27G与25G微创玻璃体切除术术后短期指标对比分析

Comparative study of the short-term results of 27-gauge versus 25-gauge microincision vitrectomy for vitreoretinal diseases

目的:比较27G与25G微创玻璃体切除术治疗玻璃体视网膜疾病术后短期指标,探讨27G微创玻璃体切除术的可行性、安全性及实用性。方法:回顾性分析2016-04/2017-10在我院行27G与25G微创玻璃体切除术治疗玻璃体视网膜疾病患者217例217眼的临床资料,其中27G组135例,25G组82例。分析两组患者手术时间、术中并发症、术后眼部炎症反应、最佳矫正视力(BCVA)恢复及眼压波动等情况。结果:两组患者均顺利完成手术,27G组无患者术中需改为25G玻璃体切除术。25G组手术时间平均56.4±38.9min,27G组45.5±26.1min,差异有统计学意义(t=2.422,P=0.016),但两组中相同疾病的患者手术时间分别比较,差异均无统计学意义(P>0.05)。术后1wk内,25G组结膜充血、前房闪辉及房水细胞累积评分平均为2.4±1.4、0.7±1、0.5±1分,均高于27G组的相应指标的平均累积评分2.1±1.6、0.3±0.6、0.2±0.4分,差异具有统计学意义(P=0.038、0.011、0.046)。术后第7d,25G组BCVA(Log MAR)较术前改善-0.4±0.9,27G组BCVA(Log MAR)较术前改善-0.2±0.9,差异无统计学意义(t=-1.636,P=0.103)。术后1wk内,25G组发生一过性低眼压16眼(19.5%),27G组21眼(15.6%),差异无统计学意义(χ2=0.565,P=0.452);去除硅油填充的病例后,25G组眼压波动(3.59±0.69mm Hg)与27G组(3.58±0.47mm Hg)比较,差异无统计学意义(t=0.007,P=0.995)。结论:27G微创玻璃体切除术可用于多种视网膜玻璃体疾病的治疗,具有创伤小、手术反应轻等特点,是治疗玻璃体视网膜疾病的一种安全、实用的手术方式。

AIM：To compare the short-term surgical results of 27-gauge（27G）with 25-gauge（25G）microincision vitrectomy surgery（MIVS）for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS. METHODS：Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity（BCVA, LogMAR）recovery and intraocular pressure fluctuation. RESULTS：All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56.4±38.9 min, which was significant longer than that of 27G group（45.5±26.1 min, t=2.422, P=0.016）. However, when comparing the surgical time for each category of disease, there were no significant differences observed（P〉0.05）. Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group（2.1±1.6, 0.3±0.6, and 0.2±0.4）, with significant differences（P=0.038, P=0.011, P=0.046 respectively）. The improvement of BCVA was -0.4±0.9 in 25G group, and -0.2±0.9 in the 27G groups respectively（t=-1.636, P=0.103）. The rate of transient ocular hypotony of the 25G vitrectomy was 19.5%（16 eyes）, which was higher than that of the 27G group without significant difference（15.6%, 21 eyes; χ2=0.565, P=0.452）. When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group（3.59±0.69mmHg）and the 27G group（3.58±0.47mmHg; t=0.007, P=0.995）. CONCLUSION： The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.