20G、23G和25G玻璃体切除术治疗特发性黄斑裂孔的疗效比较。
Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole.
作者信息
Dihowm Fatma, MacCumber Mathew
机构信息
grid.240684.c0000000107053621Graduate College, Rush University Medical Center, Chicago, IL USA.
grid.240684.c0000000107053621Department of Ophthalmology, Rush University Medical Center, Chicago, IL USA.
出版信息
Int J Retina Vitreous. 2015 Jun 26;1:6. doi: 10.1186/s40942-015-0007-6. eCollection 2015.
PURPOSE
To compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice.
METHODS
In this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy.
RESULTS
The MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\126 (20 gauge), 20\100 (23 gauge), and 20\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\60 (20 gauge), 20\69 (23 gauge), and 20\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053).
CONCLUSION
Based on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.
目的
在多外科医生的玻璃体视网膜手术中，比较20G、23G、25G经睫状体平坦部玻璃体切除术（PPV）联合两种不同气体填充治疗特发性黄斑裂孔（MH）的效果。
方法
在这个比较性、回顾性、干预性病例系列研究中，回顾了142只眼/130例患者的病历。符合纳入标准的患者：2005年1月至2012年5月期间，患有2期、3期或4期MH的眼睛，接受了20G、23G或25G PPV、内界膜（ILM）剥除及液气交换，且至少随访6个月。在玻璃体切除术后6个月、1年和2年时，通过光学相干断层扫描（OCT）评估最佳矫正视力（VA）和MH的解剖状态。
结果
一期玻璃体切除术后，MH成功闭合率在20G组为86.5%，23G组为96.4%，25G组为92%。术前VA中位数分别为20/126（20G）、20/100（23G）和20/80（25G）。术后6个月和2年时，三组间VA无显著差异（p分别为0.570和0.054）。然而，术后12个月时，VA中位数分别为20/60（20G）、20/69（23G）和20/40（25G），差异有统计学意义（p = 0.005），可能是由于白内障变化所致。25G PPV组术后最终VA中位数（2年时）为20/40，优于20G和23G PPV组的最终视力结果（分别为20/50和20/55）。差异无统计学意义。MH在96%（C3F8）和88.1%（SF6）时成功闭合（p = 0.063）。两组气体术前VA中位数均为20/100。术后6个月、1年和2年时，两组间VA中位数无显著差异（p分别为0.076、0.343和0.309）。MH在（96.9%）12 - 14%C3F8和（95.3%）15 - 16%C3F8时成功闭合（p = 0.611）。MH在（82.1%）18 - 20%SF6和（96.4%）22 - 26%SF6时闭合（p = 0.053）。
结论
基于本研究结果，20G、23G和25G PPV的MH闭合率和VA结果相似。22 - 26%的SF6或12 - 14%的C3F8可实现最大闭合率。
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