方法：选择2013-01/2015-08于我院诊断为PDR伴玻璃体积血的患者共46例50眼，其中28例30眼接受贝伐单抗治疗，设为注药组； 另外18例20眼作为对照组，对照组除未接受贝伐单抗注射外其他治疗方法及随诊等均同注药组。观察记录两组患者4wk后玻璃体积血吸收情况、术后最佳矫正视力、玻璃体再出血等情况。对于两组患者，贝伐单抗注射后每周随访，若出血吸收，眼底可看清，则及时行荧光素眼底血管造影及视网膜激光治疗； 注药后4wk，若玻璃体积血无明显吸收或积血加重者，或随访过程中出现视网膜牵引脱离者，则及时行玻璃体切除术(pars plana vitrectomy，PPV)，随诊时间3mo。

结果：随访3mo后，两组患者共避免玻璃体切除术10眼，其中注药组9眼(30%)，对照组1眼(5%)，两组间比较差异有统计学意义(χ²=6.108，P=0.0171)。随访3mo后注药组视力提高19眼(63%)，对照组视力提高7眼(35%)，组间比较差异有统计学意义(χ²=6.102，P=0.014)。两组患者中共40眼行玻璃体切除手术，注药组21眼中有5眼玻璃体腔硅油填充(24%)，对照组19眼中有12眼玻璃体腔硅油填充(63%)，硅油填充眼数比较差异有统计学意义(χ²=5.2849，P=0.0137)。

结论：贝伐单抗玻璃体腔注射后可以使部分PDR伴玻璃体积血患者避免玻璃体切除手术，降低手术难度，减少眼内硅油填充率和术后再出血，提高术后视力。

METHODS:Fifty eyes in 46 PDR patients with vitreous hemorrhage were randomly divided into two groups. Thirty eyes in 28 patients were given intravitreal bevacizumab injection as the injection group. Twenty eyes in 18 patients were given the same treatment as injection group except bevacizumab injection in the control group. The absorption of vitreous hemorrhage, operation condition, best corrected visual acuity(BCVA), vitreous hemorrhage recurrence and other complications were observed. All the patients were followed up every week. If the hemorrhage was absorbed and the fundus could be seen clearly, the fundus fluorescein angiography(FFA)and laser photocoagulation were given. At 4wk after treatment, if the hemorrhage was not absorbed and became even worse, or retinal detachment occurred during the follow-ups, pars plana vitrectomy(PPV)would be taken. The follow-up time was 3mo.

RESULTS:Three months after intravitreal bevacizumab injection, the total number of the eyes avoiding vitrectomy was 10 eyes, 9 eyes(30%)in the injection group compared with 1 eye(5%)in the control group(χ²=6.108,P=0.0171). There were 19 eyes whose BCVA increased in the injection group, the proportion was 63%(19/30); there were 7 eyes whose BCVA increased in the control group,the proportion was 35%(7/20); there was statistically significant difference(χ²=6.102,P=0.014). The total number of the eyes receiving vitrectomy was 40, 5 eyes of 21(24%)were filled with silicone oil in the injection group, compared with 12 eyes of 19(63%)in the control group(χ²=5.2849, P=0.0137).

CONCLUSION:Intravitreous injection of bevacizumab for the PDR patients with vitreous hemorrhage can reduce the possibility of vitrectomy for some patients, reduce the difficulties of the vitrectomy for the others. The operation difficulty can be less and the use of silicon oil in the vitrectomy can be reduced. It is helpful in reducing the postoperative vitreous recurrent hemorrhage and improving the postoperative BCVA.