目的：对比亚阈值微脉冲(STMP)黄激光单独和联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿(DME)的临床效果及安全性。

方法：前瞻性临床随机对照研究。选取2017-04/2018-08符合入选标准的DME患者33例58眼，随机分成单纯激光组(16例28眼)行STMP黄激光，联合治疗组(17例30眼)行玻璃体腔注射雷珠单抗联合STMP黄激光。比较治疗前后的最佳矫正视力(BCVA)、眼压、黄斑中心凹视网膜厚度(CMT)、黄斑体积(TMV)、眼底血管造影(FFA)、多焦视网膜电图(MERG)、自发荧光(AF)、黄斑色素光密度(MPOD)，并统计治疗次数。

结果：BCVA、TMV：单纯激光组治疗后6、9、12mo与治疗前比较均有差异(P<0.05)，联合治疗组治疗后3、6、9、12mo与治疗前比较均有差异(P<0.05)。两组治疗后3、6、9、12mo CMT与治疗前比较均有差异(P<0.01)。两组患者治疗后12mo MERG总反应波P₁振幅、黄斑光密度最大值(Max OD)、黄斑区平均光密度(Mean OD)与治疗前比较均有差异(P<0.01)。治疗后12mo，两组间TMV、P₁振幅均有差异(P<0.01)。随访期间单纯激光组激光次数3.32±1.09次，联合治疗组3.30±1.18次(P=0.943)。

结论：STMP黄激光单独和联合玻璃体腔注射雷珠单抗均可有效降低DME患者的黄斑水肿、提高视力且安全； 联合治疗组起效快、效果更好。

METHODS: Totally 33 patients(58 eyes)with DME were divided into two groups. Group A(laser group)received STMP yellow laser, and group B(combined treatment group)received ranibizumab intravitreal injection combined with STMP yellow laser. The best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT), total macular volume(TMV), fluorescein fundus angiography(FFA), multifocal ERG(MERG), autofluorescence(AF)and macular pigment optical density(MPOD)were compared before and after the treatments. And treatment times were counted.

RESULTS:Compared with those before treatment, there were significant differences in BCVA and TMV 6, 9, 12mo after treatment in the laser group(P<0.05). And there were significant differences in BCVA and TMV 3, 6, 9, 12mo after treatment in the combined treatment group(P<0.05). For both groups, there were significant differences in CMT before and 3, 6, 9, 12mo after treatment(P<0.01). Compared with the P₁ amplitude of MEG, Max OD and Mean OD before treatment, there were significant differences for the two groups 12mo after treatment(P<0.01). And the differences were significant in TMV and P₁ amplitudes between the two groups after 12mo of treatment(P<0.01). During the follow-up period, the laser times was 3.32±1.09 in the laser group and 3.30±1.18 in the combined treatment group(P=0.943).

CONCLUSION:Both single STMP laser and combined with intravitreal injection of ranibizumab can effectively reduce macular edema, improve vision and safety in DME patients. And the combined treatment group has faster and better effect.