27G与25G微创玻璃体切割术治疗孔源性视网膜脱离的对比分析

目的　对比分析27G与25G微创玻璃体切割术（pars plana vitrectomy，PPV）治疗原发性孔源性视网膜脱离（rhegmatogenous retinal detachment，RRD）效果，并探讨27G PPV治疗RRD的安全性及有效性。方法　回顾分析2015 年5 月至2017 年6 月我院开展的微创PPV治疗RRD患者共92例，其中25G组58例，27G组34例。对比分析两组手术时间、视网膜复位率、视力改善及并发症等。结果　25G组手术时间为（56.7±35.9）min，27G组为（55.7±36.1）min（F=0.049，P=0.852）。单次手术视网膜复位率，25G组为94.8%，27G为91.2%，差异无统计学意义（P=0.666）。25G组与27G组末次随访最佳矫正视力（best corrected visual acuity，BCVA）均较术前改善，两组间视力改善率（改善＞0.2 LogMAR）差异无统计学意义（χ²=1.860，P=0.173）。两组均无严重并发症发生。25G组有2眼（3.4%）发生医源性视网膜裂孔，27G组有1眼（2.9%）发生医源性视网膜裂孔。术后一周内，高眼压（>25 mmHg）（1 kPa=7.5 mmHg）发生率25G组为25.9%，27G组为11.8%（χ²=3.009，P=0.083）。两组均未观察到感染性眼内炎、脉络膜脱离等严重并发症。结论　27G微创PPV在手术时间、视网膜复位率、视力改善及并发症方面与25G微创PPV无显著差异。27G微创PPV是治疗RRD的安全有效的手术方式。

Retrospective comparison of 27-gauge and 25-gauge microincision vitrectomy surgery for the treatment of primary rhegmatogenous retinal detachment

Objective　To compare the 27-gauge (27G) microincision pars plana vitrectomy (PPV) with the 25G PPV for treating primary rhegmatogenous retinal detachment (RRD) and evaluate its safety and effectiveness.Methods　We retrospectively reviewed ninety-two eyes of 92 patients with RRD undergone PPV from May 2015 to June 2017.Fifty-eight eyes underwent 25G vitrectomy and 34 eyes for 27G vitrectomy,respectively.The analysis included the surgical time,the rate of reattachment of retina,improvement of visual acuity and the rate of complications.Results　The mean surgical times was (56.7±35.9)min for the 25G group and (55.7±36.1)min for the 27G group (F=0.049,P=0.852).The primary anatomical success rate after a single operation was 94.8% and 91.2% for 25G group and 27G group,respectively (P=0.666).The best corrected visual acuity (BCVA) in the last visit increased significantly in both groups,but there was no significant differences in terms of visual improvement (>0.2 logMAR) ratio between the two groups (χ²=1.860,P=0.173).No severe intraoperative complication was observed.Iatrogenic retinal breaks occurred in 2 eyes (3.4%) in the 25G group and 1 eye (2.9%) in the 27G group.The transient ocular hypertension (>25 mmHg,1 kPa=7.5 mmHg) within 1 week postoperatively was 25.9% in 25G group,and 11.8% in 27G group,respectively (χ²=3.009,P=0.083).No complication such as endophthalmitis and choroidal detachment was observed in both groups.Conclusion　This study finds no significant differences in the surgical time,the rate of reattachment of retina,improvement of BCVA and complications between the 27G and the 25G vitrectomy.27G vitrectomy appears to be a safe and effective surgery for the treatment of primary RRD.