目的：分析严重增殖性糖尿病视网膜病变(PDR)玻璃体手术后的疗效及影响因素。

方法：将2015-01/2018-01我院收治的PDR Ⅵ期患者(94例112眼)按OCT情况分为黄斑病变组(61例70眼)与无黄斑病变组(33例42眼)，比较两组随访6mo视力、黄斑区P1波振幅密度和视网膜复位情况，以视力改善作为疗效评估标准，分析PDR Ⅵ期术后疗效和影响因素。

结果：无黄斑病变组术后6mo视力分级优于黄斑病变组(P<0.05)。术后6mo黄斑病变组(1+2)环P1波振幅密度低于无黄斑病变组(P<0.05)。所有患者中，患眼1次手术视网膜解剖复位95眼(84.8%)，2次复位10眼(8.9%)，3次复位2眼(1.8%)，4次复位1眼(0.9%)，未复位4眼(3.6%)，总复位率96.4%。合并黄斑病变、长糖尿病病程患者视力改善有效率低于未合并黄斑病变、短糖尿病病程者(P<0.05)，合并黄斑病变、糖尿病病程均为影响严重PDR患者术后疗效的独立因素(P<0.05)。

结论：玻璃体切割术可改善PDR Ⅵ期患者术后视力，术前合并显著黄斑病变和糖尿病病程是影响严重PDR患者术后疗效的重要因素。

METHODS: Totally 94 patients(112 eyes)with stage VI of PDR in our hospital from January 2015 to January 2018 divided into maculopathy group(n=61 cases, 70 eyes)and non-maculopathy group(n=33 cases, 42 eyes)according to the OCT. The visual acuity, P1 wave amplitude density and retinal reattachment in macular area were compared between the two at 6mo of follow-up. Postoperative efficacy and influencing factors of stage VI of PDR were analyzed by taking vision improvement as a standard of efficacy evaluation.

RESULTS: The visual acuity grading in maculopathy group at 6mo after operation was better than that in non-maculopathy group(P<0.05). The P1 wave amplitude density in the(1+2)ring in maculopathy group was lower than that in non-maculopathy group(P<0.05). Among patients, there were 95 eyes(84.8%)of one-time retinal anatomical reduction, 10 eyes(8.9%)of twice reduction, 2 eyes(1.8%)of 3 times reduction, 1 eye(0.9%)of 4 times reduction and 4 eyes(3.6%)without reduction, and the total reduction rate was 96.4%. The effective rate in patients with maculopathy and patients with long course of diabetes mellitus was lower than that in patients without maculopathy and patients with short course of diabetes mellitus(P<0.05), and maculopathy and diabetes duration were independent factors affecting the postoperative efficacy of patients with severe proliferative diabetic retinopathy(P<0.05).

CONCLUSION: Vitrectomy can improve postoperative visual acuity of patients with stage VI of PDR, and preoperative combination of significant maculopathy and course of diabetes mellitus are important factors affecting postoperative efficacy in patients with severe PDR.