方法：回顾性分析PDR患者72例82眼的临床资料。根据手术联合方式不同，分为A组28眼，行玻璃体切割术，同期联合白内障超声乳化术及人工晶状体植入术； B组24眼，行玻璃体腔注射康柏西普及玻璃体切割术，同期联合白内障超声乳化术及人工晶状体植入术； C组30眼，Ⅰ期行玻璃体切割术，Ⅱ期行硅油取出联合白内障超声乳化术及人工晶状体植入术。观察3组术后最佳矫正视力(BCVA)及并发症情况。

结果：术后随访6～12mo。A组、B组、C组的术后平均LogMAR BCVA分别为1.007±0.455、1.000±0.482、1.033±0.531，3组较术前均有较明显的提高，差异有统计学意义(t=5.666、5.113、5.496，P<0.05)。A组、B组和C组的术后BCVA比较，差异无统计学意义(F=1.670，P=0.195)。术后并发症：A组发生前房渗出性反应6眼，一过性高眼压5眼，黄斑水肿1眼，新生血管性青光眼2眼，玻璃体再出血2眼； B组发生一过性高眼压4眼，玻璃体再出血1眼。C组发生前房渗出性反应1眼，一过性高眼压10眼，玻璃体再出血3眼。3组间前房渗出性反应的发生率差异有统计学意义(χ²=7.556，P=0.008)，A组与B组两两比较，差异有统计学意义(χ²=5.814，P=0.016)； A组与C组两两比较，差异无统计学意义(χ²=4.469，P=0.035)。其他并发症的发生率在3组间差异均无统计意义(P>0.05)。

结论：两种联合方式均可较早恢复患者视力，避免再次行白内障手术。同期联合方式与二期联合方式相比，术中观察眼底清晰，便于后节操作； 同期联合方式前房渗出性反应较重，玻璃体腔注射康柏西普能减轻同期联合方式的前房渗出性反应。

METHODS: The clinical data of 72 patients(82 eyes)with PDR were retrospectively analyzed. According to the different combined methods, the patients were divided into three groups: Group A(28 eyes)underwent vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation; Group B(24 eyes)underwent vitrectomy combined with intravitreal injection of conbercept, phacoemulsification and IOL implantation; and Group C(30 eyes)underwent vitrectomy in the first phase, and then underwent silicone oil removed combined with phacoemulsification and IOL implantation in the second phase. Visual acuity and postoperative complications were observed.

RESULTS: The follow-up period was 6-12mo. The mean postoperative LogMAR BCVA of Group A(1.007±0.455), Group B(1.000±0.482)and Group C(1.033±0.531)had all improved than their preoperative BCVA respectively, the difference was statistically significant(t=5.666, 5.113, 5.496; P<0.05). There was no statistical difference compared postoperative BCVA among three groups(F=1.670, P=0.195). The main postoperative complications were anterior chamber fibrin exudation(Group A: 6 eyes, Group B: 0 and Group C: 1 eyes), temporary intraocular hypertension(Group A: 5 eyes; Group B: 4 eyes and Group C: 10 eyes), macular edema(Group A: 1 eyes, Group B: 0 and Group C: 0), neovascular glaucoma(Group A: 2 eyes, Group B: 0 and Group C: 0)and rebleeding(Group A: 2 eyes, Group B: 1 eyes and Group C: 3 eyes). There were statistical difference compared anterior chamber fibrin exudation among three groups(χ²=7.556,P=0.008). The incidence of anterior chamber fibrin exudation in Group A was significantly higher than that in Group B(χ²=5.814,P=0.016), without significant difference compared with Group C(χ²=4.469,P=0.035). There was no statistical difference compared other postoperative complications among three groups(P>0.05).

CONCLUSION: Each group could help earlier visual rehabilitation and avoid second operation for post-vitrectomy cataract. Compared with the Group C, Group A or Group B is much clearer to observe the ocular fundus and easier to operate. Anterior chamber fibrin is heavier in Group A, intravitreal injection of conbercept can reduce anterior chamber fibrin exudation in combined surgical method.