23G和25G玻璃体切除术治疗增殖性糖尿病视网膜病变比较

Comparison of 23G and 25G vitrectomy used for proliferative diabetic retinopathy

目的 分析23G和25G玻璃体切除术治疗增殖性糖尿病视网膜病变（PDR）的临床效果,手术操作及并发症.方法 前瞻性随机对照研究.对2012年9月至2013年3月在天津医科大学眼科医院确诊并接受玻璃体切除术的PDR患者83例90只眼,数字表法随机分为23G组47只眼,25G组43只眼,分别行23G和25G玻璃体切除术,术后6个月为随访终点.对患者手术过程、最佳矫正视力（BCVA）、眼压及并发症等进行比较,并应用SPSS17.0进行统计分析.结果 25G组手术时间较长,费用较高,23G组术后缝合较多;23G组术后1、3个月和6个月BCVA≥0.02的患眼数分别占31.9％（15/47）、55.3％ （26/47）和61.7％ （29/47）,仅术后3个月和1个月比较差异有统计学意义（χ^2=5.23,P ＜0.05）;25G组术后1、3和6个月BCVA≥ 0.02的患眼数分别占27.9％ （12/43）、53.5％（23/43）和58.1％ （25/43）,仅术后3个月和1个月比较差异有统计学意义（χ^2=5.83,P＜0.05）;术后第1天,25G组眼压高于23G组,差异有统计学意义（F=7.65,P＜0.05）,1周内眼压均恢复正常.医源性裂孔、术后炎症反应两组比较差异无统计学意义（χ^2=0.71,0.54;P＞0.05）.结论 对于PDR这样的复杂疾病,25G与23G玻璃体切除术相比同样是安全有效地手术方式,两者都能达到理想的治疗效果.

Objective To compare the clinical outcomes,operative process and complications of 23G and 25G vitrectomy for proliferative diabetic retinopathy （PDR）.Methods A prospective randomized controlled study.Ninety eyes of 83 patients with PDR were enrolled and randomly divided into 23G group （47 eyes） and 25G group （43 eyes）,and underwent 23G or 25G vitrectomy respectively.The sixth months after operation was selected as the last follow-up visit and the best corrected visual acuity,intraocular pressure and postoperative complications of the two groups were compared.SPSS17.0 was used for statistic analysis.Results The surgery time was longer and the expenditure was higher in 25G group,but more patients needed sutures in 23G group.In 23G group,the number of eyes with BCVA≥0.02 at postoperative 1 month,3 and 6 months were 31.9%（15/ 47）,55.3%（26/47） and 61.7%（29/47）,respectively,and only the difference between 3 months and 1 month was significant （χ^2=5.23,P 〈0.05）.In 25G group,the number of eyes with BCVA≥0.02 at postoperative 1 month,3 and 6 months were 27.9%（12/43）,53.5%（23/43） and 58.1%（25/43）,respectively,and only the difference between 3 months and 1 month was significant （χ^2=5.83,P 〈0.05）.The intraocular pressure was significantly higher in 23G group than 25 G group on the first day post operation （F =7.65,P 〈0.05）,but they all became normal within 1 week.There was no significant difference in iatrogenic tear and postoperative inflammatory reaction between the two groups （χ^2=0.71,0.54; P 〉0.05）.Conclusions In treatment of complicated diseases such as PDR,25G vitrectomy is also an effective and safe method compared with 23G,both of them can achieve ideal therapeutic effect.