目的：探讨玻璃体内注射雷珠单抗治疗重度非增殖性糖尿病视网膜病变(nonproliferative diabetic retinopathy，NPDR)黄斑水肿患者脉络膜的厚度变化情况，分析脉络膜的厚度与患者视力的关系。

方法：选取2014-01-01/2017-01-01于我院接受治疗的80例80眼重度NPDR黄斑水肿患者为研究对象，按照随机数字表法将所有患者分为观察组和对照组，每组40例40眼。对照组采取常规方式治疗，观察组在玻璃体内注射雷珠单抗治疗。记录两组患者治疗前后1mo的黄斑中心凹下脉络膜厚度和黄斑区视网膜神经上皮厚度，并进行比较分析两组患者治疗前后1mo最佳矫正视力的变化情况，通过回归分析研究黄斑中心凹下脉络膜厚度与患者视网膜神经上皮厚度和最佳矫正LogMAR视力值的相关性，比较两组患者治疗后6wk的并发症和不良反应情况。

结果：观察组和对照组治疗前1mo黄斑中心凹下脉络膜厚度和黄斑区视网膜神经上皮厚度分别为219.57±51.24μm和474.76±95.56μm，217.56±50.36μm和473.27±96.48μm； 观察组和对照组治疗后1mo黄斑中心凹下脉络膜厚度和黄斑区视网膜神经上皮厚度分别为180.15±42.06μm和382.18±84.26μm，202.48±48.28μm和407.88±44.25μm，两组患者治疗后比较，差异有统计学意义(P<0.05)。观察组和对照组治疗后1mo最佳矫正LogMAR视力分别为0.47±0.19和0.53±0.25，两组患者治疗后比较，差异有统计学意义(P<0.05)，黄斑中心凹下脉络膜厚度和最佳矫正LogMAR视力值存在正相关性(回归系数=1.12，S=0.48，OR=1.376，P<0.05)，黄斑区视网膜神经上皮厚度和最佳矫正LogMAR视力值存在正相关性(回归系数=0.95，S=0.27，OR=1.020，P<0.05)。观察组患者治疗后6wk结膜下出血2例2眼(5%)、青光眼1例1眼(2.5%)、玻璃体内积血1例1眼(2.5%)、脉络膜脱离0例、视网膜脱离0例； 对照组患者治疗后6wk结膜下出血4例4眼(10%)、青光眼2例2眼(5%)、玻璃体内积血2例2眼(5%)、脉络膜脱离2例2眼(5%)、视网膜脱离2例2眼(5%)； 两组患者并发症和不良反应比较，差异有统计学意义(P<0.05)。

结论：重度NPDR黄斑水肿患者的脉络膜厚度与最佳矫正视力存在相关性，玻璃体内注射雷珠单抗能够有效降低黄斑中心凹下脉络膜厚度，减轻黄斑水肿情况并改善视力，且并发症比较少。

METHODS: Eighty patients with severe non-proliferative diabetic retinopathy were selected from January 1, 2014 to January 1, 2017. All patients were divided into observation group and control group according to the random number table, 40 cases in each group. The control group was treated in a conventional manner, and the observation group was injected with ranibizumab in the vitreous. The thickness of the choroid in the macular area and the thickness of the retinal neuroepithelium in the macular area were compared between the two groups before and after treatment. The changes of the corrected visual acuity were analyzed at 1mo before and after treatment. The relationship between the thickness of the choroid and the thickness of the retinal neuroepithelium and the best corrected visual acuity were compared. The complications and adverse events were compared between the two groups after 6wk of treatment.

RESULTS: The thickness of the choroid and the retinal neuroepithelium in the macular area before were 219.57±51.24μm and 474.76±95.56μm, respectively, in the observation group and the control group, 217.56±50.36μm and 473.27±96.48μm, respectively. The thickness of the choroid and the thickness of the retinal neuroepithelium in the macular area after treatment were 180.15±42.06μm and 382.18±84.26, 202.48±48.28μm and 407.88±44.25μm, respectively. The difference between the two groups was statistically significant(P<0.05). The best corrected visual acuity in the observation group and the control group were 0.47±0.19 and 0.53±0.25 respectively(P<0.05). There was a positive correlation between the choroidal thickness and the best corrected visual acuity in the macular fovea(regression coefficient=1.12, S=0.48, OR=1.376, P<0.05). There was a positive correlation between retinal neuroepithelial thickness and best corrected visual acuity in the macular area(regression coefficient =0.95, S=0.27, OR=1.020, P<0.05). There were 2 eyes(5%)with subconjunctival hemorrhage, 1 eyes(2.5%)of glaucoma, 1 eyes(2.5%)of vitreous hemorrhage, 0 of choroidal detachment, retinal detachment in 0 in observation group at 6wk after treatment. There were 4 eyes(10%)with subconjunctival hemorrhage, 2 eyes(5%)of glaucoma, 2 eyes of vitreous hemorrhage(5%), 2 eyes of choroidal detachment(5%), retinal detachment in 2 eyes(5%)in the control group, and the difference between the two groups on the complications and adverse reactions was statistically significant(P<0.05).

CONCLUSION: The choroidal thickness of patients with macular edema in severe non-proliferative diabetic retinopathy is correlated with the best corrected visual acuity. Intravitreal injection of ranibizumab can effectively reduce the macular fovea choroidal thickness, reduce macular edema and improve vision, and less complications.