关键词: 增生性糖尿病视网膜病变, 玻璃体切除术, 内界膜剥除

Abstract: Objective To observe the clinical efficacy of vitrectomy combined with inner limiting membrane (ILM) peeling in the treatment of proliferative diabetic retinopathy (PDR) with macular detachment. Design Retrospective comparative case series. Participants 39 cases (45 eyes ) diagnosed as PDR with macular detachment in Tongren Eye Center． Methods Vitrectomy and ILM peeling were performed in the ILM-removed group, in which there were 21 patients ( 24 eyes ); vitrectomy only were performed in the control group, in which there were 21 eyes of 18 patients. All the surgeries were performed by the same surgeon. Best corrected visual acuity (BCVA, LogMAR), complications, and the center macular thickness (CMT) and subretinal fluid height (SFH) were examined before the surgery and during follow-up at one week, one month, three month and six month postoperative． Main Outcome Measures BCVA, SFH, and CME. Results The BCVA of the combined group and the control group were significantly higher at 1 week, 1 month, 3 months and 6 months after operation than before operation (F=17.63, 16.94; P<0.001). The BCVA in the ILM-removed group (0.71±0.65) was higher than the control group (1.02±0.53) at three month after operation (t=2.73，P=0.009). The SFH of the two groups at 1 week, 1 month, 3 months and 6 months after operation was significantly lower than that before operation (F=17.63, 16.94; P<0.001). The CMT in the ILM-removed group (218.56±49.51 μm) was thinner than in the control group (289.32±65.34 μm ) at six month after operation (t=2.84，P=0.006). The SFH of the two groups decreased significantly at 1 week, 1 month, 3 months and 6 months after operation (F=17.63, 16.94, P<0.05). The SFH in the ILM-removed group (15.07±12.01 μm) was lower than in the control group (42.67±30.21 μm) at three month after operation (t=2.24，P=0.003). Conclusion In the treatment of PDR with macular detachment, vitrectomy combined with ILM peeling can effectively and safely improve visual acuity, reduce the thickness of macular center area and promote SRF absorption． (Ophthalmol CHN, 2021, 30: 222-226)

Key words: proliferative diabetic retinopathy, pars plana vitrectomy, internal limiting membrane peeling