目的：探究玻璃体腔注射康柏西普辅助玻璃体切割术(PPV)治疗增殖型糖尿病视网膜病变(PDR)合并玻璃体积血(VH)的疗效及安全性。

方法：前瞻性随机对照研究。选取2017-02/2019-09本院眼科收治的PDR合并VH患者作为研究对象，随机分为观察组(39例39眼)及对照组(38例38眼)。两组患者均行经睫状体平坦部标准27G PPV治疗，观察组在术前6～7d进行玻璃体腔内注射康柏西普。收集围手术期指标，随访最佳矫正视力(BCVA)、眼压、黄斑中心凹视网膜厚度(CMT)，统计手术相关并发症发生情况。

结果：观察组手术时间(74.18±15.26 vs 96.17±14.27min)、出血眼数(8% vs 37%)、硅油填充比例(18% vs 53%)、医源性裂孔发生率(15% vs 47%)少于对照组(P<0.05)； 观察组术后1mo(0.33±0.10 vs 0.60±0.21)、3mo(0.29±0.08 vs 0.59±0.30)、6mo(0.28±0.10 vs 0.66±0.25)时BCVA(LogMAR)显著优于对照组(P<0.05)； 观察组术后3mo(252.15±56.96 vs 278.41±57.48μm)、6mo(239.65±41.52 vs 268.59±33.71μm)时CMT显著优于对照组(P<0.05)； 随访期间观察组及对照组玻璃体出血发生率为5%、21%(P<0.05)； 对照组术后3眼(8%)出现牵拉性视网膜脱离，观察组未发生牵拉性视网膜脱离(P>0.05)。

结论：对于PDR合并VH患者，PPV术前辅助使用玻璃体腔注射康柏西普可缩短手术时间，减少术中出血，减轻黄斑水肿，获得更好的视力，有较好的疗效及安全性。

METHODS: In the prospective randomized controlled study, patients with PDR and VH who were admitted to ophthalmology department of the hospital from February 2017 to September 2019 were enrolled as the research objects. They were randomly divided into observation group(39 cases, 39 eyes)and control group(38 cases, 38 eyes). Both groups underwent standard 27G PPV. The observation group underwent intravitreal injection of conbercept within 6-7d before surgery. The perioperative indexes were collected. The best corrected visual acuity(BCVA), intraocular pressure and central macular thickness(CMT)were followed up. The occurrence of surgical related complications was statistically analyzed.

RESULTS: Operation time(74.18±15.26 vs 96.17±14.27min), number of bleeding eyes(8% vs 37%), ratio of silicone oil filling(18% vs 53%)and incidence of iatrogenic retinal breaks(15% vs 47%)were lower in observation than control group(P<0.05). BCVA at 1mo after surgery(0.33±0.10 vs 0.60±0.21), 3mo after surgery(0.29±0.08 vs 0.59±0.30)and 6mo after surgery(0.28±0.10 vs 0.66±0.25)were significantly better in observation than control group(P<0.05). CMT at 3mo after surgery(252.15±56.96 vs 278.41±57.48μm)and 6mo after surgery(239.65±41.52 vs 268.59±33.71μm)were significantly better in observation than control group(P<0.05). During follow up, the incidence rates of VH in observation group and control group were 5% and 21%, respectively(P<0.05). In control group, there were 3 eyes(8%)with tractional retinal detachment after surgery, while there was no tractional retinal detachment in observation group(P>0.05).

CONCLUSION: For patients with PDR and VH, intravitreal injection of conbercept before PPV can shorten operation time, reduce intraoperative blood loss and alleviate macular edema to obtain better visual acuity, with better curative effect and safety.