23G与25G＋微创玻璃体切除术治疗玻璃体积血的临床对比观察

目的：对比观察23G、25G＋经结膜免缝合玻璃体切除术（TVS）治疗玻璃体积血的安全性和有效性。方法对比分析2013年3月至2014年3月因玻璃体积血在我院行两种不同微创玻璃体切除术（23G和25G＋）患者的临床资料，采用t检验或秩和检验以及χ2检验对比观察手术时间、切口闭合情况、术后眼压、术后视力及并发症等。结果共计45例（47只眼），其中21例（22只眼）行23G微创玻璃体切除患者术（23G组），24例（25只眼）行25G＋微创玻璃体切除术（25G＋组）；23G组手术时间为35～94 min，平均55．4 min；25G＋组手术时间为30～85 min，平均47．6 min；差异无统计学意义（ P ＝0．105）。23G组、25G＋组手术切口自然闭合比率分别为45．5％、80．0％，缝合率分别54．5％、20．0％，差异有统计学意义（ P ＝0．018）。术后第1天23G组眼压为（9．1±3．8） mm-Hg，25G＋组眼压为（10．2±2．6）mmHg，差异无统计学意义（ P ＝0．712），术后第3天23G组眼压为（10．3±4．1） mmHg，25G＋组眼压为（10．9±3．7）mmHg，差异无统计学意义（ P ＝1．000），术后1周23G组眼压为（14．3±6．9） mmHg，25G＋组眼压为（15．7±6．3）mmHg，差异无统计学意义（ P ＝0．371）；23G组术后视力改善情况与25G＋组无统计学差异（ P ＝0．807）；23G组术后发生视网膜脱离1例，切口渗漏1例，复发玻璃体积血3例；25G＋组术后发生视网膜脱离2例，切口渗漏2例，复发玻璃体积血1例；两组发生率差异均无统计学意义（ P ＝1．000、1．000、0．328）。结论25G＋TVS与23G TVS均是有效的玻璃体积血治疗方法，25G＋TVS切口自然闭合率更好，其他并发症发生率无差异。

Clinical effects of 23-gauge and 25+-gauge transconjunctival sutureless vitrectomy systems for the treatment of vitreous hemorrhage

Objective To investigate the safety and efficacy of primary 23-Gauge (23G) transconjuctival suture-less vitrectomy system (TVS) and 25-Gauge (25G+) TVS for the treatment of vitreous hemorrhage.Methods This is a case-control study on the clinical data of vitreous hemorrhage patients that were treated with 23G TVS or 25G+TVS in our hospital from March 2013 to March 2014.Operation time, post-operative intraocular pressure, and complications were com-pared.Results There were 45 patients (47 eyes) enrolled.Among them, 21 (22 eyes) were treated with 23G TVS (23G group) and 24 patients (25 eyes) were treated with 25+G TVS (25G+group).Operation time in ranged from 35 to 94 minutes and averaged at 55.4 minutes in 23G group, while it ranged from 30 to 85 minutes and averaged at 47.6 minutes in 25G+group.However, there was no statistical significance in this difference.Spontaneous close of vitrectomy incision occurred in 45.5%of patients in 23G group while the rate was 80.0%in 25G+group, significantly higher ( P <0.05). All other patients needed suture.Postoperative intraocular pressure was not significantly different between the two groups at all follow up time points.Improvement of visual acuity was also similar for the two groups.Complications, including retinal detachment, leakage at incision site, vitreous hemorrhage, occurred in only a very small percentage of cases in both groups.Conclusion 25G+TVS and 23G TVS were equally effective for vitreous hemorrhage treatment.25G+TVS has better results in avoiding incision site leakage but does not differ from 23G TVS regarding other complications.