目的：评价3D手术视频系统在增生性糖尿病视网膜病变(PDR)合并牵拉性视网膜脱离(TRD)玻璃体切除术中的应用效果。

方法：回顾性分析2018-08/2019-03于我院行25G微创玻璃体切除术的PDR合并局部TRD(无牵拉性视网膜裂孔)患者32例38眼的临床资料，根据术中采用的观察系统进行分组，试验组16例19眼采用3D手术视频系统手术，对照组16例19眼采用传统显微镜手术。记录两组患者手术时间、术中医源性视网膜裂孔和硅油注入情况。术后至少随访6mo，观察最佳矫正视力及术后并发症发生情况。

结果：试验组术中发生医源性视网膜裂孔1眼，硅油注入1眼； 术后视网膜均完全复位； 术后1d玻璃体出血4眼，2～4wk后自行吸收； 术后2wk内发生高眼压6眼，药物治疗均能控制； 术后6wk后玻璃体再出血2眼； 术后6mo最佳矫正视力0.3以上者15眼。对照组术中发生医源性视网膜裂孔4眼，硅油注入5眼； 术后视网膜均完全复位； 术后1d玻璃体出血6眼，2～4wk后自行吸收； 术后2wk内发生高眼压5眼，药物治疗均能控制； 术后6wk后玻璃体再出血3眼； 术后6mo最佳矫正视力0.3以上者14眼。所有患者手术均顺利完成，均无眼内炎等严重并发症发生，但试验组手术时间明显短于对照组(37.3±4.8min vs 41.2±5.1min，P=0.020)。

结论：3D手术视频系统在PDR合并TRD玻璃体切除术中的应用能够缩短手术时间，提高手术效率。

METHODS: We retrospectively reviewed 32 patients(38 eyes)of PDR complicated with local TRD(no traction retinal hole)who underwent 25G minimally invasive vitrectomy in our hospital from August 2018 to March 2019. The patients were divided into two groups according to the observation system during the operation. 19 eyes of 16 patients in the experimental group were operated with heads-up 3D vision system, and 19 eyes of 16 patients in the control group were operated with traditional microscope. The operation time, iatrogenic retinal hole and silicone oil injection were recorded in the two groups. The patients were followed up for at least 6mo to observe the best corrected visual acuity and the occurrence of postoperative complications.

RESULTS: In the experimental group, iatrogenic retinal hole and silicone oil injection occurred in 1 eye during operation. The retina was completely reattached after operation. One day after operation, vitreous hemorrhage occurred in 4 eyes, which was self-absorbed after 2-4wk. Intraocular hypertension occurred in 6 eyes in postoperative 2wk, which could be controlled by drug treatment. Vitreous hemorrhage occurred in 2 eyes after 6wk and the best corrected visual acuity of 6mo was more than 0.3 in 15 eyes. In the control group, iatrogenic retinal hole occurred in 4 eyes, silicone oil was injected in 5 eyes during operation. The retina was completely reattached after operation. One day after operation, vitreous hemorrhage occurred in 6 eyes, which was self-absorbed after 2-4wk. Intraocular hypertension occurred in 5 eyes in postoperative 2wk, which could be controlled by drug treatment. Vitreous hemorrhage occurred in 3 eyes after 6wk, and the best corrected visual acuity of 6mo was more than 0.3 in 14 eyes. The operation of all patients was completed successfully, and no serious complications such as endophthalmitis occurred, but the operation time of the experimental group was significantly shorter than that of the control group(37.3±4.8min vs 41.2±5.1min, P=0.020).

CONCLUSION:Application of heads-up 3D vision system in PDR combined with TRD vitrectomy can shorten the operation time and improve the operation efficiency.