目的:评价23-Gauge (23G)玻璃体切割系统应用于硅油取出术的安全性和有效性。方法:回顾分析厦门眼科中心2011-02/06连续收治的硅油填充患者58例58眼。30例30眼应用23G玻璃体切割系统,28例28眼应用20G玻璃体切割系统行硅油取出术的临床资料。对两组平均手术时间、硅油取出时间,术前、术后1d；1wk；3,6mo的眼压、最佳矫正视力应用t检验进行比较分析。并对比两组网膜复位情况、并发症及患者舒适度。结果：23G组与20G组平均手术时间分别为21.81±564min及35.43±6.42min（t=6.382,P<0.01）；平均硅油取出时间分别为6.8±2.76min及6.4±2.41min（t=0.356,P>0.05）。术前、术后1d；1wk；3,6mo平均最佳矫正视力分别为：23G组：0.35±0.21,0.23±0.22,0.26±0.21,0.38±027,0.45±0.26；20G组：0.36±0.28,0.10±0.26,0.24±0.27,0.37±0.25,0.41±0.23。术前、术后1wk；3,6mo两组间平均最佳矫正视力差异无统计学意义（t值分别为0584,0.474,0.583,0.652,P均>0.05）；术后1d 23G组优于20G组（t=1.753,P<0.05）。术前、术后1d；1wk；3,6mo平均眼压分别为：23G组：18.3±2.21,12.2±2.42,15.2±231,16.3±2.97,16.5±2.23；20G组：17.6±2.28,11.1±2.47,16.4±2.37,16.9±2.27,17.4±2.26。术前、术后两组间平均眼压差异无统计学意义（P>0.05）；术后1d两组平均眼压均较术前降低,组内差异有统计学意义（t=1779,1.874,P<0.05）,余时间点组内差异无统计学意义（P>0.05）。20G组所有患者均一次性完整取出硅油,23G组2例残留少量硅油小泡,至末次随访时均自行吸收。术后两组视网膜均在位。并发症：术后1d 20G组出现2例（7%）低眼压患者,23G组出现4例（13%）,均在术后1wk后好转。两组均未出现眼内出血、脉络膜脱离、眼内炎等并发症。23G组与20G组术后眼痛等不适的平均周数分别为0.85±1.23,2.62±1.23wk（t=5.942,P<0.01）；术后眼红外观持续平均周数分别为1.15±1.23,4.13±2.38wk（t=5.753,P<0.01）。结论:23G经结膜无缝线玻璃体切割系统应用于硅油取出术安全有效。

AIM: To investigate the safety and efficacy of active removal of silicon oil with a 23-gauge(23G) transconjunctival sutureless vitrectomy system. METHODS: Clinical records of 58 patients (58 eyes) enrolled in Xiamen Eye Center from February 2011 to June 2011 underwent removal of silicon oil with a 23G transconjunctival sutureless vitrectomy system(30 patients 30 eyes) or with standard 20-gauge(20G) vitrectomy system(28 patients 28 eyes) were reviewed. The mean operation time and silicone oil removal time and the difference between preoperative and postoperative introcular pressure(IOP) levels and best-corrected visual acuity(BCVA) with two kinds system was compared by t-test. Rate of retinal reattachment and complications and postoperative comfort were also compared.RESULTS: The mean operation time was 21.81±5.64 minutes(23G group)versus 35.43±6.42 minutes(20G group),(t=6.382, P<0.01). The mean silicone oil removal time was 6.8±2.76 minutes(23G group) versus 6.4±2.41 minutes(20G group),(t=0.356, P>0.05). The preoperative and postoperative 1 day,1 week, 3 months, 6 months BCVA between the two groups(23G group vs20G group)were 0.35±0.21, 0.23±0.22, 0.26±0.21, 0.38±0.27, 0.45±0.26; 0.36±0.28, 0.10±0.26, 0.24±0.27, 0.37±0.25, 0.41±0.23. A statistically significant improvement in 23G group was found on postoperative day 1 than 20G group (t=1.753, P<0.05). No statistically significant difference were found on preoperative BCVA and postoperative 1 week, 3 months, 6 months(t=0.584, 0.474, 0.583, 0.652, P>0.05). The preoperative IOP and postoperative 1 day, 1 week, 3 months, 6 months between the two groups(23G group vs20G group)were 18.3±2.21, 12.2±2.42, 15.2±231, 16.3±2.97, 16.5±2.23; 17.6±2.28, 11.1±2.47, 16.4±2.37, 16.9±2.27, 17.4±2.26. No statistically significant difference in the preoperative and postoperative IOP between the two groups(P>0.05). A statistically significant decrease in postoperative IOP was found on day 1 in each group (t=1.779, 1.874,P<0.05). No statistically significant difference of postoperative IOP was found on 1 week, 3 months, 6 months was recorded in each group(P>0.05). Silicon oil was completely removed in 20G group. Two patients in 23G group remained a little silicon oil bubbles, and were absorbed postoperative 6 months. Retinal reattachment was achieved in all cases. Postoperative hypotony (<8mmHg) was seen on postoperative day 1 in two groups, 20G group 2 eyes (714%) versus 23G group 4 eyes(13.33%), but all resolved spontaneously within 1 week. No other postoperative complications, such as vitreous hemorrhage, choroidal detachment, endophthalmitis, were noted on examinations during follow-up. Mean number of weeks discomfort of the eye after the operation: 0.85±1.23(23G group)vs2.62±1.23(20G group), (t=5.942, P<0.01). Mean number of weeks the eye looked reddish after the operation: 1.15±1.23(23G group)vs4.13±2.38(20G group),(t=5.753, P<0.01).CONCLUSION:Active removal of silicone oil through a 23G transconjunctival sutureless vitrectomy system is safe and effective.

国家自然科学基金资助(No.81000385);福建省卫生 厅青年科研课题(No. 2010-2-119)