目的：观察玻璃体切割术(PPV)联合内界膜(ILM)剥除术治疗顽固性糖尿病黄斑水肿的临床疗效。

方法：回顾性分析顽固性糖尿病黄斑水肿并行PPV联合ILM剥除术患者56例56眼，根据有无后极部玻璃体后脱离分为A组(无玻璃体后脱离，35例35眼)和B组(有玻璃体后脱离，21例21眼)。对比分析手术前及手术后1、3、6mo时患眼最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)变化情况。

结果：A组手术后1、3、6mo平均CMT和BCVA与手术前比较均有差异(P<0.05)。B组手术后1、3、6mo平均BCVA与手术前比较均无差异(P>0.05)； 手术后1mo平均CMT与手术前比较有差异(P<0.05)，术后3、6mo平均CMT与手术前比较均无差异(P>0.05)。术后1、3、6mo，两组CMT、BCVA比较均有差异(P<0.05)。

结论：PPV联合ILM剥除术能有效治疗无玻璃体后脱离的顽固性糖尿病黄斑水肿，提高患者视力； 但当患者玻璃体已经后脱离且没有牵拉时，PPV联合ILM剥除术治疗效果不佳。

METHODS: The data of 56 eyes(56 patients)with refractory diabetic macular edema accepted PPV combined with ILM peeling were collected and retrospectively analyzed. The patients were divided into Group A(no posterior vitreous detachment): 35 cases(35 eyes)and Group B(with posterior vitreous detachment): 21 cases(21 eyes). The best corrected visual acuity(BCVA)and central macular thickness(CMT)before and 1, 3, 6mo after operation were compared and analyzed.

RESULTS: The mean CMT and LogMAR BCVA of Group A at 1, 3 and 6mo after operation were significantly different from those before operation(P<0.05); There was no significant difference in BCVA between those before and 1, 3, 6mo after operation in Group B(P>0.05). The mean CMT of 1mo after operation was significantly different from that before operation(P<0.05). There was no significant difference in mean CMT between 3 and 6mo after operation and before operation(P>0.05). CMT and BCVA were significantly different between the two groups at 1,3 and 6mo postoperatively(P<0.05).

CONCLUSION: PPV combined with ILM peeling can effectively treat refractory diabetic macular edema without posterior vitreous detachment, improve the patient's vision; However, PPV combined with ILM peeling was not effective in patients without posterior vitreous detachment.