23GTVS与25GTVS治疗复杂性孔源性视网膜脱离的临床疗效观察

Clinical effects of 23G TVS and 25G TVS for complicated rhegmatogenous retinal detachment

目的比较23G、25G经结膜无缝合玻璃体切割手术系统(transconjuctival-sutureless vitrectomy system,TVS)治疗复杂性孔源性视网膜脱离的安全性和有效性。方法回顾性分析2008年1月至2011年6月因复杂性孔源性视网膜脱离在我院行23G TVS患者60例(60眼)及25G TVS患者42例(42眼)的临床资料。对比观察手术效果及手术时间、术后眼压及并发症等。结果 102例患者中,仅2例改行传统玻璃体切割术,其余病例均顺利完成手术。23G TVS组手术时间为35～70min,平均55min;25G TVS组手术时间为40～65min,平均51min;差异无统计学意义(P=0.372)。术后第1天23G TVS组眼压为(9.0±6.1)mmHg(1kPa=7.5mmHg),25G TVS组眼压为(10.0±5.6)mmHg,差异无统计学意义(P=0.420)。23G TVS、25G TVS手术有效率分别为88.3%、83.3%,差异无统计学意义(P>0.05)。23G TVS组术后发生视网膜脱离4例,脉络膜脱离1例,玻璃体积血2例,切口渗漏4例;25G TVS组视网膜脱离2例,玻璃体积血3例,切口渗漏7例;两组术后视网膜脱离、玻璃体积血发生率差异均无统计学意义(P=0.689、0.383),切口渗漏发生率差异有统计学意义(P=0.023)。结论在治疗复杂性孔源性视网膜脱离方面,23G TVS较25G TVS能有效防治切口渗漏的发生,其他并发症发生率无差异。[眼科新进展,2013,33(1):77-79]

Objective To investigate the safety and efficacy of primary 23-Gauge （23G） transconjuctival sutureless vitrectomy system （TVS） and 25-Gauge （25G） TVS for complicated rhegmatogenous retinal detachment. Methods A retrospective study of 60 cases （50 eyes） with 23G TVS and 42 cases （42 eyes） with 25G TVS in our hospi- tal from January,2008 to June ,2011 were made. The surgical effects, surgical time, post- operative intraocular pressure,postoperative complications were compared. Results All surgeries were successfully completed except for 2 cases taking routine vitrectomy. The surgical time in 23G TVS group was from 35 minutes to 70 minutes ,averaged 55 mi- nutes,which in 25G TVS!group was from 40 minutes to 65 minutes, averaged 51 mi- nutes, there was no statistical difference （P = 0. 372 ）. The intraocular pressure at post- operative 1 day in 23G TVS group and 25G TVS group were （9.0 ~5.1 ）mmHg （ 1 kPa = 7.5 mmHg） and （ 10.0 ~ 5.6） mmHg,there was no statistical difference（P =0.420）. Thesurgical effective rate in 23G TVS group and 25G TVS group were 88.3% and 83.3% ,there was no statistical difference（P 〉 0.05 ）. In 23G TVS group ,the retinal detachment occurred in 4 cases,choroidal detachment in 1 case,vitreous hemorrhage in 2 cases,leakage of incision in 4 cases;In 25G TVS group,the retinal detachment occurred in 2 cases,vitreous hemorrhage in 3 cases,leakage of incision in 7 cases, there was no statistical difference in incidence of postoperative retinal detachment and vitreous hemorrhage between two groups （P = 0.589,0. 383 ）, but no statistical difference in incidence of leakage of inci- sion （P = 0.023 ）. Conclusion In treatment of complicated rhegmatogenous retinal detachment,23 G TVS has better effect on r）reventing leaka^e of incision than 25G TVS. but no difference in other comolications.