目的：比较分析全视网膜光凝联合雷珠单抗与曲安奈德(TA)玻璃体腔注射治疗糖尿病黄斑水肿的疗效及医疗费用。

方法：收集我院糖尿病视网膜病变伴黄斑水肿患者48例48眼。所有患者行全视网膜激光光凝后随机分为两组。雷珠单抗组：玻璃体腔注射雷珠单抗0.5mg，4wk 1次。共3次。TA组：注射曲安奈德4mg/0.1mL。治疗12wk后若黄斑中心凹视网膜厚度(CMT)≥400μm，则再次注射各组对应药物。随访6mo，对比观察两组患者治疗前及注射药物后的最佳矫正视力(BCVA)、CMT、眼压及相关治疗费用。

结果：两组患者BCVA和CMT均无显著统计学差异(P>0.05)，不同测量时间点BCVA和CMT具有显著统计学差异，不同治疗方法和时间点BCVA及CMT均存在交互作用(P<0.05)。除了TA组注药后1wk时BCVA较治疗前无明显提高(P=0.33)，其余各时间点两组BCVA均较治疗前提高(P<0.05)。治疗12、16wk雷珠单抗组BCVA提高较TA组明显，两组差异有统计学意义(P=0.03、0.045)。雷珠单抗组及TA组CMT注药后较注药前均有降低(P<0.05)。注射后1wk两组之间CMT差异有统计学意义(P<0.01)。除了1例患者需使用降眼压药物，其余两组患者眼压均在正常范围内。治疗12wk内本研究相关诊疗平均费用雷珠单抗组患者为38 736元，TA组为5 790元。治疗24wk两组平均费用分别为42 564元及7 053元。

结论：短期内全视网膜光凝联合雷珠单抗与曲安奈德玻璃体腔注射均能有效控制DME，两组治疗方法无显著差异，但全视网膜激光联合玻璃体腔注射曲安奈德治疗DME更经济。

METHODS: Forty-eight patients(48 eyes)with DME and diabetic retinopathy(DR)receiving PRP were randomly assigned to two groups, which were respectively intravitreally injected ranibizumab(0.5mg)and TA(4mg). Ranibizumab(0.5mg)was intravitreal injected every 4wk for 3 times. The effects of injection for DME were evaluated using best-corrected visual acuity(BCVA), central macular thickness(CMT)and intraocular pressure(IOP). During the follow-up, other injections were performed to eyes which had CMT greater than 400μm. The medical costs were calculated at 12wk and 24wk.

RESULTS: BCVA and CMT between 2 groups were not significantly different(P>0.05); BCVA and CMT among different time points were significantly different(P<0.05); the treatments and the time points had significant interaction on BCVA(P<0.05). BCVA was improved in two groups at all the time after injection(P<0.05), except 1wk after injection of TA(P=0.33). There was significant difference between the two groups at 12wk and 16wk on BCVA and that injected with ranibizumab was better(P=0.03, 0.045). CMT decreased in two groups at all the time after injection(P<0.05). There was significant difference only between the two groups at 1wk(P<0.01). All intraocular pressures were in the normal range, except one needed ocular hypotensive agents. The medical costs(yuan)of the ranibizumab group in 12wk and 24wk were 38 736 and 42 564,which of the TA group were 5 790 and 7 053, respectively.

CONCLUSION: Both PRP combined with ranibizumab or TA for DME can effectively control disease progression in short time. Therapeutic effect is not significant between two methods, but PRP combined with TA is more economic.