23-G微创玻璃体切割联合超声乳化白内障吸除及人工晶状体植入术治疗增殖性糖尿病性视网膜病变合并白内障

目的 观察23-G微创玻璃体切割联合超声乳化白内障吸除及人工晶状体植入术治疗增殖性糖尿病性视网膜病变（PDR）合并白内障的效果,并与20-G玻璃体切割术效果进行比较.方法 回顾性病例对照研究.PDR合并白内障患者91例（91眼）,A组41例,接受了23-G微创玻璃体切割联合超声乳化白内障吸除及人工晶状体植人术;B组50例,接受20-G玻璃体切割联合超声乳化白内障吸除及人工晶状体植入术,术后1 d、1周、2周、1个月、3个月观察视力及并发症情况.数据采用独立样本t检验、配对t检验和卡方检验进行分析.结果 平均随访17个月.A组logMAR视力从1.569±0.342提高到0.821±0.421,差异有统计学意义（t=8.99,P＜0.01）;B组logMAR视力从1.658±0.312提高到0.834±0.399,差异有统计学意义（t=11.47,P＜0.01）.术后并发症：A组中33眼（80%）术后无明显不适及水肿,B组中所有眼（100%）均有明显充血、水肿、异物感及眼部不适.另外,A组和B组分别发现3眼（7%）和1眼（2%）发生短暂性低眼压,两组差异无统计学意义;4眼（10%）和14眼（28%）发生前房纤维蛋白渗出,两组差异有统计学意义（x2=4.75,P＜0.05）.结论 23-G微创玻璃体切割联合超声乳化向内障吸除及人工晶状体植入术治疗PDR合并白内障安全有效,同20-G微创玻璃体切割手术比较,其术后恢复较快且不适感较少.

23-gauge vitrectomy combined with phacoemulsification and intraocular lenses implantation for proliferative diabetic retinopathy with coexisting cataract

Objective To compare the outcomes of 23-gauge (23-G) and 20-G vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation for proliferative diabetic retinopathy (PDR) with coexisting cataract. Methods Retrospective case-controlled study. Ninety-one patients (91 eyes) with PDR and coexisting cataract underwent 23-G (group A, 41 eyes) or 20-G (group B, 50 eyes) vitrectomy combined with phacoemulsification and IOL implantation were studied.One day, 1 week, 2 weeks, 1 month, and 3 months after surgery, the main outcome visual acuity (VA) and postoperative complications were measured. Statistical analysis was performed using an independent samples t test, a paired t test and a chi-square test. Results After the mean follow-up period of 17 months, VA improved significantly from 1.569±0.342 to 0.821±0.421 (t=8.99, P＜0.01)and from 1.658±0.312 to 0.834±0.399 (t=11.47, P＜0.01) in group A and group B, respectively. Postoperatively, 33 eyes (80%) were quiet with no chemosis in group A; in contrast, all eyes (100%) in group B showed marked congestion, chemosis, foreign body sensations and overall discomfort.Postoperative transient hypotony occurred in 3 eyes(7%)and 1 eye(2%),and inflammation in the fibrin anterior chamber was seen in 4 eyes(10%)and 14 eyes(28%)in group A and group B,respectively.The difference for the latter was significant(x2=4.75,P＜0.05).Conclusion For the management of PDR with coexisting cataract,23-G vitrectomy combined with phacoemulsification and IOL implantation is safe and effective with a faster recovery and greater comfort than in the combined 20-G vitrectomy.