27G+/25G+微创玻璃体切割手术治疗玻璃体视网膜疾病的比较

Comparison of 25-gauge+ and 27-gauge+ micro-invasive vitrectomy for vitreoretinal diseases

摘要:

目的：对比分析25G+与27G+微创玻璃体切割手术治疗玻璃体视网膜疾病的疗效及安全性。

方法：回顾性分析2019-03/2022-04于我院行玻璃体切割手术的玻璃体视网膜病变患者89例89眼的临床资料，根据手术方式分为A组(45例45眼，行25G+微创玻璃体切割手术)和B组(44例44眼，行27G+微创玻璃体切割手术)，分析两组患者术中玻璃体切割时间和手术完成时间、手术前后最佳矫正视力(BCVA)和眼压情况及术后主观舒适度和并发症情况。

结果：两组术中玻璃体切割时间无差异(P>0.05)，但B组手术完成时间短于A组(35.50±14.27min vs 41.73±14.25min，P=0.042)。两组术后BCVA均优于术前(P<0.05)，但两组间无显著差异(P>0.05)。两组术后眼压均低于术前(P<0.05)，且术后1、7d A组眼压略低于B组(P<0.05)。术后1d，A组主观舒适度评分高于B组(6.13±1.20分 vs 3.45±1.17分，P<0.001)； 术后7d，两组主观舒适度评分无差异(2.18±1.01分vs 1.93±0.87分，P=0.215)。随访期间，A组发生切口渗漏7眼(16%)，其中一过性低眼压6眼(13%)，术后出现结膜水肿10眼(22%)； B组未见切口渗漏及一过性低眼压，术后1d发生结膜水肿2眼(4%)。

结论：25G+与27G+微创玻璃体切割手术均可改善玻璃体视网膜病变患者的视力，稳定眼压，且安全，但27G+微创玻璃体切割手术后切口渗漏发生较少，眼压较稳定，手术时间相对缩短，且结膜水肿发生率更低。

Abstract:

AIM: To comparatively analyze the efficacy and safety between 25-gauge(25G+)and 27G+ micro-invasive vitrectomy for the treatment of vitreoretinal diseases.

METHODS: The clinical data of 89 cases(89 eyes)of vitreoretinal disease who received vitrectomy at our hospital from March 2019 to April 2022 were retrospectively analyzed. They were divided into two groups according to surgery. A total of 45 cases(45 eyes)who received 25G+ micro-invasive vitrectomy were included in group A, and 44 cases(44 eyes)who received 27G+ micro-invasive vitrectomy were included in group B. Vitrectomy time, operation time, preoperative and postoperative best corrected visual acuity(BCVA), intraocular pressure, subjective comfort evaluation results and complications of the both groups were analyzed.

RESULTS: There were no differences in vitrectomy time of the two groups(P>0.05), while the operation time of group B was shorter than that of group A(35.50±14.27min vs. 41.73±14.25min, P=0.042). The postoperative BCVA of the two groups were better than that before operation(P<0.05), while there was no significant difference between two groups(P>0.05). The postoperative intraocular pressure of the two groups was lower than that before operation(P<0.05), and it was slightly lower than group B at 1 and 7d after operation(P<0.05). As for the subjective comfort evaluation results, the scores of group A was higher than that of group B at 1d after operation(6.13±1.20 vs. 3.45±1.17, P<0.001); and there were no differences between two groups at 7d after operation(2.18±1.01 vs. 1.93±0.87, P=0.215). During the follow-up, 7(16%)eyes of incision leakage occurred in group A, of which 6(13%)eyes were transient hypotony, and 10(22%)eyes had conjunctival chemosis. In the group B, there was no incision leakage and transient hypotony, while conjunctival chemosis occurred in 2(4%)eyes at 1d after operation.

CONCLUSION: Both 25G+ and 27G+ micro-invasive vitrectomy can improve visual acuity, stabilize intraocular pressure and be safe in patients with vitreoretinal disease. However, 27G+ micro-invasive vitrectomy has less leakage, stable intraocular pressure, shorter operation time and lower incidence of conjunctival chemosis.