20-G与23-G玻璃体切割术治疗视网膜脱离的对比分析

摘要

Objective To analyze the clinical outcomes of 23-gauge vitrectomy and 20-gauge vitrectomy for the treatment of retinal detachment. Methods One hundred and thirty patients(130 eyes) with retinal detachment were enrolled in the study. We treated 70 patients(70eyes) with 23-gauge minimally invasive vitrectomy ( group A) and 60 patients(60 eyes) with 20-gauge vitrectomy ( group B). The duration of operation and occurrence of complications during operation were recorded. Patients were followed up for 6 to 12 months after operation to observe occurrence of retinal reattachment, visual acuity( logMAR visual acuity) , intraocular pressure and occurrence of complications. The data were statistically analyzed. Results There was significant difference in the duration of surgery between the group A and group B[ (60±12) min vs (71 ±16) min,P < 0. 05 ]. The main complication during operation was iatrogenic retinal hole, with 2 eyes in the group A and 1 eye in the group B. Lenses damage occurred in 7 eyes in the group A while 18 eyes in the group B( P < 0. 05 ) . The mean of intraocular pressure( IOP) of the group B was significantly higher than that of the group A on the first day after surgery[ (21. 4 ± 8. 2) mmHg vs ( 12. 3 ±4. 2)mmHg,P < 0. 05) ]. However,the differences were not significant 1 week and 1 month post-operation. At the last follow-up post-operation retinal reattachment was found in 67 eyes with retinal reattachment in the group A( reattachment rate was 95. 71% ) compared to 58 eyes in the group B( reattachment rate was 96. 67% ) . No significant difference was found in retinal reattachment rate and visual acuity between the two groups. Conclusions The clinical outcomes of the two vitrectomy systems are similar. However,23-gauge vitrectomy may be better than 23-gauge vitrectomy in regard of post-operative intraocular pressure and complications.%目的 比较20-G与23-G玻璃体切割术治疗视网膜脱离的临床疗效.方法 130例有晶状体眼视网膜脱离患者分别接受23-G微创玻璃体切割术(A组,70例70眼)和20-G玻璃体切割术(B组,60例60眼).记录手术时间和术中并发症的发生情况.术后随访6～12个月,观察术后视网膜复位、视力(logMAR视力)、眼压及并发症的发生情况,对相关记录指标进行统计学分析比较.结果 A组和B组的手术时间分别为(60±12)min和(71±16)min,差异有统计学意义(P<0.05).术中主要并发症为医源性裂孔,A组为2眼,B组为1眼;A组有7眼、B组有18眼发生晶状体损伤,差异有统计学意义(P<0.05).术后第一天,B组眼压(21.4±8.2)mmHg明显高于A组(12.3±4.2)mmHg,差异有统计学意义(P<0.05),术后1周和1月,两组间眼压差异无统计学意义(P>0.05).术后末次随访结果显示A组视网膜复位67例(复位率95.71%),B组视网膜复位58眼(复位率96.67%),两组视网膜复位率和末次随访的视力比较差异均无统计学意义(P>0.05).结论 23-G与20-G玻璃体切割术治疗视网膜脱离的临床疗效相近,在术后眼压及并发症方面,23-G显示出更好的优越性.