23G和20G玻璃体手术治疗增生型糖尿病视网膜病变的对比观察  

Comparison of 23G and 20G vitrectomy for treatment of proliferative diabetic retinopathy

作　　者：沈玺[1] 徐建敏[1] 李娜[1] 王晶[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院眼科,200025

出　　处：《中华眼底病杂志》2012年第3期232-236,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：上海市市级医院新兴前沿技术联合攻关项目（SHDC12010110）

摘　　要：目的对比观察20G和23G玻璃体手术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法前瞻性随机对照研究。具有玻璃体手术指征的PDR患者126例142只眼纳入研究。所有患者均行视力、眼压、间接检眼镜、眼B型超声、泪膜破裂时间（BUT）、基础泪液分泌试验（SIT）以及角膜前后表面6mm区域散光度、散光轴向检查。采用随机数字表法，将患者分为20G手术组和23G手术组，分别为66例74只眼和60例68只眼。手术后平均随访时间，20G手术组15．0个月，23G手术组12．5个月；以手术后6个月为评价两组疗效的时间点。对比分析两组患者手术中并发症、手术时间以及手术后视力、眼压、并发症及BUT、SIT、角膜前后表面散光度和散光轴向变化。结果手术后6个月随访时，20G手术组74只眼中，视力≥O．05者49只眼，占本组患眼的66．2％；23G手术组68只眼中，视力≥O．05者47只眼，占本组患眼的69．1%。两组间视力≥O．05者比较，差异无统计学意义（x2=0．14，P〉0．05）。20G手术组、23G手术组，手术中发生医源损伤18、7只眼，分别占本组患眼的24．3％、10．3％。两组间手术中医源性损伤发生率比较，差异有统计学意义（x2=4．81，P〈0．05）。20G手术组、23G手术组平均手术时间分别为（69．0±8．2）、（51．0±6．3）min。两组间平均手术时间比较，差异有统计学意义（t=3．65，P〈0．05）。手术后3d，20G手术组、23G手术组发生低眼压3、11只眼，分别占本组患眼的4．1％、14．7％。两组间低眼压发生率比较，差异有统计学意义（x2=5．85，P〈0．05）。20G手术组、23G手术组发生高眼压或继发性青光眼24、14只眼，分别占本组患眼的32．4％、20．6％，两组间手术后高眼压或继发性青光眼发生率比较，差异无统计学意义（x2=2．54，P〉0．05）。手术后1个月，20G手术组BUT、SIT长度、角Objective To compare the outcomes of 23G and 20G vitrectomy in treatment of proliferative diabetic retinopathy （PDR）. Methods This was a prospective randomized study. One hundred twenty six patients （142 eyes） suffering from PDR with symptoms requiring vitrectomy were randomly divided into 20G vitrectomy group （66 patients, 74 eyes） and 23G vitrectomy group （60 patients, 68 eyes）. Visual acuity, intraocular pressures, indirect ophthalmoscopy, B-scan ultrasound, tear film break up time （BUT）, Sehirmer I test （S I T）, astigmatic power and the astigmatic axial at 6 mm area of anterior and posterior corneal surface were observed and measured before surgery. The follow-up period was 15.0 and 12.5 months separately in 20G and 23G groups. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications, re-operation, and postoperative ocular conditions including changes of astigmatic power and the astigmatic axial measurements were analyzed. Results At last follow up, there was 49 eyes （66.2%） and 47 eyes （69.1%） with visual acuity ≥0.05 in 20G and 23G groups. Comparing visual acuity ≥ 0.05, there was no statistical difference between the groups （x2=0.14, P〉0.05）. The eyes suffering from iatrogenic injuries were 18 （24.3%） and seven （10.3%）. There was obvious difference in iatrogenic injury between the two groups （x2 =4.81, P〈0.05）. The mean surgical times were （69.0±8.2） and （51.0±6.3） minutes in 20G and 23G group, which was significantly different （t=3.65, P〈0.05）. The postoperative third day, hypotony was detected in three （4. 1%） and 11 eyes （14.7%） in 20G and 23G group, which was a significantly different （x2 =5.85, P〈 0.05）. Postoperatively high intraocular pressures were not significantly different between the two groups （X2=2.54, P〈0.05）. There were 24 （32.4%） and 14 eyes （20.6%） in20Gand 23Ggroup. There were significant differences in BUT, S I T, astigma

关 键 词：糖尿病视网膜病变/外科学 玻璃体切除术 对比研究 

分 类 号：R779.6[医药卫生—眼科] R774.1[医药卫生—临床医学]