目的：探讨玻璃体视网膜手术治疗增殖性糖尿病视网膜病变（PDR）的临床效果。方法对54例（69只眼）行玻璃体切除术的增殖性糖尿病视网膜病变患者的临床资料进行回顾性分析。所有患者均采用非接触广角观察系统23G微创玻璃体切割术，术中切除中轴部玻璃体后注入TA染色玻璃体，高速玻切除残留玻璃体后皮质及视网膜前膜，行眼内视网膜光凝，如伴有裂孔及视网膜脱离术中行C3F8或硅油填充。术后随访5-23个月平均16.2个月，观察记录最佳矫正视力、眼压、术中术后并发症等发生情况，对记录数据进行统计学分析比较。结果患者69只眼均顺利完成玻璃体手术，20只眼眼内填充硅油，30只眼填充C3F8，19眼平衡盐液填充。Ⅳ期患者术后视力改善率93.7%（15/16），Ⅴ期患者术后视力改善率73.3%（22/30），Ⅵ期患者术后视力改善率47.8%（11/23）。三组术后视力改善率比较，差异有统计学意义（P＜0.05）。术后并发症：高眼压、玻璃体出血、视网膜脱离、并发性白内障、新生血管性青光眼、眼球萎缩。结论在非接触广角观察系统下，进行23G微创玻璃体切割术治疗PDR是安全、有效、可行的方法，能够缩短手术时间，恢复视功能，术中应用TA染色玻璃体联合高速玻切，提高手术成功率，值得临床推广应用。%Objetive To observe the clinical effect of vitrectomy for proliferative diabetic retinopathy (PDR).Metods 54cases (69eyes) of PDR were treated with 23-gauge Vitrectomy and non-con-contact wild-angle viewing system (BIOM3). After cut the axial vitreous, TA was used to dye the Vitreous, and then high-speed vitrectomy technique was used to remove the residual vitreous and epiretinal membrane. Then the eyes received laser photocoagulation, In some cases where retinal tear or retinal detachment presented, gas or silicon oil was injected intracocularly .All patients were followed up for 5-23 months, meanly 16.2months. Main outcome measures included the best correcte visual acuity(BCVA), intraocular pressure (IOP), intraoperative and postoperative complications, and the data were statistically analyzed and compared. Results All 69 eyes received vitrectomy, of which silicone oil was tamponaded in 20 eyes, C3F8 was injected in 30eyes, BBS was filled in 19eyes. Stage IV patients had the visual acuity improvement rate of 93.7%(15/16), stage V patients had the rate of 73.2%(22/30), and state VI patients had the rate of 47.8%. There was obvious difference among them (P<0.05). The major postoperative complications included high intraocular pressure, vitreous hemorrhage, retinal detachment, complicated cataract, etc. Conclusion Vitrectomy with 23-gauge micro-invasive vitrectomy and non-contact wild-angle viewing system is safe, effective and practical to treat PDR. It can shorten the time of operation, help the patients recover visual performances.
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