Clinical Study Of Vitrectomy Combined With Phacoemulsification For The Treatment Of Severe Proliferative Diabetic Retinopathy

Objective To observe the clinical effect which underwent vitrectomy combined with phacoemulsification and IOL implantation(A group,28 eyes);which underwent vitrectomy combined with intravitreal injection of conbercept,phacoemulsification and IOL implantation(B group,26 eyes);and which underwent vitrectomy in the first phase,and then underwent silicone oil removed combined with phacoemulsification and IOL implantation in the second phase(C group,40 eyes)for the treatment of severe PDR.To evaluate the recovery efficacy and significance of different combined surgical methods.Methods This is a prospective randomized controlled clinical study.A total of 87 patients with severe PDR were enrolled.The follow-up period was 6~12 months.We comparative analysis the postoperative statistical results,such as the BCVA,intraocular pressure,CRT,and postoperative complications.The results were input the SPSS 20.0 statistical software,P<0.05 is a statistically significant difference.Results 1.The basic case before surgery: Comparing the basic case of three groups,there was no statistically significant difference(P>0.05).2.The postoperative statistical results 2.1 Log MAR BCVA: The mean postoperative log MAR BCVA of the three group at latest follow-up,have all improved than their preoperative log MAR BCVA respectively,the difference was statistically significant(P<0.05).The difference among three groups was statistically significant(P<0.05).While,the postoperative improvement in visual acuity among three groups has no statistically significant difference(P>0.05).2.2 Intraocular pressure: The difference of the mean postoperative intraocular pressure a week later after surgery among three groups was statistically significant(P<0.05).2.3 CRT: The mean postoperative CRT of A group,B group and C group was(293.25±93.88)μm,(231.46±71.51)μm,(281.23±74.61)μm respectively.The difference among three groups was statistically significant(P<0.05).2.4 The postoperative complications Compared the inflammatory reactions of the anterior chamber,temporary intraocular hypertension,and iris neovascularization among three groups,the difference was statistically significant(P<0.05);compared the silicone oil into the anterior chamber,NVG,rebleeding and macular edema among three groups,the difference was no statistically significant(P>0.05).Conclusions 1.Each group was safe and effective,could help earlier visual rehabilitation,avoid second operation for postvitrectomy cataract,and lighten the psychological burden and financial burden of patients.2.Compared with C group,A group or B group is more clearer to observe the ocular fundus and easier to operate.3.Compared with A group,the incidence rate of inflammatory reactions of the anterior chamber,temporary intraocular hypertension,and iris neovascularization is lower in C group.In terms of improving visual activity,C group is better than A group.4.Intravitreal injection of conbercept can reduce the incidence rate of inflammatory reactions of the anterior chamber,temporary intraocular hypertension,and iris neovascularization,and reduce postoperative CRT.In terms of improving visual activity,B group is better than A group.5.Each groups have advantages and disadvantages,we can choose different combined methods according to different patients: for the patients whose the degree of lens opacity is lighter,it is better to choose the C group’s method;and for the patients whose the degree of lens opacity is higher obviously,it is better to choose the B group’s method.