方法：回顾性分析我院2012-02/2014-05收治的PDR合并玻璃体积血行玻璃体切除手术患者。依据玻璃体积血病程分为三组，病程<1mo为A组(22眼)，病程1～3mo为B组(23眼)，病程>3mo为C组(25眼)。所有患者玻璃体腔注射雷珠单抗后1～2wk行23G玻璃体切除手术，术中或术后补充或完成全视网膜激光光凝术。术前存在晶状体混浊的患者联合超声乳化+人工晶状体植入术，如术中填充硅油者待Ⅱ期硅油取出术中植入人工晶状体。术后随访时间24～42(平均28.7)mo，观察术中并发症(术中出血、医源性裂孔)，术后并发症(玻璃体再次出血、新生血管性青光眼)，黄斑水肿情况以及最佳矫正视力。

结果：术前患者的基线资料组间比较，DR分期在三组之间存在统计学差异(P=0.033)，其余各项基线资料三组间均无统计学差异(P>0.05)。末次随访时三组间视力比较存在统计学差异(P<0.001)，A组分别与B组及C组比较差异具有统计学意义(P=0.03，P<0.001)； B组与C组之间比较差异不具有统计学意义(P>0.05)。末次随访视力达到0.5及以上者在A、B、C组中分别为41%、23%、0； 视力<0.1的患者A、B、C组分别为5%、26%、40%。硅油填充率A、B、C组分别为9%、26%、40%，三组之间比较无统计学差异(P>0.05)。术后再次玻璃体积血、再次手术、黄斑水肿、视神经萎缩，新生血管性青光眼发生率三组患者间比较差异无统计学意义(P>0.05)。

结论：PDR合并玻璃体积血早期行玻璃体切除术视力预后优于延迟手术的患者。

METHODS: Retrospective analysis. Patients who presented to our hospital between Feburary 2012 and May 2014 with VH secondary to PDR treated with vitrectomy were included. All patients were divided into three groups according to the duration of VH. A group was less than 1mo for 22 eyes, B group was 1-3mo for 23 eyes, C group was more than 3mo for 25 eyes. All patients underwent intravitreal injection of ranibizumab 1-2wk before vitrectomy, and supplemented or finished panretinal photocoagulation(PRP)intraoperatively or postoperatively. Patients with cataract accepted phacoemulsification and intraocular lens implantation. Eyes filling silicone oil were implanted intraocular lens in the second phase. All patients were followed up 24 to 42mo(mean: 28.7mo). We assessed the intraoperative complications such as hemorrhage, iatrogenic retinal hole, and postoperative complications such as vitreous hemorrhage, neovascular glaucoma. Macular edema and best corrected visual acuity were observed at every follow-up.

RESULTS:There was no significant difference for other baseline data(P>0.05)but DR stage between three groups(P=0.033). There was significant difference of last follow up visual acuity between three groups(P<0.001). The significant difference can be seen between group A and B(P=0.03). The same outcome showed between Group A and C(P<0.001). There was no significant difference between Group B and C(P>0.05). The percentage of visual acuity was 0.5 and above in the three groups were: 41%, 23%, 0 respectively. The patients with visual acuity of less than 0.1 were 5%, 26% and 40% respectively. Silicone oil filling rate of three groups were: 9%, 26%, 40% respectively and there was no significantly difference between three groups on postoperative complications(P>0.05).

CONCLUSION: Patients with VH due to proliferative diabetic retinopathy undergoing early vitrectomy may get better visual acuity than who accepting delayed vitrectomy.