Valmaggia C
Augenklinik, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Klin Monbl Augenheilkd. 2007 Apr;224(4):292-6. doi: 10.1055/s-2007-962957.
The sutureless pars plana vitrectomy (ppv) using a 25-gauge instrumentation is a minimally invasive technique which is mainly performed for procedures that do not require extensive vitreous dissection. In a consecutive case series with retrospective collection of data, the advantages and the risks of this technique are discussed in comparison with the conventional 20-gauge ppv for patients with idiopathic epiretinal membranes.
Between July 2003 and November 2004, 64 consecutive patients (26 men, 38 women, mean age: 72 years) were treated with a 20-gauge ppv, and between December 2004 and January 2006, 75 consecutive patients (42 men, 33 women, mean age: 70.4 years) were treated with a 25-gauge ppv. The patients were classified into three groups: ppv combined with phacoemulsification (group 1), ppv in pseudophakic eyes (group 2), or ppv without phacoemulsification (group 3). There were postoperative controls after at least 1, 30 and 180 days.
The visual acuity improves quicker in the groups 1 and 2 of the 25-gauge ppv compared with the 20-gauge ppv due to less postoperative inflammation and to the practical absence of postoperative astigmatism. In the group 3, after using either a 25-gauge or a 20 gauge ppv, the development of a postoperative cataract restrained the improvement of the visual acuity. The following postoperative complications were noticed using the 25-gauge ppv: transitory hypotonia with an eye pressure < 5 mmHg (9 cases) and with attendant choroidal detachment (3 cases), macular oedema (1 case), and endophthalmitis (1 case); using the 20-gauge ppv: transitory hypertonia (9 cases), macular oedema (2 cases), and retinal detachment (3 cases).
The sutureless 25-gauge ppv is advantageous for a quick postoperative recovery of the visual acuity, and may be well combined with cataract surgery. Nevertheless, this technique involves risks and its further evaluation, especially in comparison using a 23-gauge ppv, is indicated.
使用25G器械的无缝合玻璃体切除术（PPV）是一种微创技术，主要用于不需要广泛玻璃体切割的手术。在一个回顾性收集数据的连续病例系列中，与传统的20G PPV相比，讨论了该技术在特发性视网膜前膜患者中的优势和风险。
2003年7月至2004年11月，64例连续患者（26例男性，38例女性，平均年龄：72岁）接受了20G PPV治疗，2004年12月至2006年1月，75例连续患者（42例男性，33例女性，平均年龄：70.4岁）接受了25G PPV治疗。患者分为三组：PPV联合超声乳化术（第1组）、人工晶状体眼的PPV（第2组）或不进行超声乳化术的PPV（第3组）。术后至少在1天、30天和180天后进行检查。
25G PPV的第1组和第2组视力改善比20G PPV更快，这是由于术后炎症较少且几乎没有术后散光。在第3组中，使用25G或20G PPV后，术后白内障的发展抑制了视力的改善。使用25G PPV观察到以下术后并发症：眼压<5 mmHg的暂时性低眼压（9例）及伴有脉络膜脱离（3例）、黄斑水肿（1例）和眼内炎（1例）；使用20G PPV：暂时性高眼压（9例）、黄斑水肿（2例）和视网膜脱离（3例）。
无缝合25G PPV有利于术后视力快速恢复，并且可能与白内障手术很好地结合。然而，该技术存在风险，需要进一步评估，尤其是与23G PPV进行比较。
