23 G玻璃体手术系统治疗增生性糖尿病视网膜病变的回顾分析

目的 探讨23 G玻璃体手术治疗增生性糖尿病视网膜病变（PDR）的特点。设计 回顾性病例系列。研究对象 2010年1月至2011年6月北京同仁医院眼底病科连续收治的100例（105眼）接受玻璃体手术治疗的PDR患者。方法  回顾上述患者的病历资料。对手术方式、手术时间、术后视力以及术后炎性反应和并发症等情况进行分析。主要指标  手术方式、手术时间、器械进出眼内次数、术后视力以及术后炎性反应和并发症。结果  105眼接受23 G玻璃体手术。其中术前单纯玻璃体积血者32眼，平均手术时间（52.0±15.2）分钟，平均器械进出眼内（8.5±2.5）次；需剥离视网膜前增生膜而无明显牵拉性视网膜脱离者23眼，平均手术时间（65.0±12.7）分钟，平均器械进出眼内（12.4±3.4）次；伴有明显视网膜脱离者50眼，平均手术时间（87.0±17.1）分钟，平均器械进出眼内（15.7±4.1）次。硅油填充30眼。所有患者无术中锯齿缘离断，术中使用眼内电凝16眼（15.2%），无使用眼内剪刀者。术后1~3个月视力均有不同程度改善。结论  23 G玻璃体手术适用于从简单到复杂的各种PDR的治疗，熟练掌握23G玻璃体手术能提高手术效率、减少并发症、改善患者愈后。（眼科，2012，21：97-101）

23 gauge vitrectomy for proliferative diabetic retinopathy

Objective To evaluate the efficacy of 23 gauge(G) vitrectomy for proliferative diabetic retinopathy(PDR).Design Retrospective case series.Participants 105 eyes of 100 patients with PDR from Beijing Tongren Hospital were included.Methods All the eyes were performed 23-gauge vitrectomy on by the same surgeon from January 2010 to June 2011.Surgical procedures including surgical time,times of tool exchanges,visual outcome and postoperative reactions were summarized.Main Outcome Measures Surgical time,times of tool exchanges,visual outcome and postoperative reactions.Results 32/105 eyes were simple vitreous hemorrhage,in which the average surgical time was 52.0±15.2 minutes,and times of tool exchanges were 8.5±2.5.23/105 eyes needed proliferative membrane peeling without significant tractional retinal detachment,in which the average surgical time was 65.0 ±12.7 minutes,and times of tool exchanges were 12.4±3.4.50/105 eyes were tractional and secondary rhegmatogenous retinal detachment,in which the average surgical time was 87.0±17.1 minutes,and times of tool exchanges were 15.7±4.1.Silicone oil injection was performed on 30 eyes.There was no dialysis of ora serrata in all the patients.As for intraoperative bleeding episodes,electrocoagulation were performed on 16/105 eyes.No intraocular scissors were used.Visual acuity of all patients improved 1-3 months after operation.Conclusion 23 G system vitrectomy can be used in both simple and complicated cases of PDR.The advantages based on the unique construction of the vitrector and using of cannulas lead to get high efficiency,less intraoperative and postoperative complications and better outcome.