方法：选取我院2015-03/2016-06确诊为严重PDR患者61例74眼，根据自愿原则，31例37眼在VRS前行玻璃体腔注射ranibizumab治疗，设为联合组，30例37眼行纯VRS，设为对照组。对比两组术后的玻璃体积血率、BCVA(LogMAR)、平均眼压、黄斑中心凹视网膜厚度及并发症。

结果：联合组术后1wk玻璃体积血率为8%，显著低于对照组的27%，差异有统计学意义(χ²=4.573，P=0.032)； 联合组术后>1～4wk玻璃体积血率为0，而对照组为16%，差异有统计学意义(P=0.033)； 联合组术后>1～3mo玻璃体积血率为0，低于对照组的8%，差异无统计学意义(P=0.238)； 术后3mo联合组的BCVA明显好于对照组，差异有统计学意义(t=2.320，P=0.023)； 术后3mo两组平均眼压差异无统计学意义(t=0.516，P=0.608)； 术后3mo联合组平均黄斑中心凹视网膜厚度为298.8±78.3μm，显著低于对照组的357.1±86.2μm，差异有统计学意义(t=3.045，P=0.003)； 联合组一过性高眼压率为14%，显著低于对照组的32%，差异有统计学意义(χ²=10.385，P=0.001)； 联合组的视网膜前膜率、复发性牵拉性视网膜脱落率及新生血管性青光眼率均低于对照组，但差异无统计学意义(P>0.05)。

结论：玻璃体腔注射ranibizumab辅助VRS虽存在一定争议，但在合适的剂量、频率和时间下能取得显著的疗效，安全性也较高。

METHODS: Totally 61 patients and 74 eyes were selected with severe PDR from March 2015 to June 2016 in our hospital. According to the principle of voluntary, 37 eyes of 31 cases in the VRS before the IVR treatment was set to the joint group, 37 eyes of 30 cases line pure VRS was set to the VRS group. We compared the vitreous volume, logMAR, mean IOP, macular central retinal thickness and complications between the 2 groups.

RESULTS: The blood rate of glass in the combination group was 8% after 1wk of postoperative which was significantly lower than that of the VRS group 27%(χ²=4.573, P=0.032). The glass volume blood rate of the combined group was 0 after 1mo of postoperative while the VRS was 16%(P=0.033). The blood rate of glass in the combination group was 0 at 3mo of postoperative, and 8% in the VRS group(P=0.238). The LogMAR in the combined group was significantly lower than that in the VRS group(t=2.320, P=0.023). There was no significant difference in the mean IOP between the two groups(t=0.516, P=0.608). The mean macular retinal thickness of the combined group was 298.8±78.3μm which significantly lower than the VRS group 357.1±86.2μm(t=3.045, P=0.003). The combined high intraocular pressure rate of the combined group was 14% which was significantly lower than 32% of the control group(χ²=10.385, P=0.001). The rate of anterior membrane of the retina of the combined group, the rate of recurrent traction and the rate of retinal detachment of the newborn were lower than that of the VRS group, but the difference was not statistically significant(P>0.05).

CONCLUSION: IVR assisted VRS, although there is a certain controversy, but in the appropriate dose, frequency and time to achieve significant efficacy, safety is also high.