目的： 对比25G+玻璃体切割联合玻璃体腔注射康柏西普及单纯行25G+玻璃体切割术治疗严重增生性糖尿病视网膜病变(PDR)的临床疗效。

方法：回顾性临床病例对照研究。选取2014-10/2016-08在我院行25G+玻璃体切割术的严重PDR患者35例42眼，其中行25G+玻璃体切割术前玻璃体腔注射康柏西普眼用注射液18例22眼为A组； 仅行25G+玻璃体切割术患者17例20眼为B组，比较两组患者手术时间、术中并发症的发生情况、观察两组患者术后3mo时玻璃体再积血(RVH)发生率、黄斑中心凹厚度(CFT)，术后6mo时BCVA(LogMAR)、CFT。

结果：术中A、B两组患者的手术时间分别为58.23±8.18和72.41±10.31min，差异有统计学意义(t=2.9，P=0.002)。术中主要并发症为医源性裂孔和术中撕膜时较大量出血，A组分别为2眼、1眼，B组为7眼、6眼，差异均有统计学意义(P=0.041、0.027)。RVH发生率：术后3mo时A组为2眼、B组为8眼，两组RVH发生率比较差异有统计学意义(P=0.030)。BCVA(LogMAR)：术后6mo时A组为0.92±0.35，B组为1.04±0.43，两者比较差异无统计学意义(t=0.241，P=0.212)，但均较术前(A组为1.86±0.64，B组为1.73±0.82)明显提高，差异有统计学意义(t=4.614、7.355，均P<0.01)。CFT：术后3mo时，A组为273.42±25.21μm、B组为284.58±27.44μm，两者比较差异无统计学意义(t=0.488，P=0.179)，但均较术前(A组为351.6±34.4μm、B组为358.2±37.1μm)明显下降，差异有统计学意义(t=3.152、4.933，均P<0.01)； 术后6mo时A组为238.16±16.35μm，B组为247.04±17.43μm，两者比较差异无统计学意义(t=0.571，P=0.133)，但均较术前明显下降，差异有统计学意义(t=2.474、 4.802，均P<0.01)。

结论：严重PDR患者行25G+玻璃体切割联合术前玻璃体腔注射康柏西普治疗可有效改善视力，减轻黄斑水肿症状，相比较单纯玻璃体切割术还可缩短手术时间，减少术中并发症的发生，显著降低术后3mo的RVH发生率。

METHODS: A clinical case control study. A total of 35 patients(42 eyes)with severe PDR who underwent 25G+ vitrectomy in our hospital from October 2014 to August 2016 were randomly divided into two groups: A and B. Among them, 18 cases(22 eyes)was given conbercept intravitreal injection combined with vitrectomy as Group A; 17 cases(20 eyes)was only given vitrectomy without conbercept injection were Group B. Observation of operation duration, intraoperative complications, the incidence of vitreous hemorrhage(RVH), macular foveal thickness(CFT)at 3mo after operation were observed, best corrected visual acuity(logMAR BCVA), and macular foveal thickness(CFT)at 6mo after operation were observed too.

RESULTS: The operative time of Group A and B was 58.23±8.18min and 72.41±10.31min, the difference was statistically significant(t=2.9, P=0.002). During the operation, the main complications were iatrogenic hiatus and intraoperative bleeding, Group A of 2 eyes and 1 cases, Group B of 7 eyes and 6 eyes, the difference was statistically significant(P=0.041, 0.027). The incidence of vitreous hemorrhage(RVH): at 3mo after operation, that in Group A was 2 eyes, and in Group B was 8 eyes, the incidence of vitreous hemorrhage was statistically significant between the two Groups(P=0.030). The best corrected visual acuity was 0.92±0.35 in Group A and 1.04±0.43 in Group B at 6mo postoperatively, but there was no significant difference between the two groups(t=0.241, P=0.212), but compared with the preoperative visual acuity improved obviously, the difference was statistically significant(t=4.614, t=7.355; P<0.01). CFT: at 3mo after operation, that of Group A was 273.42±25.21μm, Group B was 284.58±27.44μm, there was no significant difference between the two groups(t=0.488, P=0.179), but there were significantly decrease, the difference was statistically significant(t=3.152, t=4.933; P<0.01); at 6mo after operation, CFT of Group A was 238.16±16.35μm, Group B was 247.04±17.43μm, there was no significant difference between the two groups(t=0.571, P=0.133), but there were significantly decrease, the difference was statistically significant(t=2.474, t=4.802; P<0.01).

CONCLUSION: The 25G+ vitrectomy combined with preoperative conbercept intravitreal injection in patients with severe proliferative diabetic retinopathy can effectively improve vision and reduce macular edema,compared with simple vitrectomy, the operation time can be shortened, the incidence of complications can be reduced, and the incidence of vitreous hemorrhage in 3mo after operation can be significantly reduced.