25G+与27G+微创玻璃体切割术治疗玻璃体积血疗效比较

Comparison of effects of 25G+and 27G+pars plana vitrectomy in the treatment of vitreous hemorrhage

目的比较25G+与27G+微创玻璃体切割术(PPV)治疗玻璃体积血的临床效果。方法选择2019年12月至2022年8月新乡医学院第三附属医院收治的玻璃体积血患者50例(50眼)为研究对象,根据手术方式不同将患者分为25G+组与27G+组,25G+组患者行25G+PPV治疗,27G+组患者行27G+PPV治疗。比较2组患者手术时间与术中并发症情况。分别于术前及术后3个月,应用早期治疗糖尿病视网膜病变研究组(ETDRS)视力表标准检查流程检查2组患者的视力,Callon型非接触眼压计测2组患者的眼压,比较2组患者术后并发症和结膜下出血范围等相关指标。结果25G+组与27G+组患者的性别、年龄、术前视力及眼压等基本资料比较差异无统计学意义(P>0.05)。25G+组患者的玻璃体内手术时间显著短于27G+组(P<0.05)。术后1 d,27G+组患者结膜下水肿出血范围显著小于25G+组(P<0.05)。25G+组与27G+组患者术后1 d、1周、1个月、3个月的ETDRS视力显著高于治疗前(P<0.05);术后1 d、1周、1个月、3个月,2组患者ETDRS视力比较差异无统计学意义(P>0.05)。术后1 d,25G+组患者眼压显著低于27G+组(P<0.05)。术后1周、1个月、3个月,25G+组与27G+组患者眼压比较差异无统计学意义(P>0.05)。术后1 d时,25G+组出现术后一过性低眼压3例,27G+组患者未观察到低眼压。25G+组患者13眼(52.0%)在拔出巩膜穿刺套管时因出现切口渗液而行切口缝合,27G+组均未行巩膜切口缝合。2组患者术中均未出现医源性损伤。术后随访3个月,2组患者均未发现眼内感染及脉络膜脱离等并发症。结论25G+PPV与27G+PPV在治疗玻璃体积血中均能获得较好的临床疗效,且手术安全有效。相较于25G+PPV术式,27G+PPV可显著缩小患者术后结膜下出血水肿范围更小,维持眼压稳定。

Objective To compare the clinical effects of 25G+and 27G+pars plana vitrectomy(PPV)for vitreous hemorrhage.Methods Fifty patients(50 eyes)with vitreous hemorrhage treated in the Third Affiliated Hospital of Xinxiang Medical University from December 2019 to August 2022 were selected as the research subjects.The patients were divided into a 25G+group and a 27G+group according to different surgical methods.Patients in the 25G+group underwent 25G+PPV treatment,and patients in the 27G+group underwent 27G+PPV treatment.The operation time and the incidence of intraoperative complications were compared between the two groups.Before surgery and 3 months after surgery,the visual acuity of patients in the 2 groups was examined by using the standard visual acuity chart of early treatment of diabetic retinopathy study(ETDRS)group,and the intraocular pressure of patients in the 2 groups was measured by using the Callon non-contact tonometer.Postoperative complications and subconjunctival hemorrhage scope of patients in the 2 groups were compared.Results There were no significant differences in gender,age,preoperative visual acuity and intraocular pressure of patients between the 25G+group and the 27G+group(P<0.05).The operation time of patients in the 25G+group was significantly shorter than that in the 27G+group(P<0.05).At 1 day after surgery,the subconjunctival hemorrhage scope of patients in the 27G+group was significantly smaller than that in the 25G+group(P<0.05).Patients in both the 25G+and 27G+groups had significantly better ETDRS visual acuity at 1 day,1 week,1 month and 3 months after surgery compared with before surgery(P<0.05).There was no statistically significant differencein the ETDRS visual acuity of patients between the two groups at 1 day,1 week,1 month and 3 months after surgery(P>0.05).The intraocular pressure of patients in the 25G+group was significantly lower than that in the 27G+group at 1 day after surgery(P<0.05).There was no significant difference in intraocular pressure of patients between the 25G+group and the 27G+group at 1 week,1 month and 3 months after surgery(P>0.05).At 1 day after surgery,transient hypotonia was observed in 3 patients in the 25G+group,while no hypotonia was observed in the 27G+group.In the 25G+group,13 eyes(52.0%)underwent incision suture due to incision seepage when the scleral puncture cannulae were removed,while in the 27G+group,no scleral incision suture was performed.No iatrogenic injury occurred during the operation in both groups.During the 3-month follow-up,no intraocular infection or choroidal detachment was found in both groups.Conclusion Both 25G+PPV and 27G+PPV can achieve better clinical efficacy in treating vitreous hemorrhage,and the operation is safe and reliable.Compared with 25G+PPV,27G+PPV can significantly reduce subconjunctival hemorrhage and edema and stabilize intraocular pressure of patients.