目的：探讨单独采用黄斑局灶/格栅样光凝术与黄斑局灶/格栅样光凝术联合雷珠单抗治疗糖尿病性黄斑水肿(diabetic macular edema，DME)患者的疗效。

方法：本研究观察对象为2014-08/2016-08于我院眼科治疗的DME患者70例99眼，按照治疗方式不同分为观察组与对照组。对照组49眼单独行黄斑局灶/格栅样光凝术治疗，观察组50眼在此基础上术前5～7d加用玻璃体腔注射雷珠单抗治疗。比较两组患者手术前后最佳矫正视力(best corrected visual acuity，BCVA)，光学相干断层成像技术(optical coherence tomography，OCT)检查各时期中央黄斑厚度(central macular thickness，CMT)，采用荧光素眼底血管造影(fluorescein fundus angiography，FFA)检查比较视网膜新生血管(retinal neovascularization，RNV)渗漏面积以及黄斑水肿渗漏情况。

结果：两组患者手术后BCVA均明显改善，且观察组术后各时间点均显著高于对照组，差异具有统计学意义(P<0.05)； 两组患者治疗后CMT、RNV渗漏面积均显著降低，且观察组术后各时间点均显著低于对照组，差异具有统计学意义(P<0.05)； 两组术前均有不同程度黄斑水肿渗漏发生，术后观察组黄斑水肿渗漏眼数比例显著低于对照组，差异具有统计学意义(P<0.05)； 两组均无明显并发症出现。

结论：黄斑局灶/格栅样光凝术联合雷珠单抗联合治疗DME疗效更优，视力改善更显著。

METHODS: Totally 70 patients(99 eyes)with DME treated in our hospital from August 2014 to August 2016 were randomly divided into the observation group and the control group, with 50 eyes and 49 eyes, respectively. Patients in control group were treated with macular focal/grid laser photocoagulation, and based on this, the observation group was treated with intravitreal injection of ranibizuma at 5-7d before operation. The best corrected visual acuity(BCVA)before and after operation was compared between the two groups. Central macular thickness(CMT)was examined by optical coherence tomography(OCT), and fluorescein fundus angiography(FFA)was used to examine the leakage area of retinal neovascularization(RNV)and macular edema.

RESULTS: The BCVA in both groups increased significantly after operation, and the BCVA in observation group was significantly higher than that of the control group at each time point after operation, the difference was statistically significant(P<0.05). After treatment, the CMT and leakage area of RNV in both groups significantly decreased, and the leakage area of the observation group were significantly less than those in control group at each time point(P<0.05). There were different degrees of macular edema leakage in the two groups before operation, and the proportion of eye with macular edema and leakage in observation group was significantly lower than that in control group, the difference was statistically significant(P<0.05). No obvious complications occurred in the two groups.

CONCLUSION: Compared with macular focal/grid laser photocoagulation, the combination of macular focal/grid laser photocoagulation and ranibizumab has better curative effect on DME and RNV reduction. Moreover, the patients' visual acuity improve significantly with a higher safety.