方法：收集整理并分析2009-08/2015-02间我院33例66眼仅有新生血管(包括视乳头或者视网膜上)不伴有视网膜纤维增殖膜以及玻璃体积血的PDR病历及随访资料。治疗方法一：全视网膜激光光凝在1mo内分次进行完成； 治疗方法二：先玻璃体内注射雷珠单抗，5d后进行激光，1mo内完成全视网膜光凝。随访患者治疗前、激光治疗后1、2、3wk，1、2、3mo的视力、眼压、眼底、眼B超等检查。

结果：在33例66眼患者中，男16例32眼，女17例34眼，年龄23～65岁。观察在激光期间以及之后3mo随访中，视力以及发生玻璃体积血和黄斑水肿的情况。治疗一组的患者18例36眼，治疗前视力低于0.3者10眼(28%)，0.3～0.6者20眼(56%)，0.8～1.0者6眼(17%)。治疗期间发生玻璃体积血22眼(61%)； 发生黄斑水肿或者加重10眼(28%)。治疗二组的患者15例30眼，治疗前视力低于0.3者9眼(30%)，0.3～0.6者15眼(50%)，0.8～1.0者6眼(20%)。发生玻璃体积血6眼(20%)； 发生黄斑水肿或者加重4眼(13%)。两组间治疗前视力等基本情况差别无明显统计学意义(P>0.05)，在两种不同治疗方式后，两组间最后视力的差异有统计学意义(P<0.05)。

结论：通过在激光前玻璃体内注射雷珠单抗的治疗，可以明显降低PDR患者的玻璃体积血以及黄斑水肿等并发症的发生。眼内雷珠单抗联合激光是治疗仅有新生血管不伴有纤维增殖膜以及玻璃体积血的PDR有效手段，可减少玻璃体积血和黄斑水肿等严重并发症的发生，降低对患者视功能的损伤的同时，增强患者治疗的依从性。

METHODS:From August 2009 to February 2015, the data of 33 PDR patients(66 eyes)with only neovascular vessels(including the nipple or retina)without proliferative fiber membrane from retinal or vitreous hemorrhage was recorded and followed-up. Treatment 1: the pan-retinal laser photocoagulation by several times in 1mo were completed; treatment 2: patients were given intravitreal injection of ranibizumab at first, 5d later laser photocoagulation by several times, and the pan-retinal laser photocoagulation was completed in 1mo. All patients before and after laser treatment 1, 2, 3wk, 1, 2 and 3mo were followed-up on visual acuity(VA), intraocular pressure(IOP), fundus examination, type B ultrasound etc.

RESULTS:In the 33 patients with PDR, there were 16 males(32 eyes), 17 females(34 eyes), and aged 23～65 years old. The 18 patients(36 eyes)treated with treatment 1,had 10 eyes(28%)with VA<0.3, 20 eyes(56%)with VA 0.3～0.6, 6 eyes(17%)with VA 0.8～1.0; vitreous hemorrhage happened in 22 eyes(61%)during the treatments; macular edema happened or became worse in 10 eyes(28%). The 15 patients(30 eyes)treated with treatment 2,had 9 eyes(30%)with VA<0.3, 15 eyes(50%)with VA 0.3～0.6, 6 eyes(20%)with VA 0.8～1.0; vitreous hemorrhage happened in 6 eyes(20%)during the treatments; macular edema happened or became worse in 4 eyes(13%). The VA and other aspects between the two groups before treatments had no significant differences(P<0.05).After the two kinds of treatments, the difference on VA between the two groups was statistically significant(P>0.05).

CONCLUSION:Intravitreal injection of ranibizumab before laser photocoagulation can reduce the risk of complications, such as vitreous hemorrhage and macular edema. This treatment is an effective way for PDR patients with only neovascular vessels and without proliferative fiber membrane from retinal or vitreous hemorrhage, which can reduce the risk of complications, such as vitreous hemorrhage and macular edema, reduce the injury for patients' VA and improve the compliance in patients.