Department of Ophthalmology, University Hospital of Grenoble, Joseph Fourier University, Grenoble, France.
Graefes Arch Clin Exp Ophthalmol. 2011 Oct;249(10):1459-68. doi: 10.1007/s00417-011-1645-5. Epub 2011 Apr 16.
To compare the safety and efficacy of 20- and 23-gauge pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RD) with proliferative vitreoretinopathy (PVR) grade B or less.
This comparative nested case-control study included 35 consecutive 23-gauge transconjunctival PPV cases matched (1:1) with 35 cases of 20-gauge PPV (from a prospective cohort of 1,150 patients) for the baseline visual acuity (VA), axial length, lens and macular status, the location and number of breaks, and PVR grade. All patients had complete PPV, cryotherapy, fluid-gas exchange, and a minimum follow-up of 6 months. The exclusion criteria were eyes with previous vitreoretinal surgery, combined vitrectomy and cataract surgery, RD secondary to trauma or macular hole, diabetic retinopathy, aphakic eyes, giant tears, or posteriorly located breaks precluding treatment using transconjunctival cryotherapy.
Baseline examination disclosed pseudophakia in 77.1%, high myopia in 11.4%, 2.7 ± 2.2 retinal breaks/eye, attached macula in 37.1%, and PVR grade B in 24.3% of the cases. The mean operative time and intraoperative complication rate (11.4%) were similar in both groups. In the 23-G group, we noted three cases of iatrogenic retinal tears and one case of choroidal detachment secondary to a dislodgment of the infusion line. Suturing the sclerotomy sites or the conjunctiva was required in 5.7 and 51% of the eyes, respectively. The single reattachment rate was similar in both groups, 74.3% in the 20-G group, and 80% in the 23-G group. The final anatomical success rate was 97% in the two groups. Mean preoperative VA of 1.2 ± 0.9 logMAR improved similarly in both groups to 0.4 ± 0.4 at the 6-month visit. A final vision of 20/40 or better was achieved similarly in 62.9% of the eyes in the 20-G group and 60% in the 23-G group.
Twenty-three-gauge PPV provides anatomical and visual results similar to the 20-G technique for the management of uncomplicated rhegmatogenous RD.
比较 20 号和 23 号巩膜切开式玻璃体切除术（PPV）治疗伴有增殖性玻璃体视网膜病变（PVR）B 级或以下的原发性孔源性视网膜脱离（RD）的安全性和疗效。
这是一项对比嵌套病例对照研究，纳入了 35 例连续接受 23 号经结膜巩膜切开式 PPV 的患者（来自前瞻性队列的 1150 例患者），并匹配（1:1）了 35 例 20 号 PPV 患者，比较了两组的基线视力（VA）、眼轴长度、晶状体和黄斑状态、裂孔位置和数量以及 PVR 分级。所有患者均接受了完整的 PPV、冷凝治疗、眼内液-气交换治疗，并进行了至少 6 个月的随访。排除标准包括：既往玻璃体视网膜手术史、玻璃体切除术联合白内障手术、创伤或黄斑裂孔导致的 RD、糖尿病视网膜病变、无晶状体眼、巨大裂孔或后部裂孔，这些裂孔无法通过经结膜冷凝治疗进行治疗。
基线检查显示，77.1%的患者为假晶状体眼，11.4%的患者为高度近视，每只眼有 2.7±2.2 个视网膜裂孔，37.1%的患者黄斑贴附，24.3%的患者 PVR 分级为 B。两组的平均手术时间和术中并发症发生率（11.4%）相似。在 23-G 组中，我们注意到 3 例医源性视网膜裂孔和 1 例因输液管移位导致的脉络膜脱离。分别有 5.7%和 51%的眼需要缝合巩膜切口或结膜。两组的单次视网膜复位率相似，20-G 组为 74.3%，23-G 组为 80%。两组的最终解剖成功率均为 97%。两组的平均术前视力（1.2±0.9 logMAR）均有相似程度的提高，在 6 个月时分别达到 0.4±0.4。在 20-G 组中，有 62.9%的眼最终视力达到 20/40 或更好，在 23-G 组中，有 60%的眼最终视力达到 20/40 或更好。
23 号巩膜切开式 PPV 为治疗单纯性孔源性 RD 提供了与 20-G 技术相似的解剖学和视觉结果。
