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

摘要:

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(LogMAR)较术前改善-0.4±0.9，27G组BCVA(LogMAR)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±0.69mmHg)与27G组(3.58±0.47mmHg)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。

Abstract:

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.