目的：观察康柏西普联合25G微创玻璃体切除术治疗增生性糖尿病视网膜病变(PDR)的临床效果，并分析术后玻璃体再积血的影响因素。

方法：选取2017-04/2019-11于我院确诊并治疗的PDR患者179例179眼，根据患者病情和意愿分组，观察组108例行康柏西普联合25G微创玻璃体切除术，对照组71例仅行25G微创玻璃体切除术。比较两组患者术前基线资料、术中情况、手术前后最佳矫正视力(BCVA)、眼压、N1波潜伏期波幅、黄斑区中央凹视网膜厚度(CMT)及术后并发症情况，分析PDR患者术后玻璃体再积血的影响因素。

结果：观察组患者手术时间、术中出血率、电凝止血使用率、医源性视网膜裂孔发生率、激光点数及硅油填充率均低于对照组(P<0.05)。两组术后6mo BCVA、CMT及N1波潜伏期波幅均较术前改善，且观察组优于对照组(均P<0.05)。观察组总并发症发生率明显低于对照组(14.8% vs 40.8%，P<0.05)。发生术后玻璃体再出血患者31例31眼，多因素Logistic回归分析结果显示，HbA1c升高、血管闭塞、增生视网膜牵引及未使用康柏西普治疗是PDR患者术后玻璃体再积血的危险因素。

结论：康柏西普联合25G微创玻璃体切除术治疗PDR可降低术中出血率，减少并发症，缩短手术时间，进而利于提高视力，改善视功能。有效控制血糖以降低HbA1c水平，术中尽量剥除纤维血管增生膜以解除视网膜牵引，并联合使用康柏西普进行治疗，可降低术后玻璃体再积血发生的风险。

METHODS: Totally 179 eyes of 179 PDR patients confirmed and treated in our hospital from 2017-04/2019-11 were selected and grouped according to patients' condition and intention. 108 patients in the observation group underwent conbercept combined with 25G minimally invasive vitrectomy, while 71 patients in the control group underwent 25G minimally invasive vitrectomy only. The baseline data, intraoperative condition, best corrected visual acuity(BCVA), intraocular pressure, amplitude of N1 wave latency, central macular thickness(CMT)in the macular area before and after operation, and postoperative complications were compared between the two groups. The influencing factors of vitreous rehaemorrhage in PDR patients were analyzed.

RESULTS:The operative time, intraoperative bleeding rate, electrocoagulation rate, incidence of iatrogenic retinal hiatal aperture, the number of laser points and silicone oil filling rate of the observation group were all lower than those of the control group(P<0.05). After 6mo, BCVA(LogMAR), CMT and N1 wave latencies amplitude of the two groups were improved compared with those before operation, and the observation group was better than the control group(all P<0.05). The incidence of total complications in the observation group was lower than that in the control group(14.8% vs 40.8%, P<0.05). There were 31 cases and 31 eyes with vitreous rehaemorrhage after operation. Multivariate Logistic regression analysis showed that elevated HbA1c, vascular occlusion, proliferative retinal traction and no use of conbercept were risk factors for postoperative vitreous rehaemorrhage in PDR patients.

CONCLUSION: Conbercept combined with 25G minimally invasive vitrectomy in the treatment of PDR can reduce the intraoperative bleeding rate, reduce complications, shorten the operation time, and thus help to improve visual acuity and visual function. Effective control of blood glucose to reduce HbA1c level, intraoperative removal of fibrovascular hyperplasia membrane as much as possible to relieve retinal traction, and combined treatment with conbercept can reduce the risk of postoperative vitreous rehaemorrhage.