Shao Yan, Dong Li-Jie, Zhang Yan, Liu Hui, Hu Bo-Jie, Liu Ju-Ping, Li Xiao-Rong
Tianjin Medical University Eye Hospital; Tianjin Medical University Eye Institute; The College of Optometry & Ophthalmology, Tianjin 300384, China.
Int J Ophthalmol. 2015 Jun 18;8(3):528-33. doi: 10.3980/j.issn.2222-3959.2015.03.16. eCollection 2015.
To determine the difference of surgical induced astigmatism between conventional 20-gauge sutured vitrectomy and 23-gauge transconjunctival sutureless vitrectomy, and the influence of corneal pachymetry and intraocular pressure (IOP) on surgical induced astigmatism in diabetic patients.
This retrospective, consecutive case series consisted of 40 eyes of 38 diabetic subjects who underwent either 20-gauge or 23-gauge vitrectomy. The corneal curvature and thickness were measured with Scheimpflug imaging before surgery and 1wk; 1, 3mo after surgery. We compared the surgical induced astigmatism (SIA) on the true net power in 23-gauge group with that in 20-gauge group. We determined the correlation between corneal thickness change ratio, IOP and SIA measured by Pentacam.
The mean SIAs were 1.082±0.085 D (mean±SEM), 0.689±0.070 D and 0.459±0.063 D at postoperative 1wk; 1, 3mo respectively in diabetic subjects. The vitrectomy induced astigmatisms were declined significantly with time (F 2,36=33.629, P=0.000) postoperatively. The 23-gauge surgery group induced significantly less astigmatism than 20-gauge surgery group (F -1,37=11.046, P=0.020). Corneal thickness in diabetes elevated after surgery (F 3,78=10.532, P=0.000). The linear regression analysis at postoperatively 1wk went as: SIA=-4.519+4.931 change ratio (Port3) +0.026 IOP (R(2)=0.46, P=0.000), whereas the rate of corneal thickness change and IOP showed no correlation with the change of astigmatism at postoperatively 1 and 3mo.
There are significant serial changes in both 20-gauge and 23-gauge group in diabetic subjects. 23-gauge induce less astigmatism than 20-gauge and become stable more rapidly than 20-gauge. The elevation of corneal thickness and IOP was associated with increased astigmatim at the early postoperative stage both in 23-gauge and 20-gauge surgery group.
确定传统20G缝合式玻璃体切除术与23G经结膜无缝合玻璃体切除术之间手术诱导散光的差异，以及角膜测厚和眼压（IOP）对糖尿病患者手术诱导散光的影响。
本回顾性连续病例系列研究纳入了38例接受20G或23G玻璃体切除术的糖尿病患者的40只眼。术前及术后1周、1个月、3个月用眼前节分析系统测量角膜曲率和厚度。比较23G组与20G组手术诱导散光（SIA）的真实净度数。确定眼前节分析系统测量的角膜厚度变化率、眼压与SIA之间的相关性。
糖尿病患者术后1周、1个月、3个月时平均SIA分别为1.082±0.085D（平均值±标准误）、0.689±0.070D和0.459±0.063D。玻璃体切除术后诱导散光随时间显著下降（F2,36=33.629，P=0.000）。23G手术组诱导的散光明显少于20G手术组（F-1,37=11.046，P=0.020）。糖尿病患者术后角膜厚度增加（F3,78=10.532，P=0.000）。术后1周的线性回归分析结果为：SIA=-4.519+4.931变化率（Port3）+0.026眼压（R(2)=0.46，P=0.000），而术后1个月和3个月时角膜厚度变化率和眼压与散光变化无相关性。
糖尿病患者20G组和23G组均有显著的系列变化。23G诱导的散光比20G少，且比20G更快趋于稳定。23G和20G手术组术后早期角膜厚度和眼压升高均与散光增加有关。
