Department of Ophthalmology, Norfolk and Norwich University Hospital, Norfolk, UK.
Eye (Lond). 2009 May;23(5):1187-91. doi: 10.1038/eye.2008.175. Epub 2008 Jun 6.
To directly compare the per-operative safety and efficacy of the 20- and 23-gauge vitrectomy systems as well as day 1 intraocular pressure (IOP).
Data were collected on 50 consecutive vitrectomy cases performed using the 20-gauge system and 23-gauge sutureless vitrectomy. All surgeries were carried out by one surgeon (RLB) at a single centre. Data collected prospectively included indication for surgery, iatrogenic retinal tears, and operating times.
Most common indications for surgery were macular hole, rhegmatogenous retinal detachment, diabetic vitreous haemorrhage (no tractional retinal detachment), and macular pucker. Intraocular tamponade with air, sulphur hexafluoride (SF6), hexafluoroethane (C2F6) or octafluoropropane (C3F8), or silicone oil was used in 25 patients in the 20-gauge group and 46 patients in the 23-gauge group. One scleral port required suture in patients who underwent 23-gauge vitrectomy (0.67%). Every 20-gauge patient had all the three ports sutured. The mean first day IOP was 22.88 mm Hg in the 20-gauge vs 17.58 mm Hg in the 23-gauge (P<0.001). Four patients in the 20-gauge group had an IOP >40 mm Hg compared to none in the 23-gauge group. In contrast, four patients had postoperative hypotony in the 23-gauge group compared to none in the 20-gauge group. The mean operating time for all the 50 cases in each group was 39.4 (20 gauge) vs 29 min (23 gauge) P<0.001.
Our study indicates less risk of considerably raised IOPs and reduced surgical operating time with the 23-gauge system. Additional advantages observed included faster wound healing, diminished conjunctival scarring, improved patient comfort, and decreased postoperative inflammation.
直接比较 20 号和 23 号玻璃体切割系统的术中安全性和疗效，以及第 1 天的眼内压（IOP）。
收集了 50 例连续使用 20 号系统和 23 号无缝线玻璃体切割术进行玻璃体切割的病例数据。所有手术均由一位医生（RLB）在一家中心进行。前瞻性收集的数据包括手术指征、医源性视网膜裂孔和手术时间。
最常见的手术指征是黄斑裂孔、孔源性视网膜脱离、糖尿病性玻璃体出血（无牵引性视网膜脱离）和黄斑前膜。20 号组 25 例和 23 号组 46 例患者分别采用空气、六氟化硫（SF6）、六氟乙烷（C2F6）或八氟丙烷（C3F8）或硅油进行眼内填塞。23 号玻璃体切割术中有 1 例巩膜切口需要缝合（0.67%）。每例 20 号患者的三个切口均需缝合。20 号组第 1 天平均眼压为 22.88mmHg，23 号组为 17.58mmHg（P<0.001）。20 号组有 4 例患者眼压>40mmHg，而 23 号组无 1 例。相比之下，23 号组有 4 例术后发生低眼压，而 20 号组无 1 例。两组各 50 例患者的平均手术时间分别为 39.4 分钟（20 号）和 29 分钟（23 号）（P<0.001）。
我们的研究表明，23 号系统眼压升高的风险较低，手术时间较短。观察到的其他优点包括更快的伤口愈合、减少结膜瘢痕、提高患者舒适度和减少术后炎症。
