23G玻切头代替眼内膜剪用于20G玻璃体切割术治疗晚期PDR

目的：探讨在晚期增生性糖尿病视网膜病变（advanced proliferative diabetic retinopathy，PDR）20G玻璃体切割术中是否可应用23G玻璃体切割头代替眼内膜剪。方法：前瞻性非对照病例研究。对27例27眼经眼底检查和B超确诊为糖尿病视网膜病变Ⅵ期患者施行20G玻璃体切割术，术中以23G玻璃体切割头代替眼内膜剪清除新生血管膜，术毕完成全视网膜光凝，17眼灌注液填充，6眼填充12% C3F8，4眼填充硅油。随访3mo。分析患者玻璃体手术起止时间、术中发生的医源性裂孔数、手术中视网膜出血需电凝的次数，最佳矫正视力（BCVA）、视网膜复位情况。结果：手术时间为35～120（平均79.19±29.82）min； 术中发生医源性裂孔共2例（7%）。术后随访3mo，BCVA〉0.1者9眼，0.05～0.1者10眼，〈0.05者8眼。视网膜在位25眼（93%），2眼术后硅油下视网膜仍未完全复位。结论：在20G玻璃体切割术治疗晚期PDR时，完全可以用23G玻璃体切割头代替眼内膜剪清除新生血管膜。

Efficacy of 23-gauge vitrectomy cutter replaeing scissors in conventional 20-gauge pars plana vitrectomy for severe PDR

AIM： To determine whether the 23-gauge（23G）vitrecomy cutter could replace scissors in conventional 20-gauge（20G）pars plana vitrectomy for treating severe proliferative diabetic retinopathy（PDR）.METHODS：Non-comparative interventional case series. Totally 27 eyes of 27 patients with PDR stageⅥ confirmed by funduscopy and B-ultrasound scan were enrolled. They underwent 20G vitrectomy, in which 23G vitrectomy cutter replaced scissors to remove neuvascular membrane. All 27 eyes received complete panretinal photocoagulation, 17 eyes received no tamponade, 6 eyes were 12% C3F8 tamponade, 4 eyes were filled with silicone oil. The follow up time was 3mo. The operation duration time, iatrogenic retinal tear and retinal bleeding need electric coagulation, best corrected visual acuity（BCVA）, retinal reattachment were analyzed.RESULTS： The operative time was 35-120（average 79.19±29.82）min; intraoperative iatrogenic retinal breaks were detected in 2 eyes（7%）. At the end of 3mo follow up, BCVA〉0.1 were in 9 eyes, from 0.05-0.1 in 10 eyes, 〈0.05 in 8 eyes. Retinal reattached in 25 eyes（93%）, still detached in other 2 eyes with silicone oil.CONCLUSION： The 23G vitrectomy cutter could replace scissors in conventional 20G pars plana vitrectomy for treating severe PDR.