23G与25G+玻璃体切割手术治疗视网膜脱离的对比分析

Analysis of 23G and 25G + vitrectomy for retinal detachment

目的:比较23G与25G+玻璃体切割手术治疗孔源性视网膜脱离的临床疗效。方法:回顾性病例研究。回顾47例47眼单纯孔源性视网膜脱离患者分别接受23G玻璃体切割手术(A组27例27眼)和25G+玻璃体切割手术(B组20例20眼)。记录手术时间和术中并发症的发生情况。观察术后视力、眼压及视网膜复位情况,两组术后随访时间分别为3d,1wk,3mo,对相关记录进行统计学分析比较。结果:23G组和25G+组的手术时间分别为50.21±4.52、49.15±5.14min,两组平均手术时间比较,差异无统计学意义(P>0.05)。术中主要并发症为视网膜出血、医源性裂孔,23G组为5眼(其中视网膜出血3眼、医源性裂孔2眼),25G+组为2眼(其中视网膜出血1眼、医源性裂孔1眼),差异有统计学意义(P<0.05)。23G组和25G+组术后视力均较术前提高,两组间术后视力各时间点比较差异均无统计学意义(P>0.05)。23G、25G+两组术后3d低眼压分别为3眼和1眼,差异有统计学意义(P<0.05),但术后1wk和3mo,两组间眼压差异无统计学意义(P>0.05)。术后3mo结果显示23G组视网膜复位26眼(复位率96%),25G+组视网膜复位19眼(复位率95%),差异无统计学意义(P>0.05)。结论:23G与25G+玻璃体切割手术治疗孔源性视网膜脱离的临床疗效相近,但25G+玻璃体切割术可减少术中并发症及降低手术后早期低眼压的发生。

AIM ： To compare the clinical effect of 23 G and 25 G ＋vitrectomy for retinal detachment.METHODS： Forty seven patients with retinal detachment were treated with 23 G vitrectomy（ 27 eyes in 27 cases as group A） and 25 G ＋ vitrectomy（ 20 eyes in 20 cases as group B）. The operation time and the incidence of intraoperative complications were recorded. The occurrence of retinal reposition,visual acuity,intraocular pressure（ IOP） and complications were observed.Postoperative follow-up time of the two groups were 3d,1wk,3mo. The relevant records were statistically analyzed and compared.RESULTS： The operation time of 23 G group and 25 G ＋group were 50. 21 ＋ 4. 52 min,49. 15 ＋ 5. 14 min,respectively and there was no significant difference between the two groups（ P 0. 05）. The main complications were retinal hemorrhage and iatrogenic retinal hole. There were 3eyes with retinal hemorrhage, 2 eyes with iatrogenic retinal hole in 23 G group, and 1 eye with retinal hemorrhage,1 eye with iatrogenic retinal hole in the 25G＋group,and the difference was statistically significant（ P0. 05）. The postoperative visual acuity of 23 G group and25 G ＋ group were significantly improved, and the differences between the two groups were not statistically significant at different time points after operation（ P 0. 05）. The number of eyes with hypotonia in 23 G and 25G＋group were 3 and 1 eyes respectively,the difference was statistically significant（ P 0. 05）. But there were no significant differences between the two groups on IOP at1 wk and 3mo after surgery（ P0. 05）. At the last follow-up,the results showed that 26 eyes（ 96%） with retinalreposition in 23 G group,19 eyes（ 95%） in 25 G ＋ group,the difference was not statistically significant（ P0. 05）. CONCLUSION： The clinical effect of 23 G and 25 G ＋vitrectomy for retinal detachment is similar, but 25 G ＋vitrectomy can reduce incidence of complications and early postoperative lowIOP.