27G微创玻璃体切除手术的发展及应用

自二十世纪初25 G、23 G无缝线玻璃体切除术的相继推出，已将我们带入玻璃体视网膜手术的微创时代约有10余年历史。与传统20 G三通道玻璃体切除术相比，25 G、23 G无缝线微创玻璃体切除术不仅缩小巩膜切口，而且还大大简化了手术程序，缩短了手术时间及降低了手术并发症。因此，在过去十余年时间里，越来越多的医生由传统的20 G玻璃体切除术转向25 G、23 G玻璃体切除术。但随着微创玻璃体切除术的普及，无缝线巩膜切口的相关并发症也随之增多。本着“越小越好”的理念，眼科学者开始研究下一代玻切手术，并且得益于不断更新换代的高速玻切机、高通量的照明光源、更精细的制造技术和清晰广角镜的发展，日本学者Oshima于2010年正式推出了27G玻璃体切除术。27 G玻璃体切除术较之前的微创玻璃体切除术切口更小，切割速率更高，带给眼底外科医生全新的体验。目前27 G甚至更细的玻璃体切除术尚处在继续革新之中，围绕其优缺点、适应证及未来发展也逐渐成为大家关注讨论的焦点。本文在此结合笔者27 G玻璃体切除术经验，对27 G微创玻璃体切除术玻璃体切除术进行了一个简要的综述。

Progress and application of 27-gauge micro-incision vitrectomy

Abstract?Since the introduction of 25-gauge/23-gauge ( 25G/23G ) sutureless micro -incision vitrectomy surgery ( MIVS ) at the beginning of the 21 century, we have stepped into an era of micro-incision vitreoretinal surgery more than10a. The current 25/23G MIVS provide numerous advantages over the conventional 20G vitrectomy surgery including simplified surgical procedure, shortened operating time, decreased complications as well as smaller sclerotomy wound.As a result, vitreoretinal surgeons have been shifting gradually from 20-gauge to 25/23-gauge vitrectomy in the past decade. As the 25/23G MIVS adapted worldwide, however, its drawbacks were also increasingly reported. Most criticism regarding to current 25/23G MIVS are focusing on would sealing related complications.Based on stablished notion regarding vitrectomy -“the smaller the better”, researchers and doctors were keeping on exploring the next generation of vitrectomy system. Thanks to the innovation and development in new generation vitrectomy machines, high lumen output light source, more delicate manufacturing technology and clear wild angle fundus view system, Dr.Oshima from Japan launched the first 27-gauge vitrectomy surgery system.It provided us novel surgical experience with smaller sclerotomy wound and faster cut rate. Further development and refinement of vitrectomy with 27-gauge or more are still on its way and will continue in the future. Undoubtedly, MIVS would be heated debated regarding its pro/con, complications, indications and future development.Combined with our own experiences, here we briefly reviewed the 27-gauge vitrectomy surgery.