23G和20G玻璃体切割手术治疗IEM的对比研究

Therapeutic observation of 23-gauge vs 20-gauge system for surgical removal of idiopathic epimacular membrane

摘要:

目的：比较 23G经结膜无缝线玻璃体手术与传统20G玻璃体手术治疗特发性黄斑前膜（IEM）的疗效。 方法：将2008-03/2011-06在我院诊断为黄斑前膜并需行玻璃体切割的连续病例56例56眼随机分为23G组与20G组，分别行23G及20G玻璃体切割手术。统计分析术后1d，1wk,3mo时最佳矫正视力、眼压、术中术后并发症、手术时间及术后前房炎症反应及眼部刺激征的严重程度，术后随访5～22（平均16）mo。 结果：23 G组术后3mo内平均对数视力log MAR逐步提高，三个时间点分别为1.78±0.94,1.51±0.88,1.48±091，术后第1d,1wk,3mo视力与术前相比有统计学意义(t=3.3917，P=0.003；t=11.1779，P=0.0000;t=4.3424,P=0.0000)；20G组术后平均对数视力也逐步提高，三个时间点分别为2.11±1.00,1.93±1.02,1.64±1.00，术后第1wk,3mo视力与术前相比有统计学意义(t=2.3578,P=0.033；t= 3.5552，P=0.003)。两组术后3mo内三个时间点视力差异均无统计学意义(t=0.9582,P=0.34；t=12761，P=0.211；t=0.4897,P=0.628)。23G组术后3个时间点眼压分别为11.62±9.7,15.86±6.6,16.84±56mmHg，20G组术后3个时间点眼压分别为18.56±7.71,15.33±5.21,14.72±3.56mmHg，两组术后第1d眼压差异有统计学意义（P<0.001）。 23G组平均手术时间41.20±7.47分，少于20G组平均手术时间52.28±7.11分，两者比较差异有统计学意义（P<0.001）。两组术后无视网膜脱离、黄斑前膜复发及眼内炎的发生。23G组术后的炎症反应及刺激症状明显轻于20G组。 结论：23G TSV治疗IEM简化了手术步骤，增加了患者舒适度，提高了手术效率和质量，实现了玻璃体切割手术的微创化，值得应用。

Abstract:

AIM: To compare therapeutic effect in surgical removal of idiopathic epimacular membrane(IEM) with transconjuctival sutureless 23-gauge(23G) vitrectomy and conventional 20-gauge(20G) vitrectomy. METHODS: Fifty-six cases 56 eyes with IEM underwent either 23- or 20-gauge vitrectomy from March 2008 to June 2011. Main outcome measures included visual acuity(VA), intraocular pressure(IOP), operative complications and surgical time．Postoperative mean follow up was 16 months. RESULTS: The VA increased three months after surgery in 23G group. The logMAR at day 1, week 1 and month 3 was 1.78±0.94, 1.51±0.88, 1.48±0.91, respectively. The differences between the three time points and preoperative baseline was significant (t=3.3917, P=0003；t=11.1779, P=0.0000; t=4.3424, P=0.0000). The VA of the three points was logMAR=2.11±1.00, 1.93±102, 164±1.00 respectively in 20G group. The differences between postoperative week 1, month 3 and preoperative baseline was significant(t=2.3578, P=0.033; t=3.5552, P=0.003). The intergroup differences at the three time point was not significant(t=0.9582, P=0.34；t=1.2761, P=0211; t=0.4897, P=0.628). The mean IOP at day 1, week 1 and month 3 in 23G group was 11.62±9.7, 15.86±6.6, 16.84±5.6mmHg while in 20G group was 18.56±7.71, 1533±5.21, 14.72±3.56mmHg, respectively. The differences of IOP at day 1 was significant(P<0.001). The mean surgical time of 23G group 41.20±7.47 minutes was significantly less than that of 20G group(52.28±7.11 minutes, P<0.001). No endophthalmitis or retinal detachment was found in both 23G and 20G group. Postoperative discomfort and intraocular inflammation were significantly reduced in the 23-gauge group. CONCLUSION: The 23G TSV system is a safe and efficient surgical technique for IEM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing the patients discomfort.