目的：利用术中荧光血管造影(IOFA)技术评估增生性糖尿病视网膜病变(PDR)术前进行玻璃体腔注射抗血管内皮生长因子(VEGF)治疗的最佳时间点。

方法：回顾性研究。收集2023年1月至2025年2月在四川省人民医院就诊的因PDR伴玻璃体积血行玻璃体切除手术的患者的临床资料。按术前玻璃体腔注射康柏西普的时间分为A组(术前3 d注射)、B组(术前7 d注射)、C组(术前14 d注射)。通过IOFA观察PDR患者眼底新生血管(NV)的个数和大小，并收集术前最佳矫正视力(BCVA)、玻璃体积血分级、术中手术时间、电凝使用频率、高灌注压持续时间、玻璃体视网膜黏连分级及术后BCVA、黄斑中心区厚度(CMT)等信息，进行多维度分析。

结果：本研究共纳入玻璃体积血的PDR患者91例94眼，其中A组31例31眼，男18例，女13例，平均年龄53.26±12.38岁； B组34例37眼，男21例，女13例，平均年龄51.61±14.16岁； C组26例26眼，男18例，女8例，平均年龄51.00±12.02岁。三组患者一般资料具有可比性(均P>0.05)。对IOFA辅助下观察到的NV个数、大小比较分析，B组与C组的NV个数、大小均小于A组(均P<0.0167)； 但B组与C组比较无差异(均P>0.05)。三组手术时间、电凝使用频率、高灌注压持续时间、玻璃体视网膜黏连分级等其他术中指标无差异(均P>0.05)。

结论：IOFA证实，术前7 d、14 d抗VEGF治疗较术前3 d能更有效地抑制PDR患者视网膜NV活性。

METHODS:A retrospective case series study was conducted on patients who underwent vitrectomy for PDR with vitreous hemorrhage(VH)at Sichuan Provincial People's Hospital from January 2023 to February 2025. Patients were divided into three groups according to the interval between intravitreal conbercept injection and surgery: Group A(3 d before surgery), Group B(7 d before surgery), and Group C(14 d before surgery). IOFA was used to assess the number and size of retinal neovascularization(NV). Additional data were collected including preoperative best corrected visual acuity(BCVA), vitreous hemorrhage grading, operative time, frequency of intraoperative endodiathermy, duration of high perfusion pressure, vitreoretinal adhesion grade, postoperative BCVA, and central macular thickness(CMT). Multidimensional analyses were performed.

RESULTS:This study enrolled a total of 91 patients(94 eyes)with PDR accompanied by vitreous hemorrhage. Among them, Group A consisted of 31 patients(31 eyes; 18 males, 13 females; mean age 53.26±12.38 y), Group B consisted of 34 patients(37 eyes; 21 males, 13 females; mean age 51.61±14.16 y), and Group C consisted of 26 patients(26 eyes; 18 males, 8 females; mean age 51.00±12.02 y), with baseline characteristics comparable among the three groups(all P>0.05). Comparative analysis of NV visualized via IOFA revealed that both the number and size of NVs were significantly lower in Groups B and C than in Group A(all P<0.0167), while no statistically significant differences were observed between Groups B and C(both P>0.05). No significant differences were found among the three groups regarding other intraoperative parameters, including operation time, frequency of electrocoagulation application, duration of high perfusion pressure, or grading of vitreoretinal adhesion(all P>0.05).

CONCLUSION:IOFA confirms that preoperative anti-VEGF therapy administered 7 or 14 d before surgery is more effective than a 3 d interval in suppressing retinal NV activity in PDR patients.