目的：观察23G微创玻璃体切割术联合雷珠单抗玻璃体腔注射治疗增生性糖尿病视网膜病变(PDR)的临床效果。

方法：回顾性研究。采集2016-01/2020-01医院收治的PDR患者78例89眼，按术前是否给予雷珠单抗玻璃体腔注射治疗分为手术组(仅行23G微创玻璃体切割术，35例41眼)与联合组(23G微创玻璃体切割术联合术前玻璃体腔注射雷珠单抗治疗，43例48眼)，比较两组手术时间、术中出血、术中电凝止血次数、眼内填充及视网膜裂孔发生情况； 治疗前，术后1d，3mo最佳矫正视力(BCVA)、眼压、黄斑中心凹厚度(CMT)、视网膜新生血管荧光素渗漏面积的变化； 治疗前、术后1wk均抽取房水测定血管内皮生长因子(VEGF)-A、人基质细胞衍生因子-1(SDF-1)、色素上皮衍生因子(PEDF)含量的变化； 统计两组随访3mo手术并发症发生率。

结果：联合组手术时间短于手术组，电凝止血次数、硅胶填充眼数少于手术组(P<0.05)，术中总出血眼数少于手术组(P<0.05)； 术后1d，3mo联合组BCVA改善优于手术组(P<0.05)，CMT、视网膜新生血管渗漏面积低于手术组(P<0.05)； 两组眼压比较无差异(P>0.05)； 术后1wk，两组VEGF-A、SDF-1、PEDF均降低(P<0.001)，联合组房水内VEGF-A、SDF-1、PEDF均低于手术组(P<0.001)； 联合组医源性裂孔及玻璃体再积血发生率低于手术组(P<0.05)，其余各并发症均无差异(P>0.05)。

结论：23G微创玻璃体切割术联合雷珠单抗玻璃体腔注射治疗PDR整体价值优于单独应用23G微创玻璃体切割术，可降低手术难度，缩短手术时间，减少术中出血及器械操作，促进术后视力恢复，抑制视网膜新生血管生成，降低医源性损伤发生风险，并发症少，更安全有效。

METHODS: A retrospective review was performed on 78 patients with PDR who were seen between January 2016 and January 2020. Those treated with 23G micro-invasive vitrectomy alone were included in the surgery group(n=35, 41 eyes), while those treated with 23G micro-invasive vitrectomy and preoperative intravitreal injection of ranibizumab were included in the combined group(n=43, 48 eyes). The operation time, intraoperative blood loss, frequency of electric coagulation hemostasis during surgery, intraocular tamponade, occurrence of retinal tear, changes in the best corrected visual acuity(BCVA), intraocular pressure, central macular thickness(CMT)and fluorescein leakage area of retinal neovascularization before treatment, at 1d and 3mo were compared between the 2 groups. Aqueous humor samples were collected before treatment and at 1wk to determine changes in vascular endothelial growth factor(VEGF)-A, human stromal cell-derived factor-1(SDF-1)and pigment epithelial-derived factor(PEDF)levels. The incidence of surgical complications within 3mo of follow-up was counted.

RESULTS: Operation time for the combined group was shorter than that for the surgery group, the frequency of electric coagulation hemostasis, the number of eyes filled with silica-gel and the total number of intraoperative bleeding eyes were lower and smaller than those in the surgery group(P<0.05). At 1d and 3mo, the improvement of BCVA was better in the combined group than in the surgery group(P<0.05), CMT and retinal neovascularization leakage area were smaller than the surgery group(P<0.05), but no significant difference was found in intraocular pressure between the 2 groups(P>0.05). At 1wk, VEGF-A, SDF-1 and PEDF decreased in both groups(P<0.001), lower in the combined group than in the surgery group(P<0.001). The incidences of iatrogenic tear and vitreous re-hemorrhage were lower in the combined group than in the surgery group(P<0.05). There was no significant difference in the incidence of the other complications between the 2 groups(P>0.05).

CONCLUSION: 23G micro-invasive vitrectomy combined with intravitreal injection of ranibizumab is superior to 23G micro-invasive vitrectomy alone in the treatment of PDR since the combined treatment can reduce surgical difficulty, shorten the operation time, reduce intraoperative blood loss and instrument operation, promote postoperative recovery of visual acuity, inhibit retinal neovascularization, and reduce the risks of iatrogenic injury, with fewer complications. Also, it is safer and more effective.