23-G经结膜无缝合玻璃体手术与常规20-G玻璃体手术治疗孔源性视网膜脱离的临床对比研究

发布时间：2018-10-23 17:35

【摘要】：目的：对23-G经结膜无缝合玻璃体手术与常规20-G玻璃体手术治疗孔源性视网膜脱离进行前瞻性临床对比研究,为临床医师选择手术方式提供参考依据。方法：自2010年6月至2010年12月收集因孔源性视网膜脱离在青岛大学医学院附属医院眼科行玻璃体切割手术治疗的患者,共52例52只眼,随机分为23G组和20G组,所有手术由同一医师完成,观察对比各项指标。结果： 1.视力：最终矫正视力均较术前显著提高(P0.01),视力提高程度除在术后7天,15天有差异外(P0.05),其他时间段两组间无显著差异(P0.05)。 2.眼压：术后第1天23G组和20G组分别有3例和1例眼压9mmHg,20G组中4例眼压21mmHg,术前术后的眼压变化两组间无显著性差异(P0.05)。 3.手术时间：两组手术总时间无显著差异(P0.05)。 4.角膜曲率：20G组术后1周,4周角膜曲率同术前相比变化具有统计学意义(P0.05),23G组仅术后1周变化较术前有统计学意义(P0.05)。 5.眼前节炎症反应：23G组的眼前节炎症反应程度均较20G组轻(P0.05)。 6.泪膜稳定性：20G组患者术后早期角膜荧光染色、泪膜破裂时间、泪液分泌量均较23G组变化明显,(P均0.05)。 7.患者舒适度：20G组患者的异物感、干涩感、流泪较23G组重(P0.05)；眼痛、眼痒、眼分泌物则无显著差异(P0.05)。 8.切口并发症：两组切口玻璃体嵌顿和增殖物内生没有显著差异(P0.05)。 9.术后并发症：两组术后出现一过性低眼压和高眼压；20G组出现1例视网膜再次脱离；23G组出现1例切口微渗漏；两组均未发生眼内炎。结论：两种手术方式均可有效治疗原发性孔源性视网膜脱离,23G手术具有切口小,伤口恢复快,炎症反应轻,并发症少,病人不适症状轻的特点,但因23C玻璃体手术切口自闭,术后存在切口渗漏,发生眼内炎的风险。
[Abstract]:Objective: to compare 23-G vitreous surgery with 20-G vitreous surgery in the treatment of rhegmatogenous retinal detachment. Methods: from June 2010 to December 2010, 52 patients (52 eyes) with rhegmatogenous retinal detachment treated by vitrectomy in Ophthalmology Hospital of Qingdao University Medical College were randomly divided into 23G group and 20G group. All the operations were performed by the same physician and the indexes were observed and compared. Results: 1. Visual acuity: the final corrected visual acuity was significantly improved than before (P0.01), visual acuity improved in addition to 7 days, 15 days there was a difference (P0.05), other time between the two groups no significant difference (P0.05). 2. IOP: 3 cases in 23G group and 1 case in 20G group had intraocular pressure 21 mm Hg on the 1st day after operation. There was no significant difference in intraocular pressure between the two groups before and after operation (P0.05). Operation time: there was no significant difference in total operation time between the two groups (P0.05). 4. Corneal curvature: the corneal curvature in 20G group was significantly higher than that in preoperative group at 1 week and 4 weeks (P0.05), while in 23G group only 1 week after operation was significantly higher than that before operation (P0.05). Anterior segment inflammatory reaction: 23 G group of anterior segment inflammation degree than 20 G group light (P0.05). Lacrimal film stability: the early postoperative corneal fluorescence staining, tear film rupture time and tear secretion in 20G group were significantly different from those in 23G group (, (P 0. 05). Patient comfort: 20G group of patients with foreign body feeling, dry sense, tears than 23G group heavy (P0.05), eye pain, eye itching, eye secretion is no significant difference (P0.05). Incision complications: there was no significant difference in vitreous incarceration and proliferation between the two groups (P0.05). Postoperative complications: temporary low intraocular pressure and high intraocular pressure in both groups, retinal detachment in 1 case in 20 G group, incision microleakage in 1 case in 23 G group, and no endophthalmitis in both groups. Conclusion: the two surgical methods are effective in the treatment of primary rhegmatogenous retinal detachment. The 23G operation is characterized by small incision, quick wound recovery, light inflammatory reaction, less complications, and mild symptoms of discomfort in patients, but the incision is autistic because of 23 C vitreous surgery. Postoperative incision leakage, the risk of endophthalmitis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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