20G与23G玻璃体切割手术治疗后段眼内异物的临床评价

Clinical Assessment of 20G and 23G Vitrectomy for Treatment of Posterior Segment Intraocular Foreign Bodies

【目的】分析20G与23G玻璃体切割手术治疗后段眼内异物的临床疗效,探讨两者有效性及安全性差异。【方法】回顾性病例研究。选取接受不同玻璃体切割手术治疗的后段眼内异物71例71只眼,根据术式不同分为20G玻璃体切割手术组(20G组)及23G玻璃体切割手术组(23G组),前者37例37只眼,后者34例34只眼。对象均予创口缝合,合并外伤性白内障者联合白内障手术,行20G/23G玻璃体切割联合球内异物取出,术中酌情行视网膜激光光凝、冷凝及眼内填充治疗。记录异物取出及视网膜复位情况、手术时间、术后炎症反应及眼部刺激症状、住院时间、最佳矫正视力以及术后并发症等情况,随访至少6个月。【结果】两组眼内异物取出率及初期视网膜复位率均100%;除术后低眼压发生率两组比较差异有统计学意义(P<0.05)外,其余并发症比较差异均无统计学意义(P>0.05)。两组的手术时间、平均住院日、术后炎症反应评分与眼部刺激症状以及两组手术前后的视力分布进行自身比较,差异有统计学意义(P<0.05)。至末次随访,两组各自接受的非计划再次手术例数、视网膜复位情况以及术后视力分布情况比较,差异均无统计学意义(P>0.05)。【结论】20G与23G玻璃体切割手术治疗后段眼内异物均安全有效,两者临床疗效及手术安全性相当;23G组术后低眼压发生率更高,但在缩短手术时间及住院时间、减轻术后炎症反应及眼部刺激症状方面较20G组更有优势。

[ Objective ] To analyze the clinical curative effect of 20G and 23G vitreetomy for posterior segment intraocular foreign bodies, to explore the differences of their efficacy and safety. [Methods] This was a retrospective case study. Select 71 patients （71 eyes） who suffered from posterior segment intraocular foreign bodies and underwent different ways of vitrectomy, according to the way of vitrectomy, the patients were enrolled into 20G vitreetomy group （20G group, 37 patients, 37 eyes） and 23G vitrectomy group （23G group, 34 patients, 34 eyes）. All patients were given wound suture, and patients complicated traumatic cataract should underwent cataract surgery; then were given 20G/23G vitrectomy and extraction of intraction foreign bodies, and （or） be given retinal laser photocoagulation, cryocoagulation, and endotamponade during the procedure. Extraction of intraction foreign bodies and the location of retinal, surgical time, postoperative inflammation and stimulus syndrome, length of hospital stay, the best corrected acuity （BCVA） and other complications after surgery were registered. Minimmn follow-up was 6 months. [ Results ] The rate of extraction of intraction foreign bodies and early retinal reattachment rate were 100% of the two groups. Comparing the complications after surgery between the two groups, the differences had no statistical significance （ all P 〉 0.05 ） except the incidence of postoperative ocular hypotenison. The significant difference was found in the comparison of surgical time, average hospitalized days, postoperative inflam- mation score and stimulus syndrome between the two groups, and there were significant differences when the vision distribution before and after surgery in two groups were self-compared （P 〈 0.05）. At lastest follow up, the differences had no statistical significance when comparing the cases of unplanned surgical reoperation, the location of retinal and the vision distribution between the two groups （ P 〉 0.05 ）. [ Conclusion ] 20G and 23G vitrectomy are both safely and effectively perfoxTned in patients with posterior segment intraocular foreign bodies , the efficacy and safety of them are comparable. There is higher incidence of postoperative ocular hypotension in 23G group, and it has an ascendant than 20G group in shorter surgical time and length of hospital stay, lighter postoperative inflammation and stimulus syndrome.