23G 和 20G 玻璃体切割术治疗增生性镰状细胞视网膜病变的比较 - 临床结果和手术管理。
A comparison of 23-gauge and 20-gauge vitrectomy for proliferative sickle cell retinopathy - clinical outcomes and surgical management.
机构信息
Vitreoretinal Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK.
Medical Retina Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK.
出版信息
Eye (Lond). 2018 Sep;32(9):1449-1454. doi: 10.1038/s41433-018-0127-y. Epub 2018 May 22.
AIMS
To report anatomical and functional outcomes in patients with proliferative sickle retinopathy (PSR) who underwent 23-gauge (23G) and 20-gauge (20G) vitrectomy.
METHODS
Retrospective consecutive case series of patients who underwent vitreoretinal intervention for complications of PSR between April 2009 and February 2015. Operations were performed at a tertiary referral centre, Moorfields Eye Hospital. Visual acuity and anatomical success rates were evaluated for PSR complicated by retinal detachment, tractional vitreous haemorrhage and macular hole. Proliferative diabetic retinopathy cases were excluded.
RESULTS
A total of 71 eyes (63 patients) underwent vitreoretinal surgery for PSR complications with 26 months mean follow-up. Primary indications were: tractional retinal detachment (TRD, n = 17), TRD with rhegmatogenous retinal detachment (n = 16), rhegmatogenous retinal detachment (n = 5, macula-on: 1, macula-off: 4), vitreous haemorrhage (n = 19), epiretinal membrane (n = 6), and full thickness macula hole (n = 8). Thirty-nine cases underwent 20G vitrectomy, and 23G surgery was performed in 32 eyes. Mean best corrected visual acuity (BCVA) improved from pre-operative 1.30 LogMAR to final BCVA of 0.74 LogMAR (p < 0.01, paired t-test). 23G vitrectomy yielded slightly better 32 vs. 25 ETDRS-letter improvement compared with 20G vitrectomy (p = 0.60, NS, unpaired t-test). 23G was associated with fewer per-operative complications (23G, 18% vs. 20G,13%). The subset of 38 eyes with retinal detachment demonstrated 79% primary reattachment rate, and a smaller BCVA improvement of 3 lines (p = 0.07, paired t-test).
CONCLUSIONS
Surgical intervention for complicated PSR can preserve and/or improve vision although the degree of visual acuity stabilisation remains guarded in tractional/rhegmatogenous detachments. 23G vitrectomy may give a better functional outcome with lower per-operative complication rates.
目的
报告接受 23 号（23G）和 20 号（20G）玻璃体切割术治疗增生性镰状细胞性视网膜病变（PSR）患者的解剖和功能结果。
方法
回顾性连续病例系列，纳入 2009 年 4 月至 2015 年 2 月期间在三级转诊中心莫尔菲尔德眼科医院因 PSR 并发症而接受玻璃体视网膜干预的患者。评估伴有视网膜脱离、牵引性玻璃体积血和黄斑裂孔的 PSR 患者的视力和解剖成功率。排除增殖性糖尿病性视网膜病变病例。
结果
共有 71 只眼（63 例患者）因 PSR 并发症接受玻璃体视网膜手术，平均随访 26 个月。主要适应证为：牵引性视网膜脱离（TRD，n=17）、TRD 伴孔源性视网膜脱离（n=16）、孔源性视网膜脱离（n=5，黄斑上：1，黄斑下：4）、玻璃体积血（n=19）、视网膜内膜（n=6）和全层黄斑裂孔（n=8）。39 例患者接受 20G 玻璃体切割术，32 只眼行 23G 手术。最佳矫正视力（BCVA）从术前的 1.30 LogMAR 提高到最终的 0.74 LogMAR（p<0.01，配对 t 检验）。23G 玻璃体切割术较 20G 玻璃体切割术的 32 个 vs. 25 个 ETDRS 字母改善（p=0.60，NS，非配对 t 检验）。23G 相关的术中并发症更少（23G，18%比 20G，13%）。38 只眼视网膜脱离的亚组显示出 79%的初次复位率，BCVA 改善仅为 3 行（p=0.07，配对 t 检验）。
结论
尽管在牵引性/孔源性脱离中视力稳定程度仍值得关注，但治疗复杂 PSR 的手术干预可以保留和/或改善视力。23G 玻璃体切割术可能具有更好的功能结果和较低的术中并发症发生率。
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