目的：比较25G和27G玻璃体切割系统治疗累及黄斑区孔源性视网膜脱离的疗效、安全性及并发症。

方法：回顾性分析2021-01/2023-12于我院首次诊断为孔源性视网膜脱离(脱离范围累及黄斑区)并且接受25G或27G玻璃体切割联合视网膜复位的患者60例60眼，根据术中使用玻璃体切割系统不同分为25G组30例30眼术中使用25G玻璃体切割系统进行手术操作； 27G组30例30眼术中使用27G玻璃体切割系统进行手术操作。术后随访6 mo，比较两组患者手术前后最佳矫正视力(BCVA)、眼压、手术操作时间、视网膜复位情况、并发症。

结果：27G组患者平均手术时间略长于25G组(40.20±7.52 vs 36.97±7.47 min)，25G组术中出现切口渗漏7眼(23%)高于27G组1眼(3%)，但两组间无差异(P>0.05)。术后6 mo，27G组和25G组患者BVCA(LogMAR)(0.37±0.19 vs 0.40±0.17)均较术前(0.98±0.32 vs 0.84±0.33)改善(均P<0.05)，两组间术后BCVA无差异(P>0.05)。术后1 d时25G组平均眼压(12.29±2.86 mmHg)低于27G组(15.87±3.70 mmHg，P<0.001)，术后1 wk，1 mo时两组间平均眼压比较均无差异(均P>0.05)。两组患者术后不同时间视网膜复位情况，术中与术后并发症比较均无差异(均P>0.05)。

结论：25G和27G玻璃体切割术是一种安全有效的治疗孔源性视网膜脱离方法。但27G玻璃体切割系统具有切口小、自闭性好、眼压稳定等优势。

METHODS:This retrospective study analyzed 60 patients(60 eyes)initially diagnosed with RRD involving the macular area and undergoing 25G or 27G vitrectomy combined with retinal reattachment at our hospital from January 2021 to December 2023. Patients were divided into 25G group(30 eyes)and 27G group(30 eyes). Best corrected visual acuity(BCVA), intraocular pressure(IOP), surgical duration, retinal reattachment rate and complications of both groups of patients were compared before and after surgery.

RESULTS: The mean surgical time in the 27G group was slightly longer than in the 25G group(40.20±7.52 vs 36.97±7.47 min). Incision leakage occurred in 7 eyes(23%)in the 25G group versus 1 eye(3%)in the 27G group, though the difference was not statistically significant between two groups(P>0.05). At 6 mo postoperatively, BCVA(LogMAR)improved significantly in both groups(27G: 0.37±0.19 vs preoperative 0.98±0.32; 25G: 0.40±0.17 vs preoperative 0.84±0.33; all P<0.05), with no statistical difference in BCVA(P>0.05). At 1 d postoperatively, the 25G group had lower mean IOP(12.29±2.86 mmHg)compared to the 27G group(15.87±3.70 mmHg; P<0.001), but no differences were observed at 1 wk or 1 mo postoperatively(all P>0.05). Retinal reattachment rates and complications(intra- or postoperative)showed no significant intergroup differences(all P>0.05).

CONCLUSION: Both 25G and 27G vitrectomy are safe and effective in treating rhegmatogenous retinal detachment. However, the 27G vitrectomy offers advantages such as small incisions, better self-sealing properties, and more stable IOP.