目的：探究激光光凝联合抗血管内皮生长因子(VEGF)药物不同时机治疗糖尿病视网膜病变(DR)的临床效果。

方法：前瞻性研究。将2018-01/2019-01我院收治的120例191眼DR患者按随机数字表法分为A(单纯激光光凝，30例44眼)、B(玻璃体腔注射雷珠单抗，30例46眼)、C(激光光凝后延迟玻璃体腔注射雷珠单抗，30例49眼)、D组(玻璃体腔注射雷珠单抗后延迟激光光凝，30例52眼)。激光光凝和/或抗VEGF药物治疗完毕后随访6mo，比较各组患者治疗前后最佳矫正视力(BCVA)、眼压、黄斑中心凹厚度(CMT)，观察激光光凝和抗VEGF治疗情况及并发症和糖尿病性黄斑水肿复发情况。

结果：治疗前四组患者BCVA和CMT均无差异(P>0.05)，治疗后1wk，1、3、6mo BCVA和CMT均较治疗前改善(P<0.05)，且C、D组患者治疗后不同时间BCVA、CMT均优于A、B组(P<0.05)，D组患者治疗后1wk，1、3mo BCVA、CMT均优于C组(P<0.05)。治疗前后四组患者眼压均无明显变化(P>0.05)。C、D组患者激光参数及次数均低于A组，且D组患者激光参数均低于C组(P<0.05)； C、D组患者玻璃体腔注药次数均少于B组(P<0.05)，但C、D组患者激光次数和注药次数均无差异(P>0.05)。随访期间，四组患者并发症发生率及糖尿病性黄斑水肿复发率均无差异(P>0.05)。

结论：抗VEGF药物玻璃体腔注射后延迟激光光凝治疗DR疗效优于单纯激光光凝、单纯玻璃体腔注射及激光光凝后延迟玻璃体腔注射，可改善患者BCVA，减轻黄斑水肿，减少激光能量、激光次数及抗VEGF注药次数，同时安全性肯定。

METHODS: A prospective study was conducted. Totally 120 patients(191 diseased eyes)with DR who were admitted to the hospital between January 2018 and January 2019 were divided into group A(treated with simple laser photocoagulation, 30 cases, 44 diseased eyes), group B(treated with intravitreal injection of ranibizumab, 30 cases, 46 diseased eyes), group C(treated with intravitreal injection of ranibizumab after laser photocoagulation, 30 cases, 49 diseased eyes)and group D(treated with laser photocoagulation after intravitreal injection of ranibizumab, 30 cases, 52 diseased eyes). Patients in each group were followed up for 6mo after the end of treatment. The best corrected visual acuity(BCVA), intraocular pressure and central foveal thickness(CMT)of each group were compared before and after treatment. The situation of laser photocoagulation and anti-VEGF treatment, complications and recurrence of diabetic macular edema were observed.

RESULTS: There was no significant difference in BCVA or CMT among the four groups before treatment(P>0.05). The two indexes were improved at 1wk, 1mo, 3mo and 6mo after treatment(P<0.05). Besides, they were better in group C and group D than in group A and group B at different time after treatment(P<0.05). The BCVA and CMT in group D were better than those in group C at 1wk, 1mo and 3mo after surgery(P<0.05). There was no significant difference in intraocular pressure among the four groups before or after treatment(P>0.05). The laser parameters and frequency of laser treatment were lower or fewer in group C and group D than in group A, and lower in group D than in group C(P<0.05). The frequencies of intravitreal injection in group C and group D were fewer than that in group B(P<0.05). There was no significant difference in the frequency of laser treatment or drug injection between groups C and group D(P>0.05). There was no significant difference in the incidence of complications or the incidence of diabetic macular edema among the four groups during follow up(P>0.05).

CONCLUSION: The effect of laser photocoagulation after intravitreal injection of anti-VEGF drug is better than simple photocoagulation, simple intravitreal injection or intravitreal injection of ranibizumab after laser photocoagulation in the treatment of DR. It can improve the BCVA, relieve macular edema, reduce laser energy, frequency of laser treatment and injection frequency of anti-VEGF drug, with safety.