目的：探讨抗血管内皮生长因子(vascular endothelial growth factor， VEGF)辅助玻璃体切割术(pars plana vitrectomy，PPV)治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)的效果及作用机制。

方法：将92例92眼行PPV的PDR患者，根据术前有无玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)分为单纯PPV组(41例41眼)和联合治疗组(51例51眼)，其中联合治疗组于PPV术前5～7d进行IVR。比较两组手术时间、电凝次数、硅油填充率、术后并发症发生率、术后3mo患眼BCVA及手术前后不同时间点房水和玻璃体VEGF、色素上皮衍生因子(pigment epithelium-derived factor，PEDF)含量。

结果：联合治疗组手术时间短于单纯PPV组，电凝次数少于PPV组，硅油填充、医源性视网膜裂孔及玻璃体再积血的几率均低于单纯PPV组，差异均有统计学意义(P<0.05)； 联合治疗组PPV时房水及玻璃体VEGF、PEDF含量低于单纯PPV组，差异均有统计学意义(P<0.05)； 联合治疗组术后3mo患眼BCVA好于单纯PPV组，差异有统计学意义(P<0.05)。

结论：IVR联合PPV治疗PDR可降低PPV围手术期VEGF、PEDF水平，减少术中电凝次数，降低术后医源性视网膜裂孔及玻璃体再积血发生率，提高视力水平。

METHODS: A total of 92 patients(92 eyes)with PDR treated by PPV were divided into the simple PPV group(41 patients with 41 affected eyes)and the combined treatment group(51 patients with 51 affected eyes)according to whether the patient underwent intravitreal injection of Ranibizumab(IVR). The combined treatment group was treated with IVR at 5-7d before PPV. The surgical time, times of electrocoagulation, silicone oil filling rate, the incidence of postoperative complications, LogMAR BCVA of affected eyes, levels of VEGF and pigment epithelium derived factor(PEDF)in aqueous humor and vitreous body were compared between the two groups.

RESULTS: The surgical time was shorter, the times of electrocoagulation was less, the silicone oil filling rate and the incidence rates of iatrogenic retinal hole and vitreous body hematocele were lower in the combined treatment group than in the simple PPV group(P<0.05). Levels of VEGF and PEDF in aqueous humor and vitreous body of the combined treatment group during PPV were lower than those in the simple PPV group(P<0.05). The LogMAR BCVA of the affected eyes of the combined treatment group in 3mo after surgery was better than that of the simple PPV group(P<0.05).

CONCLUSION: IVR combined with PPV can reduce the perioperative levels of VEGF and PEDF, reduce the times of electrocoagulation and the incidence of iatrogenic retinal hole and vitreous body hematocele, and improve the visual acuity of patients with PDR.