方法：对37例55眼糖尿病黄斑水肿(diabetic macular edema，DME)患者首先采用玻璃体腔注射曲安奈德4mg，术后3wk采用眼底激光对黄斑水肿进行局部直接光凝或格栅样光凝，分别在激光治疗术后1，3，6mo行最佳矫正视力、眼压、眼底检查，术后3mo行光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)检查，术后6mo行OCT检查，将术后各时间点检测结果与术前值进行比较，做出客观评价。

结果：与治疗前相比，术后3wk，激光治疗后1mo，术后3mo，术后6mo视力提高者分别占34.2%，84.6%，87.9%，79.6%； 术前、术后3mo和术后6mo平均视力分别为0.1627±0.1016，0.2743±0.1617， 0.2615±0.1833，术前视力与术后3mo和6mo视力有显著统计学差异(P<0.01)，术后3mo视力提高有效率为83.6%。OCT测量黄斑区视网膜厚度显示，术前、术后3mo和术后6mo黄斑区平均视网膜厚度分别为467.5±150.9，272.7±120.1，308.1±136.2μm，术前黄斑区厚度与术后3mo及6mo有显著统计学差异(P<0.01)。治疗前后FFA显示黄斑区及相关血管的荧光素渗漏较术前明显减少。

结论：激光联合曲安奈德玻璃体腔注射治疗黄斑水肿疗效好，并发症少，术后3mo效果最为显著。

METHODS: Thirty-seven cases(55 eyes)with DME were selected and treated by intravitreal TA injection first and laser photocoagulation after three weeks, best-corrected visual acuity(BCVA), fundus examination and intraocular pressure(IOP)were examined before TA injection and 1 month, 3 and 6 months after treatment, optical coherence tomography(OCT), fundus fluorescein angiography(FFA)were examined 3 months after treatment.

RESULTS: The average visual acuity was 0.1627±0.1016, 0.2743±0.1617, 0.2615±0.1833 at preoperative, 3 and 6 months after treatment. The visual acuity after treatment was significantly improved than preoperative(P<0.01). The average macular thickness was 467.5±150.9μm, 272.7±120.1μm, 308.1±136.2μm at preoperative, 3 and 6 months after treatment. The macular thickness after treatment was significantly lower than preoperative(P<0.01). The macular area and related vascular fluorescein leakage was significantly reduced after treatment.

CONCLUSION: The combination of triamcinolone acetonide intravitreous injection with retinal laser photocoagulation can be an effective method in the treatment of DME, visual acuity improved efficiency was best 3 months after treatment.