目的：探讨抗血管内皮生长因子(VEGF)联合全视网膜光凝术(PRP)治疗重度非增殖期糖尿病视网膜病变(sNPDR)合并黄斑水肿(DME)对黄斑区血流密度变化的影响。

方法：回顾性选取2018-10/2019-04在我院确诊的sNPDR合并DME患者30例30眼，根据治疗方案进行分组，其中A组15例15眼采用“1+PRN”方案采用玻璃体腔内注射雷珠单抗7d后行PRP治疗，B组15例15眼采用单纯PRP治疗。对比两组治疗前后黄斑区6mm×6mm浅层毛细血管(SCP)和深层毛细血管(DCP)血流密度、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)变化情况。

结果：与术前相比，A组患者术后2wk，1mo DCP血流密度显著增加、CMT明显降低、BCVA明显改善(均P<0.05)，B组患者术后1mo CMT降低、BCVA改善(均P<0.05)。术后2wk、1mo，A组患者DCP血流密度较B组明显增加(43.37%±2.72% vs 41.03%±2.60%，45.01%±2.28% vs 41.20%±2.43%，均P<0.05)，CMT较B组明显降低(303.4±30.36μm vs 329.60±31.47μm，268.67±30.27μm vs 319.40±28.63μm，均P<0.05)，BCVA(LogMAR)较B组明显改善(0.28±0.11 vs 0.40±0.13，0.23±0.14 vs 0.38±0.15，均P<0.05)。

结论：抗VEGF联合PRP治疗sNPDR合并DME患者短期内可有效增加DCP血流密度，减轻黄斑水肿，改善视力。

METHODS: Data of 30 eyes in 30 patients at Guangxi Zhuang Autonomous Region People's Hospital from October 2018 to April 2019 were retrospectively reviewed, and they were randomly divided into group A and group B each with 15 cases. Group A was received PRP treatment after one initial intravitreal ranibizumab injection followed by pro re nata(PRN)at 7d, while group B was administered PRP alone. The blood flow density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)in macular area(6mm×6mm), central macular thickness(CMT), and best corrected visual acuity \〖BCVA(LogMAR)\〗 were compared between the two groups before and after treatment.

RESULTS: Compared with before operation, the DCP blood flow density was significantly increased, CMT was obviously decreased, and BCVA was markedly improved in group A at 2wk and 1mo after surgery(all P<0.05), while CMT was decreased and BCVA was improved in group B at 1mo after operation(all P<0.05). Postoperative in group A at 2wk and 1mo, the DCP blood flow density was significantly higher than that in group B(43.37%±2.72% vs 41.03%±2.60%, 45.01%±2.28% vs 41.20%±2.43%, P<0.05), CMT was obviously lower than group B(303.4±30.36μm vs 329.60±31.47μm, 268.67±30.27μm vs 319.40±28.63μm, all P<0.05), and BCVA(LogMAR)was markedly improved compared with group B(0.28±0.11 vs 0.40±0.13, 0.23±0.14 vs 0.38±0.15, all P<0.05).

CONCLUSION: Anti-VEGF combined with PRP can effectively increase DCP blood flow density, reduce macular edema and improve visual acuity in the short term in patients with sNPDR with DME.