目的：探究增生性糖尿病视网膜病变(PDR)行玻璃体切除术后黄斑区视网膜血流密度的变化及影响因素，并构建预测模型。

方法：回顾性分析2019-06/2021-06于我院行玻璃体切除术治疗的PDR患者173例173眼的临床资料，根据术后黄斑区视网膜血流密度变化情况将患者分为正常组(118例118眼)和下降组(55例55眼)。比较两组患者的一般资料、术前实验室检查指标和术中情况； 采用多因素Logistic回归分析影响患者术后黄斑区视网膜血流密度变化的因素； 构建列线图预测模型，并评价其预测效能。

结果：下降组的糖尿病病程、合并黄斑病变患者比例、血清TC、TG、LDL-C、HbA1c、血管闭塞、增生视网膜牵引患者比例明显高于正常组，HDL-C明显低于正常组(P<0.05)； 多因素Logistic回归分析结果显示，糖尿病病程>17a(OR=4.526)、合并黄斑病变(OR=4.983)、HbA1c>6.25%(OR=4.283)、血管闭塞(OR=5.216)、增生视网膜牵引(OR=4.765)均是导致患者术后黄斑区视网膜血流密度下降的危险因素(P<0.05)； 列线图预测模型的区分度和准确性较好，具有较高的预测价值。

结论：糖尿病病程、合并黄斑病变、HbA1c、血管闭塞及增生视网膜牵引均与PDR行玻璃体切除术后黄斑区视网膜血流密度下降有关，了解风险因素有利于手术的决策。

METHODS: The clinical data of 173 patients with 173 eyes in PDR who underwent vitrectomy in our hospital from June 2019 to June 2021 were analyzed retrospectively. According to the changes of macular retinal blood flow density after operation, the patients were divided into normal group(118 cases with 118 eyes)and descending group(55 cases with 55 eyes). The general data, preoperative laboratory examination index and intraoperative condition of the two groups were compared. Multivariate Logistic regression was used to analyze the factors affecting the changes of retinal blood flow density in macular area after operation. Construct the line chart prediction model and evaluate its prediction efficiency.

RESULTS: The course of diabetes, proportion of patients with complicated maculopathy, serum TC, TG, LDL-C, HbA1c, vascular occlusion and hyperplastic retinal traction in the decreasing group were significantly higher than those in the normal group, while HDL-C was significantly lower than that in the normal group(P<0.05). Multivariate Logistic regression analysis showed that course of diabetes > 17a(OR=4.526), complicated maculopathy(OR=4.983), HbA1c > 6.25%(OR=4.283), vascular occlusion(OR=5.216)and hyperplastic retinal traction(OR=4.765)were all risk factors of the decrease of macular retinal blood flow density after operation(P<0.05). The line chart prediction model has good differentiation and accuracy, and has high prediction value.

CONCLUSION: Course of diabetes, complicated maculopathy, HbA1c, vascular occlusion and proliferative retinal traction are all related to the decrease of macular retinal blood flow density after vitrectomy with PDR. Understanding the risk factors is beneficial to surgical decision-making.