Naruse Zeon, Shimada Hiroyuki, Mori Ryusaburo
Miyahara Ophthalmological Clinic, Saitama City, Saitama, Japan.
Department of Ophthalmology, Nihon University Hospital, 1-6 Surugadai, Kanda, Chiyodaku, Tokyo, 101-8309, Japan.
Int Ophthalmol. 2019 Sep;39(9):1973-1980. doi: 10.1007/s10792-018-1030-z. Epub 2018 Oct 4.
To compare postoperative outcomes of 27-gauge (G) and 25-G vitrectomy conducted as day surgery for proliferative diabetic retinopathy (PDR).
One hundred eighty-five consecutive PDR patients (185 eyes) who underwent primary vitrectomy (27-G in 64 eyes, 25-G in 121 eyes) were analyzed.
The 27-G and 25-G groups did not differ significantly in preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, age, or preoperative intraocular pressure. The proportions of simultaneous cataract surgery (27-G vs. 25-G: 59.4% vs. 62.4%) and air-filled eyes (76.6% vs. 85.1%) were not significantly different between two groups. Both groups showed significant improvement in ETDRS score at postoperative 1, 3, and 6 months (all, P < 0.0001). Mean gain in ETDRS score from baseline was apparently better in 27-G group than in 25-G group at 1, 3, and 6 months, but there were no significant differences (1 month: 20.3 vs. 13.1 letters, P = 0.0703; 3 months: 22.9 vs. 17.5 letters, P = 0.1561; 6 months: 24.3 vs. 19.3 letters, P = 0.3313). Operation time was apparently longer for 27-G vitrectomy, but there was no significant difference (54.0 vs. 51.1 min, P = 0.3676). The same was observed for postoperative intraocular pressure at postoperative day 1 (19.7 vs. 18.1 mmHg, P = 0.1353). Incidence of postoperative retinal detachment (1.6% vs. 0.8%) and reoperation due to vitreous hemorrhage (6.3% vs. 6.6%) was not different between two groups.
The 27G system is as safe and as useful as the 25G system when used for PDR and can be expected to achieve earlier recovery of postoperative visual acuity.
比较27号（G）和25G玻璃体切割术作为日间手术治疗增殖性糖尿病视网膜病变（PDR）的术后效果。
分析185例连续接受初次玻璃体切割术的PDR患者（185只眼）（64只眼采用27G，121只眼采用25G）。
27G组和25G组在术前糖尿病视网膜病变早期治疗研究（ETDRS）评分、年龄或术前眼压方面无显著差异。两组同时进行白内障手术的比例（27G组对25G组：59.4%对62.4%）和眼内填充气体的比例（76.6%对85.1%）无显著差异。两组在术后1、3和6个月时ETDRS评分均有显著改善（均P < 0.0001）。在1、3和6个月时，27G组ETDRS评分相对于基线的平均增加明显优于25G组，但无显著差异（1个月：20.3对13.1字母，P = 0.0703；3个月：22.9对17.5字母，P = 0.1561；6个月：24.3对19.3字母，P = 0.3313）。27G玻璃体切割术的手术时间明显更长，但无显著差异（54.0对51.1分钟，P = 0.3676）。术后第1天的术后眼压情况也是如此（19.7对18.1 mmHg，P = 0.1353）。两组术后视网膜脱离的发生率（1.6%对0.8%）和因玻璃体出血再次手术的发生率（6.3%对6.6%）无差异。
27G系统用于PDR时与25G系统一样安全有效，有望实现术后视力的更早恢复。
