方法：确诊为糖尿病黄斑水肿的患者60例60眼按照随机原则分为两组：单纯注药组30例30眼，行玻璃体腔内雷珠单抗注射； 联合治疗组30例30眼，先行玻璃体腔内雷珠单抗注射，再于注药1wk后行黄斑格栅样光凝。观察两组治疗后最佳矫正视力(BCVA)，光学相干断层扫描(OCT)显示的黄斑中心凹厚度(CMT)及术后并发症等。

结果：单纯注药组治疗后4，8，12wk的BCVA分别为0.390±0.075，0.367±0.088，0.319±0.064，CMT分别为221.63±112.34，337.73±99.56，432.92±100.46μm，与治疗前相比效果明显，但治疗后随访期间BCVA呈现下降趋势，CMT呈现上升趋势。而联合治疗组治疗后4，8，12wk的BCVA分别为0.385±0.036，0.382±0.079，0.377±0.097，CMT分别为249.77±106.55，270.40±92.88，275.84±97.34μm，可见治疗后效果满意，且随访期间疗效保持平稳。治疗后8，12wk联合治疗组BCVA及CMT均优于单纯治疗组(P<0.05)。

结论：玻璃体腔内注射雷珠单抗能够有效提高糖尿病黄斑水肿患者的视力，降低黄斑中心凹厚度，联合黄斑格栅样光凝治疗更能保证疗效稳定而持久。

METHODS:Totally 60 eyes(60 patients)with DME were randomly divided into 2 groups: 30 eyes of simple injection group underwent intravitreal injection of ranibizumab, and 30 eyes of combined treatment group underwent intravitreal injection of ranibizumab and macular grid photocoagulation 1wk later. The best corrected visual acuity(BCVA), central macular thickness(CMT)measured by optical coherence tomography(OCT)and postoperative complications were observed.

RESULTS:In simple injection group, the BCVA after operation were separately 0.390±0.075(4wk), 0.367±0.088(8wk)and 0.319±0.064(12wk),the CMT after operation were separately 221.63±112.34μm(4wk), 337.73±99.56μm(8wk)and 432.92±100.46μm(12wk), which were much better than pre-operation. But during follow-up, the BCVA presented down trend and the CMT was on the rise slowly. In combined treatment group, the BCVA after operation were separately 0.385±0.036(4wk), 0.382±0.079(8wk)and 0.377±0.097(12wk),the CMT after operation were separately 249.77±106.55μm(4wk), 270.40±92.88μm(8wk)and 275.84±97.34μm(12wk), which were satisfactory and steady during follow-up, better than simple injection group(P<0.05).

CONCLUSION:Intravitreal injection of ranibizumab can effectively improve visual acuity and decrease central foveal thickness for patients with DME, combining with macular grid photocoagulation can ensure therapeutic effects steady and permanent.