目的：观察玻璃体腔注射雷珠单抗(intravitreal injection of ranibizumab，IVR)、全视网膜激光光凝(panretinal photocoagulation，PRP)及两者联合对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)患眼行23G微创玻璃体切割手术(pars plana vitrectomy，PPV)的影响。

方法：回顾性对照研究。将临床确诊为PDR并行23G微创玻璃体切割术的患者142例169眼纳入研究。A组：PPV术前行IVR患者35例41眼，B组：PPV术前行PRP患者34例39眼，C组：PPV术前行IVR和PRP患者32例38眼，D组：PPV术前未行IVR及PRP患者41例51眼。比较4组患眼的玻璃体切割手术时间、术中出血量、使用电凝情况、医源性裂孔、眼内硅油填充及术后1mo最佳矫正视力(best corrected visual acuity，BCVA)、并发症的情况。

结果：四组平均手术时间分别为70.03±8.91、71.13±8.89、68.60±6.73、103.23±17.44min，A、B、C组平均手术时间均明显比D组短，差异具有统计学意义(P<0.05)。四组术中发生医源性裂孔的眼数组间整体比较，差异均无统计学意义(χ²=0.531，P>0.05)。四组术中使用电凝的眼数分别为8、11、7、38眼，A、B、C组术中使用电凝的眼数明显比D组少，差异均有统计学意义(χ²_AD=27.499、χ²_BD=19.105、χ² _CD=27.405，均P<0.0167)； A、B、C组术中使用电凝的眼数两两比较，差异均无统计学意义(χ²=1.305，P>0.05)。四组术中硅油填充的眼数分别为6、7、5、28眼，A、B、C组术中硅油填充的眼数明显比D组少，差异均有统计学意义(χ²_AD=15.818、χ²_BD=12.698、χ²_CD=18.014，均P<0.0167)； A、B、C组术中硅油填充的眼数组间整体比较，差异均无统计学意义(χ²=0.360，P>0.05)。四组术中出现持续或严重出血的眼数组间整体比较，差异无统计学意义(χ²=2.809，P>0.05)。PPV术后1mo，四组平均BCVA分别为0.274±0.151、0.175±0.079、0.277±0.137、0.177±0.059，A、B、C组平均BCVA均比D组提高，差异均具有统计学意义(均P<0.05)。术后1wk，四组玻璃体再次出血的眼数分别为5、5、4、20眼，A、B、C组术后玻璃体再次出血的眼数均比D组减少，差异均有统计学意义(χ²_AD=8.385、χ²_BD=7.675、χ² _CD=9.100，均P<0.0167)； 术后1、3mo四组术中玻璃体再次出血眼数组间整体比较，差异均无统计学意义(χ²_1mo=2.933、χ²_3mo=2.249， P>0.05)。

结论：PDR患眼23G微创玻璃体切割术前行IVR、PRP治疗能有效缩短手术时间，减少术中出血及电凝止血、眼内填充物的使用率，有效提高患眼视力。

AIM: To study the effect of 23G minimally invasive vitrectomy surgery assisted with intravitreal injection of ranibizumab(IVR)and panretinal photocoagulation(PRP)and combine both of them in the treatment of proliferative diabetic retinopathy(PDR).

METHODS: Retrospective control study. A total of 142 patients(169 eyes)with PDR were recruited to have 23G vitrectomy surgery and were divided into 4 groups as intravitreal injection of ranibizumab(Group A, 35 patients, 41 eyes), panretinal photocoagulation(Group B, 34 patients, 39 eyes), combine IVR and PRP(Group C, 32 patients, 38 eyes)and control group(Group D, 41 patients, 51 eyes). The average operating time, blooding during operation, the use of filler and electric coagulation, iatrogenic breaks, best corrected visual acuity in 1mo and complication were comparatively analyzed among the 4 groups.

RESULTS: The average operating time was 70.03±8.91min in Group A, 71.13±8.89min in Group B, 68.60±6.73min in Group C and 103.23±17.44min in Group D. The average operating time of A, B, C groups were significantly reduced than Group D, the difference was statistically significant(P_AD,P_BD,P_CD<0.05). The difference of iatrogenic breaks in four groups was no statistically significant(χ²=0.531, P>0.05). Electric coagulation were used in 8 eyes of Group A, in 11 eyes of Group B, in 7 eyes of Group C and in 38 eyes of Group D. The use of electric coagulation in Group A, B, C were significantly reduced than Group D, the difference was statistically significant(χ²_AD=27.499, χ²_BD=19.105, χ²_CD=27.405, P_AD,P_BD,P_CD<0.0167). But there was no significant difference in Group A, B, C(χ²=1.305, P>0.05). Filler were needed in 6 eyes of Group A, in 7 eyes of Group B, in 5 eyes of Group C and in 28 eyes of Group D, the use of filler in A, B, C groups were significantly reduced than D group, the difference was statistically significant(χ²_AD=15.818, χ²_BD=12.698, χ²_CD=18.014,P_AD、P_BD、P_CD<0.0167); but there was no difference in A,B,C groups(χ²=0.360, P>0.05). Continuous or severe bleeding during the operation in the four groups were no difference(χ²=2.809, P>0.05).The best corrected visual acuity of 1mo after surgery was 0.274±0.151, 0.175±0.079, 0.277±0.137, 0.177±0.059 respectively in the four groups; Groups A, B, C were significantly increased than Group D, the difference was statistically significant(P_AD,P_BD,P_CD<0.05). There were 5, 5, 4, 20 eyes happened vitreous hemorrhage again respectively in Group A, B, C, D of 1wk; Group A, B, C were significantly reduced than Group D, the difference was statistically significant(χ²_AD=8.385, χ²_BD=7.675, χ²_CD=9.100, P_AD, P_BD, P_CD<0.0167); but there were no difference after 1 and 3mo among four groups(χ²_1mo=2.933, χ²_3mo=2.249, P_1mo, P_3mo>0.05).

CONCLUSION:The therapy of ranibizumab and panretinal photocoagulation before vitrectomy surgery can effectively shorten the operation time, reduce the use of filler and electric coagulation and complication, effectively increase the visual acuity.