目的：观察前后段联合手术对增生型糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)患者的脉络膜厚度的影响。

方法：采用回顾性病例对照研究。将在青岛市市立医院确诊为PDR且具备前后段联合手术条件的患者60例60眼纳入研究。并根据是否伴有有临床意义的黄斑水肿(clinical significant macular edema，CSME)将PDR组分为CSME(+)组31例31眼和CSME(-)组29例29眼。将27例27眼与患者年龄及性别匹配的正常眼作为对照组。所有PDR患眼均行前后段联合手术。使用频域光学相干断层扫描的增强深部成像技术(enhanced depth imaging spectral domain optical coherence tomography，EDI-SDOCT)对对照组和PDR组术后1wk，1、3、6mo进行扫描，并测量黄斑中心凹(subfoveal choroidal thickness，SFCT)及距黄斑中心凹鼻侧(nasal choroidal thickness，NCT)、颞侧(temporal choroidal thickness，TCT)各1 500μm的脉络膜厚度。比较前后段联合手术后患眼脉络膜厚度的变化。

结果：CSME(+)组和CSME(-)组前后段联合术后1mo SFCT、NCT、TCT较术后1wk，3、6mo均增加，且差异有统计学意义(均P<0.05)，术后6mo SFCT、NCT、TCT较术后1wk，1、3mo均减少，且差异具有统计学意义(均P<0.05)。CSME(+)组和CSME(-)组术后1wk，1、3mo的SFCT、NCT、TCT均大于对照组，且差异有统计学意义(均P<0.05)，术后6mo的SFCT、NCT、TCT与对照组相比差异均无统计学意义(P>0.05)。分别比较CSME(+)组与CSME(-)组术后1wk，1、3、6mo SFCT、NCT、TCT差异均无统计学意义(均P>0.05)。

结论：PDR患者前后段联合术后1mo内脉络膜厚度是增加的，1mo之后脉络膜厚度是降低的，术后6mo脉络膜厚度接近正常状态。PDR是否伴有CSME对术后脉络膜厚度无明显影响。

METHODS:A retrospective, case-control study enrolled 60 eyes of 60 patients with PDR diagnosed at Qingdao Municipal Hospital. The patients, who had conditions that warranted anterior-posterior joint surgery, were divided into a clinically significant macular edema group(PDR/CSME+; 31 patients, 31 eyes)and a non-CSME group(PDR/CSME-; 29 patients, 29 eyes). Twenty-seven eyes of 27 normal patients were included in the control group. All affected eyes underwent anterior-posterior joint surgery. After surgery, the subfoveal choroidal thickness(SFCT), and the nasal choroidal thickness(NCT)and temporal choroidal thickness(TCT), which were obtained at a distance of 1500μm from the fovea in the nasal and temporal directions, respectively, were measured in the control and PDR groups by enhanced depth imaging spectral domain optical coherence tomography(EDI-SDOCT)at 1wk, 1, 3, and 6mo after surgery. Changes in choroidal thickness after anterior-posterior joint surgery were compared between the groups.

RESULTS: The SFCT, NCT, and TCT were significantly thicker at 1mo than at 1wk, 3, and 6mo after surgery in the PDR/CSME+ and PDR/CSME- groups(P<0.05). The SFCT, NCT, and TCT were significantly thinner at 6mo than at 1wk, 1, and 3mo after surgery in the PDR/CSME+ and PDR/CSME- groups(P<0.05). The SFCT, NCT, and TCT in the PDR/CSME+ and PDR/CSME- groups at 1wk, 1, and 3mo after surgery were significantly thicker than those in the control group(all P<0.05), but the SFCT, NCT, and TCT at 6mo after surgery showed no significant difference compared with the control group(all P>0.05). There was no significant difference in the SFCT, NCT, or TCT at 1wk, 1, 3, or 6mo between the PDR/CSME+ and PDR/CSME- groups(P>0.05).

CONCLUSION: The choroidal thickness of PDR patients increases within 1mo after surgery, and decreased after 1mo, but is not significantly different between the control group and the PDR groups at 6mo after surgery. Whether PDR is associated with CSME has no effect on the choroidal thickness after surgery.