27G与23G玻璃体切割手术的特征及临床结果比较
Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery.
作者信息
Saleh Omar A, Alshamarti Saif A, Abu-Yaghi Nakhleh E
机构信息
Department of Ophthalmology, Jordan University of Science and Technology, Irbid, Jordan.
Department of Ophthalmology, College of Medicine, University of Al-Qadisiyah, Diwanyah, Iraq.
出版信息
Clin Ophthalmol. 2020 Jun 9;14:1553-1558. doi: 10.2147/OPTH.S255162. eCollection 2020.
PURPOSE
To compare characteristics, clinical outcomes and complication profiles of a cohort of patients undergoing 27-gauge versus 23-gauge vitrectomy surgery at a tertiary medical center in the Middle East.
METHODS
This is a retrospective comparative study of indication-matched patients undergoing 27-gauge versus 23-gauge pars plana vitrectomy for a set of predetermined diagnoses. Data including indications for surgery, clinical exams, visual outcomes, and complications were documented and analyzed.
RESULTS
A total of 22 patients who had 27-gauge pars plana vitrectomy were compared with 44 patients who had 23-gauge surgery for matched indications by a single retina surgeon. Mean follow-up was 14 months after surgery. Indications included macular pucker, macular hole, and vitreous hemorrhage. Both the rate of hypotony at postoperative day 1 and the need for sclerotomy stitching at the end of surgery were significantly more frequent in 23-gauge compared to 27-gauge cases (25% in 23-gauge compared to 0% in 27-gauge (p=0.012) and 18% in the 23-gauge compared to 0% in the 27-gauge (p=0.045), respectively). The mean duration of surgery was similar among groups (35 mins in the 27-gauge group versus 39 mins in the 23-gauge group (p=0.116)), and all eyes achieved anatomic success. In the 27-gauge group, best-corrected visual acuity improved from a mean of 20/90 at baseline to a mean of 20/40 at 1 month (p=0.005) and in the 23-gauge group from a mean of 20/95 to 20/50 (p=0.001) with no statistical difference between the groups.
CONCLUSION
In this cohort of patients undergoing vitrectomy at a tertiary eye center, the rate of hypotony and the need for sclerotomy suturing were significantly less in the 27-gauge group versus the 23-gauge group. Surgical outcomes were similar in both study groups. The use of the novel 27-gauge instrument system is useful in selected vitreoretinal diseases and appears comparable to the widely used 23-gauge system.
目的
比较中东一家三级医疗中心接受27G与23G玻璃体切除术的一组患者的特征、临床结局及并发症情况。
方法
这是一项对因一系列预定诊断而接受27G与23G玻璃体切除术的适应症匹配患者的回顾性比较研究。记录并分析包括手术适应症、临床检查、视力结局及并发症等数据。
结果
由同一位视网膜外科医生对22例行27G玻璃体切除术的患者与44例行23G手术的匹配适应症患者进行比较。术后平均随访14个月。适应症包括黄斑皱襞、黄斑裂孔及玻璃体积血。与27G病例相比，23G病例术后第1天的低眼压发生率及手术结束时巩膜切开缝合的需求显著更高（23G为25%，27G为0%（p = 0.012）；23G为18%，27G为0%（p = 0.045））。两组手术平均时长相似（27G组为35分钟，23G组为39分钟（p = 0.116）），所有术眼均获得解剖学成功。27G组最佳矫正视力从基线时的平均20/90提高至1个月时的平均20/40（p = 0.005），23G组从平均20/95提高至20/50（p = 0.001），两组间无统计学差异。
结论
在这家三级眼科中心接受玻璃体切除术的这组患者中，27G组的低眼压发生率及巩膜切开缝合需求显著低于23G组。两个研究组的手术结局相似。新型27G器械系统在特定玻璃体视网膜疾病中有用，且似乎与广泛使用的23G系统相当。
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