Kobayashi Wataru, Kunikata Hiroshi, Abe Toshiaki, Nakazawa Toru
From the *Department of Ophthalmology and †Division of Clinical Cell Therapy, Tohoku University Graduate School of Medicine, Sendai, Japan.
Asia Pac J Ophthalmol (Phila). 2014 Nov-Dec;3(6):331-6. doi: 10.1097/APO.0000000000000031.
To compare the anatomical and functional outcomes of 25- and 23-gauge microincision vitrectomy surgery (25G and 23G MIVS) instrumentation with the standard 20G pars plana vitrectomy (20G PPV) system in the treatment of primary macular hole retinal detachment (MHRD).
A retrospective comparative study.
Forty-six eyes of 45 patients with MHRD underwent pars plana vitrectomy from March 1, 2006 to April 31, 2011. Fourteen, 13, and 19 eyes underwent 20G PPV, 23G MIVS, and 25G MIVS, respectively. The analysis included characteristics of the patients, single operation reattachment rate, final reattachment rate, closure rate of the macular hole, and rate of complications. The median follow-up period was 273 days.
Preoperative characteristics were similar in the 3 groups. The single operation success rate was 11 (79%) of 14 for 20G PPV, 10 (77%) of 13 for 23G MIVS, and 14 (74%) of 19 for 25G MIVS (P = 0.95). The closure rate of the macular hole was 9 (64%) of 14 for 20G PPV, 9 (69%) of 13 for 23G MIVS, and 11 (58%) of 19 for 25G MIVS (P = 0.78). One hundred percent of patients achieved final reattachment after multiple surgeries, excluding 2 patients who dropped out during the follow-up period. Rates of visual recovery and complications, including hypotony, were similar for all 3 procedures.
The outcomes of 25G and 23G MIVS for the management of MHRD did not differ significantly from 20G PPV. Microincision vitrectomy surgery may be considered an alternative treatment, even for MHRD.
比较25G和23G微切口玻璃体切除术（25G和23G MIVS）器械与标准20G经平坦部玻璃体切除术（20G PPV）系统在治疗原发性黄斑裂孔性视网膜脱离（MHRD）中的解剖和功能结果。
一项回顾性比较研究。
2006年3月1日至2011年4月31日，45例MHRD患者的46只眼接受了经平坦部玻璃体切除术。其中，分别有14只、13只和19只眼接受了20G PPV、23G MIVS和25G MIVS手术。分析内容包括患者特征、单次手术复位率、最终复位率、黄斑裂孔闭合率及并发症发生率。中位随访期为273天。
3组患者的术前特征相似。20G PPV组14例中有11例（79%）单次手术成功，23G MIVS组13例中有10例（77%），25G MIVS组19例中有14例（74%）（P = 0.95）。20G PPV组14例中有9例（64%）黄斑裂孔闭合，23G MIVS组13例中有9例（69%），25G MIVS组19例中有11例（58%）（P = 0.78）。排除2例随访期间失访的患者，所有患者经多次手术后均实现最终复位。所有3种手术的视力恢复率和并发症发生率（包括低眼压）相似。
25G和23G MIVS治疗MHRD的结果与20G PPV相比无显著差异。即使是MHRD，微切口玻璃体切除术也可被视为一种替代治疗方法。
