27G与25G经平坦部玻璃体切除术治疗单纯孔源性视网膜脱离的1年疗效
One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair.
作者信息
Sborgia Giancarlo, Niro Alfredo, Sborgia Luigi, Grassi Maria Oliva, Gigliola Samuele, Romano Mario R, Boscia Francesco, Sborgia Alessandra, Alessio Giovanni
机构信息
1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy.
Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy.
出版信息
Int J Retina Vitreous. 2019 Jun 4;5:13. doi: 10.1186/s40942-019-0164-0. eCollection 2019.
BACKGROUND
27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up.
METHODS
A 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded.
RESULTS
All functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively ( > .05, > .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 ( < .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 ( < .001), without significant difference between the groups ( > .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV ( = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV ( > .05). One single case of choroidal detachment occurred.
CONCLUSIONS
Reattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy.
背景
27G和25G经结膜无缝合玻璃体切除术（TSV）在治疗孔源性视网膜脱离（RRD）方面，在安全性、有效性和玻璃体切除时间上被认为相当，不过仍需要更大规模的长期比较研究来证实此前的认知。此外，从未对手术时长和玻璃体切除时间进行过综合比较。我们的目的是比较27G与25G TSV在治疗单纯性RRD并随访1年时的安全性和疗效。
方法
对92例连续患者进行了一项为期12个月的单中心前瞻性、随机、干预性研究。46例患者接受27G TSV（第1组），46例接受25G TSV（第2组）。主要结局指标为初次和最终复位率，以及最终功能成功（视力≥20/200，LogMar值为1）。次要结局指标为手术时间和玻璃体切除时间。记录并发症情况。
结果
仅88例患者获得了术后12个月内所有基线及随访时间点的全部功能和形态学数据。第1组有4例患者术后退出研究。两组基线特征无显著差异。第1组的初次和最终复位率分别为90.5%和100%，第2组分别为95.6%和100%（分别>0.05，>0.05）。第1组视力从1.5±1.09 LogMar改善至0.38±0.55 LogMar（<0.001），第2组从1.2±0.9 LogMar改善至0.49±0.53 LogMar（<0.001），两组间无显著差异（>0.05）。27G TSV的手术时间为73.2±11.3分钟，25G TSV的手术时间为64.4±9.5分钟（P = 0.0001）。27G TSV的玻璃体切除时间为19.9±3.8分钟，25G TSV的玻璃体切除时间为20.8±3.8分钟（>0.05）。发生了1例脉络膜脱离。
结论
27G和25G TSV治疗RRD的复位率、功能成功率和玻璃体切除时间相当。27G玻璃体切除术的手术时间明显更长。
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