目的：研究雷珠单抗联合激光光凝治疗糖尿病性黄斑水肿(diabetic macular edema，DME)的临床疗效。

方法：选取2014-06/2016-06于我院治疗的190例190眼DME患者的病历资料进行回顾性分析。将单独使用雷珠单抗玻璃体腔注射治疗的90例90眼患者设为对照组，在此基础上联合视网膜激光光凝治疗的100例100眼患者设为观察组。比较两组患者术前、术后最佳矫正视力(best corrected visual acuity，BCVA)； 光学相干断层扫描(optical coherence tomography，OCT)测量黄斑中心凹厚度(central macular thickness，CMT)； 眼底血管造影(fundus fluorescein angiography，FFA)评价两组患者黄斑水肿渗漏情况； 比较两组患者注药次数； 随访统计并发症发生情况。随访12mo。

结果：观察组治疗后平均BCVA分数均显著高于术前，对照组治疗后1、3、6、12mo显著高于术前，治疗后6、12mo组间比较差异具有统计学意义(P<0.05)，治疗后1、3mo组间比较差异无统计学意义(P>0.05)； 两组患者治疗后CMT均显著降低，且治疗后1、3、6、12mo观察组显著低于对照组，差异具有统计学意义(P<0.05)； 末次随访观察组无黄斑水肿渗漏率为45.0%，显著高于对照组(30.0%)，差异具有统计学意义(P<0.05)； 观察组注药次数显著低于对照组，差异具有统计学意义(P<0.05)； 两组患者术后均无明显并发症。

结论：联合视网膜激光光凝治疗相较于单独采用雷珠单抗治疗，可改善远期视力和黄斑水肿，减少注药次数，且降低CMT效果更佳。

METHODS: The clinical data of 190 patients(190 eyes)with DME treated in our hospital from June 2014 to June 2016 were retrospectively analyzed; 90 patients(90 eyes)received intravitreal ranibizumab injections were included into control group, and 100 patients(100 eyes)received the combination of intravitreal ranibizumab injections and laser photocoagulation were included into observation group. The best corrected visual acuity(BCVA)between the two groups before and after operation was compared. The central macular thickness(CMT)and the leakage of macular edema of the two groups were measured by the optical coherence tomography(OCT)and fundus fluorescein angiography(FFA)respectively. The number of drug injection between the two groups was recorded. Then patients were followed up and the incidence of the complications was recorded. All the patients were followed up for 12mo.

RESULTS: The average BCVA scores in the observation group after operation were significantly higher than those before operation. The preoperative average BCVA scores in the control group were lower than those at 1, 3, 6 and 12mo after operation. The difference between the two groups was statistically significant at 6 and 12mo after treatment(P<0.05), and there was no statistically significant difference at 1 and 3mo after treatment(P>0.05). CMT significantly decreased in both groups after treatment. CMT of the observation group was significantly thinner than that of the control group after 1, 3, 6 and 12mo treatments, the difference was statistically significant(P<0.05). In the last follow-up, the no macular edema leakage rate of the observation group was 45.0%, which was significantly higher than that of the control group(30.0%), the difference was statistically significant(P<0.05). The number of drug injection in the observation group was significantly lower than that in the control group, the difference was statistically significant(P<0.05), and there was no obvious complication in the two groups after the operation.

CONCLUSION: Compared with ranibizumab treatment alone, the combination of laser photocoagulation has better long-term vision improvement and better reduction of CMT. The combination treatment can also improve the condition of macular edema with less number of drug injection.