目的：分析术前不同时机玻璃体腔注射康柏西普(IVC)辅助玻璃体切割术(PPV)治疗增生型糖尿病视网膜病变(PDR)的临床疗效。

方法：前瞻性随机对照研究。选取2018-10/2019-06广西壮族自治区人民医院眼科收治并确诊为严重PDR的患者47例47眼随机分为两组，A组患者26例26眼于PPV术前2～3d行IVC术，B组患者21例21眼于 PPV术前7～8d行IVC术。记录两组患者手术时间、术中出血次数、电凝次数、医源性视网膜裂孔发生次数、视网膜切开和硅油填充情况。随访至术后6mo，检测最佳矫正视力(BCVA)，观察两组患者术后并发症发生情况。

结果：术后6mo，两组患者BCVA均较术前改善(均P<0.05)，但两组间无差异(1.37±0.83 vs 1.18±0.98，P>0.05)。A组患者平均手术时间短于B组(73.19±22.78min vs 91.00±31.36min，P<0.05)，但两组患者术中出血次数、电凝次数、医源性视网膜裂孔发生次数、视网膜切开及硅油填充情况均无差异(P>0.05)。术后1wk，B组患者高眼压发生率高于A组(43% vs 15%，P<0.05)。随访期间两组患者均无复发性玻璃体出血，继发性青光眼、复发性视网膜脱离发生率均无差异(P>0.05)。

结论：PDR患者行玻璃体切割术前2～3d较7～8d玻璃体腔注射康柏西普更能缩短手术时间，两种治疗方式均可改善术后视力，临床疗效和安全性基本一致。

METHODS: A prospective, randomized, controlled study. From October 2018 to June 2019, a total of 47 eyes of 47 patients with PDR were selected in the Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region. The patients were randomly divided into two groups: the patients who received IVC 2-3d before PPV as group A(26 eyes of 26 patients); and the patients who received IVC 7-8d before PPV as group B(21 eyes of 21 patients). The analysis included the operation time, the number of intraoperative bleeding, electrocoagulation, iatrogenic retinal tears, omental incision eyes, silicone oil-filled eyes. All patients were followed up 6mo, the best corrected visual acuity(BCVA)and the postoperative complications of the two groups were ducumented by the observers.

RESULTS: The BCVA measured 6mo after PPV were significantly better than that measured before PPV in both groups(P<0.05), there was no significant difference in BCVA between the two groups(1.37±0.83 vs 1.18±0.98, P>0.05). The average operation time of group A was lower than that of group B(73.19±22.78min vs 91.00±31.36min, P<0.05), there were no significant difference in the number of intraoperative bleeding, electrocoagulation, iatrogenic retinal tears, omental incision eyes, silicone oil-filled eyes between the two groups(P>0.05). One week after PPV, the incidence of high intraocular pressure in group B was higher than that in group A(group B: 43% vs group A: 15%, P<0.05). 6mo postoperative follow up, no recurrent vitreous hemorrhage occurred in either group, there were no significant difference in the incidence of secondary glaucoma and recurrent retinal detachment between the two groups(P>0.05).

CONCLUSION: PDR patients who received IVC 2-3d prior to PPV had shorter operation time than patients who received IVC 7-8d prior to PPV. Both groups can improve postoperative visual acuity, and the long-term clinical efficacy and safety are basically the same.