糖尿病视网膜病变23G和20G玻璃体手术

The 23G and 20G vitrectomy for patients with diabetic retinopathy

目的 对比观察23G和20G玻璃体手术治疗增生型糖尿病视网膜病变（PDR）的临床结果和并发症.方法 接受玻璃体切除手术治疗的PDR 52例（64只眼）纳入本回顾性对比研究.按其所接受的手术方式分为23G微创玻璃体切除手术组（23G组）和20G玻璃体切除手术组（20G组）,分别为32例（40只眼）和20例（24只眼）.手术后随访6个月,对比分析两组的最佳矫正视力,眼压及术中术后并发症情况.结果 两组术后1,3和6个月最佳矫正视力均比术前有显著提高（χ2=20.32,22.56,18.23,P＜0.01）.23G组术后第一天的眼压低于术前眼压（t=2.75,P＜0.01）.23G组的手术时间短于20G组（t=2.71,P=0.01）.除23G组有9只眼（22.5％）发生早期术后低眼压（与20G组比较,χ2 =4.56,P=0.03）,两组术中术后并发症情况无明显差异.结论 23G微创玻璃体切除手术治疗PDR的有效性与20G玻璃体切除手术基本相同,两者术中术后并发症情况差异无统计学意义.

Objective To compare the clinical outcomes and complications between 23-gauge and 20-gauge transconjunctival sutureless vitrectomy for patients with proliferative diabetic retinopathy. Methods 64 eyes of 52 consecutive patients who underwent diabetic vitrectomy were enrolled in this retrospectively comparative study. 40 eyes of 32 patients underwent 23G microincision vitrectomy（23G group）. 24 eyes of 20 patients underwent 20G vitrectomy （20G group）. The follow-up time was 6 months. The best corrected visual acuity （BCVA）, intraocular pressure （IOP）, and incidence of intraoperative and postoperative complications were compared. Results BCVA of both groups at postoperative 1,3 and 6 months improved significantly compared with the preoperative BCVA （χ2 =20. 32,22. 56,18.23 ,P 〈0.01 ）. The IOP of the 23-gauge group at postoperative day 1 was lower than the preoperative IOP （ t = 2. 75, P 〈 O. O1 ）. The Operating time of 23-gauge group was shorter than the 20-gauge group （ t = 2. 71 ,P 〈 0.01 ）. There was no significant difference in the incidence of intraoperative and postoperative complications except transient postoperative hypotony, which occurred in 9 eyes （22.5%） of the 23-gauge group （χ2 = 4. 56, P = 0.03 ）. Conclusion 23-gauge transconjunctival sutureless vitrectomy appears to be as effective as 20-gauge vitrectomy for proliferative diabetic retinopathy. There is no significant difference between two methods in intraoperative and postoperative complications.