目的：评估玻璃体腔注射雷珠单抗联合黄斑区格栅样光凝治疗糖尿病性黄斑水肿(DME)的临床疗效。

方法： 前瞻性研究。纳入2016-10/2018-12在我院就诊的DME患者78例101眼，随机分为玻璃体腔注射雷珠单抗组(单纯注药组)38例49眼和玻璃体腔注射雷珠单抗联合黄斑格栅样光凝组(联合治疗组)40例52眼，随访12mo，对比分析两组患者最佳矫正视力(BCVA)与黄斑中心凹厚度(CRT)的变化，以及患者眼内注药次数。

结果：随访12mo末，联合治疗组与单纯注药组BCVA(LogMAR)(0.44±0.22 vs 0.55±0.23)与CRT(335.3±65.9 vs 370.4±84.4μm)有差异(P<0.05)。联合治疗组的平均注药次数少于单纯注药组(4.04±1.08 vs 5.83±1.92次，t=-5.722，P<0.05)。两组患者眼压(13.87±2.55 vs 14.04±2.69mmHg)无差异(P>0.05)。

结论：玻璃体腔注射雷珠单抗联合黄斑格栅样光凝可以有效治疗DME，减少眼内注药频次，是DME的一种优化治疗策略。

METHODS: In this prospective cohort study, total 78 patients(101 eyes)diagnosed with diabetic macular edema in Dongguan People's Hospital from October 2016 to December 2018 were randomly divided into two groups. 40 patients(52 eyes)were in combination therapy group and 38 patients(49 eyes)were in monotherapy group. The changes of best corrected visual acuity(BCVA), central retinal thickness(CRT)and frequency of injections in two groups were compared after 12mo follow-up.

RESULTS: At the end of 12mo follow up, the BCVA(0.44±0.22 vs 0.55±0.23)and CRT(335.3±65.9μm vs 370.4±84.4μm; P<0.05)were better in combination therapy group than that in monotherapy group. Fewer injections were required in combination therapy group compared with that in the monotherapy group(4.04±1.08 vs 5.83±1.92 injections, t= -5.722, P<0.05). There was no significant difference between two groups(13.87±2.55 vs 14.04±2.69mmHg, P>0.05)in intraocular pressure.

CONCLUSION: Combination therapy of ranibizumab and macular grid photocoagulation was an effective treatment for DME patients, could significantly reduced the frequency of injections, and represent a superior therapeutic approach to DME patients.