦门眼科中心2011-02/06连续收治的硅油填充患者58例58眼。30例30眼应用23G玻璃体切割系统,28例28眼应用20G玻璃体切割系统行硅油取出术的临床资料。对两组平均手术时间、硅油取出时间,术前、术后1d;1wk;3,6mo的眼压、最佳矫正视力应用t检验进行比较分析。并对比两组网膜复位情况、并发症及患者舒适度。结果:23G组与20G组平均手术时间分别为21.81±5.64min及35.43±6.42min(t=6.382,P<0.01);平均硅油取出时间分别为6.8±2.76min及6.4±2.41min(t=0.356,P>0.05)。术前、术后1d;1wk;3,6mo平均最佳矫正视力分别为:23G组:0.35±0.21,0.23±0.22,0.26±0.21,0.38±0.27,0.45±0.26;20G组:0.36±0.28,0.10±0.26,0.24±0.27,0.37±0.25,0.41±0.23。术前、术后1wk;3,6mo两组间平均最佳矫正视力差异无统计学意义(t值分别为0.584,0.474,0.583,0.652,P均>0.05);术后1d23G组优于20G组(t=1.753,P<0.05)。术前、术后1d;1wk;3,6mo平均眼压分别为:23G组:18.3±2.21,12.2±2.42,15.2±2.31,16.3±2.97,16.5±2.23;20G组:17.6±2.28,11.1±2.47,16.4±2.37,16.9±2.27,17.4±2.26。术前、术后两组间平均眼压差异无统计学意义(P>0.05);术后1d两组平均眼压均较术前降低,组内差异有统计学意义(t=1.779,1.874,P<0.05),余时间点组内差异无统计学意义(P>0.05)。20G组所有患者均一次性完整取出硅油,23G组2例残留少量硅油小泡,至末次随访时均自行吸收。术后两组视网膜均在位。并发症:术后1d20G组出现2例(7%)低眼压患者,23G组出现4例(13%),均在术后1wk后好转。两组均未出现眼内出血、脉络膜脱离、眼内炎等并发症。23G组与20G组术后眼痛等不适的平均周数分别为0.85±1.23,2.62±1.23wk(t=5.942,P<0.01);术后眼红外观持续平均周数分别为1.15±1.23,4.13±2.38wk(t=5.753,P<0.01)。结论:23G经结膜无缝线玻璃体切割系统应用于硅油取出术安全有效。

AIM： To investigate the safety and efficacy of active removal of silicon oil with a 23- gauge （23G） transconjunctival sutureless vitrectomy system. METHODS： Clinical records of 58 patients （58 eyes） enrolled in Xiamen Eye Center from February 2011 to June 2011 underwent removal of silicon oil with a 23G transconjunctival sutureless vitrectomy system（30 patients 30 eyes） or with standard 20 - gauge （20G） vitrectomy system（28 patients 28 eyes） were reviewed. The mean operation time and silicone oil removal time and the difference between preoperative and postoperative introcular pressure（lOP） levels and best-corrected visual acuity（BCVA） with two kinds system was compared by t- test. Rate of retinal reattachment and complications and postoperative comfort were also compared. RESULTS： The mean operarion time was 21.81 ±5.64 minutes（23G group） versus 35. 43 ± 6. 42 minutes （20G group）, （ t = 6. 382, P〈 0. 01 ）. The mean silicone oil removal time was 6.8±2.76 minutes（23G group） versus 6.4±2.41 minutes（20G group） , （ t= 0. 356, P〉0,05）. The preoperative and postoperative 1 day,1 week, 3 months, 6 months BCVA between the two groups（23G group vs 20G group） were 0. 35±0. 21, 0. 23±0. 22, 0. 26±0. 21, 0.38±0.27,0.45±0.26; 0.36±0.28, 0.10±0.26, 0.24±0.27, 0.37±0.25, 0.41±0.23. A statistically significant improvement in 23G group was found on postoperative day 1 than 20G group （t= 1.753, P〈0.05）. No statistically significant difference were found on preoperative BCVA and postoperative 1 week, 3 months, 6 months（ t= 0.584, 0.474, 0. 583, 0.652, P〉0.05）. The preoperative lOP and postoperative 1 day, 1 week, 3 months, 6 months between the two groups（23G group vs 20G group） were 18.3±2.21, 12.2±2.42, 15.2± 2.31, 16.3±2.97, 16.5±2.23; 17.6±2.28, 11.1±2.47, 16.4± 2.37, 16.9±2.27, 17.4±2.26. No statistically significant difference in the preoperative and postoperative lOP between the two groups （ P 〉 0. 05 ）. A statistically significant decrease in postoperative lOP was found on day1 in each group （t= 1. 779, 1. 874, P〈0.05）. No statistically significant difference of postoperative lOP was found on 1 week, 3 months, 6 months was recorded in each group（P〉0.05）. Silicon oil was completely removed in 20G group. Two patients in 23G group remained a little silicon oil bubbles, and were absorbed postoperative 6 months. Retinal reattachment was achieved in all cases. Postoperative hypotony （ 〈 8mmHg ） was seen on postoperative day 1 in two groups, 20G group 2 eyes （7.14%） versus 23G group 4 eyes（13. 33%）, but all resolved spontaneously within 1 week. No other postoperative complications, such as vitreous hemorrhage, choroidal detachment, endophthalmitis, were noted on examinations during follow-up. Mean number of weeks discomfort of the eye after the operation： 0.85±1.23（23G group）vs2.62±1.23（20G group）, （t=5.942, P〈0.01）. Mean number of weeks the eye looked reddish after the operation： 1. 15 ± 1. 23 （23G group） vs 4. 13± 2. 38 （20G group） ,（ t=5.753, P〈0.01 ）. CONCLUSION：Active removal of silicone oil through a 23G transconjunctival sutureless vitrectomy system is safe and effective.