Garweg Justus G, Ouassi Dean, Pfister Isabel B
Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.
Department of Ophthalmology, Inselspital, Bern, Switzerland.
Clin Ophthalmol. 2020 Jan 31;14:299-305. doi: 10.2147/OPTH.S233884. eCollection 2020.
Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes.
This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra- and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma.
Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; =0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy.
In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.
微创经结膜无缝线玻璃体切除术（MIVS）已发展成为治疗标准，较小的切口被认为可减少眼表创伤并缩短恢复时间。黄斑手术目前最相关的局限性可能是光强度和27G器械的稳定性。因此，我们想比较标准的23G和27G玻璃体切除术与使用一个23G和两个27G端口的混合技术在手术时间和短期结果方面的差异。
这项回顾性比较纳入了2017年10月至2018年6月期间在单中心连续接受选择性微创玻璃体切除术治疗视网膜前膜或特发性黄斑裂孔的90例患者。比较的主要标准是以总手术时间作为主要结局参数，以及治疗过程中及术后需要特殊处理的并发症，同时将术前至术后1个月最佳矫正视力（BCVA）和中心视网膜厚度（CRT）的恢复情况作为次要参数，作为从原有病变和手术创伤中恢复的独立参数。
与27G相比，23G和23/27G的手术时间更短（23G：38.4±13.1；27G：48.1±15.3；23/27G：34.9±9分钟；P = 0.0005），BCVA和CRT结果无差异。在任何情况下都无需从27G转换为更大尺寸的端口。对可疑视网膜病变应用冷冻疗法的比例分别为15%、30%和22.5%，除此之外，视网膜裂孔的应用比例分别为5%、0%和7.5%。术后发生4例视网膜脱离（4.4%），23G组1例，23/27G组3例，均需要再次进行玻璃体切除术。
在这个探索性病例系列中，结合23G和27G技术优点的23/27G混合玻璃体切除术可缩短手术时间且无明显缺点。与白内障手术联合也没有问题。
