目的：观察眼底激光联合曲安奈德(triamcinolone acetonide，TA)治疗糖尿病性视网膜病变(diabetic retinopathy，DR)的疗效。

方法：对2016-09/2017-09我院94例112眼DR患者临床资料进行回顾性分析，根据其治疗方案分为眼底激光+TA组(研究组，54例64眼)和眼底激光组(对照组，40例48眼)。于治疗前(T1)及治疗7d和1、3、6mo(T2、T3、T4、T5)时监测治疗情况，包括最佳矫正视力(best corrected visual acuity，BCVA)、黄斑区视网膜厚度； T5时评估疗效，记录临床表现(眼底出血、渗出、视网膜水肿)改善时间； 于T1、T5时检测患者血清学相关指标，包括细胞间黏附分子(intercellular adhesion moleclar-1，ICAM-1)、血管内皮生长因子(vascular endothelial growth factor，VEGF)水平。

结果：T1～T5时，两组患者BCVA、黄斑区视网膜厚度组间效应、时间点效应及组间与时间点交互效应差异均有统计学意义(P<0.05)； T2～T5时，两组患者BCVA和黄斑区视网膜厚度随时间推移而减小，差异均有统计学意义(P<0.05)。研究组疗效优于对照组，眼底出血、渗出、视网膜水肿改善时间小于对照组，差异均有统计学意义(P<0.05)。T5时，两组患者血清ICAM-1、VEGF水平均较T1时降低，且研究组低于对照组，差异均有统计学意义(P<0.05)。

结论：眼底激光联合TA可有效改善DR患者视力和视网膜水肿，疗效显著，并对促进临床症状恢复、减轻血管内皮损伤、抑制新生血管形成有一定帮助。

METHODS: The clinical data of 94 patients(112 eyes)in our hospital from September 2016 to September 2017 were analyzed retrospectively. According to the treatment regimen, the patients were divided into fundus photocoagulation with TA group(study group, 54 cases 64 eyes)and fundus photocoagulation group(control group, 40 cases 48 eyes). The treatment conditions \〖best corrected visual acuity(BCVA), macular retinal thickness\〗 were monitored before treatment(T1)and after 7d, 1, 3 and 6mo of treatment(T2, T3, T4, T5), and the efficacy was assessed at T5, and the improvement times of clinical manifestations(fundus hemorrhage, exudation, retinal edema)were recorded, and the serological markers \〖intercellular adhesion molecule(ICAM-1)and vascular endothelial growth factor(VEGF)\〗 were measured at T1 and T5.

RESULTS: At T1 to T5, there were statistically significant differences in the between-group effects, time-point effects and interaction effects of between-group and time-point of BCVA and macular retinal thickness(P<0.05). At T2 to T5, the BCVA was improved in the two groups with time while the macular retinal thickness was decreased with time(P<0.05). The efficacy in study group was better than that in control group, and the improvement times of fundus hemorrhage, exudation and retinal edema were less than those in control group(P<0.05). At T5, the serum levels of ICAM-1 and VEGF in the two groups were lower than those at T1, and the levels were lower in study group than those in control group(P<0.05).

CONCLUSION: Fundus photocoagulation combined with TA can effectively improve the visual acuity and retinal edema in patients with DR, and it has significant efficacy, and it can help promote the recovery of clinical symptoms, reduce the vascular endothelial injury, and inhibit the neovascularization.