方法：2014-12/2015-08同期收治的增生期糖尿病视网膜病变合并黄斑水肿患者分为两组。雷珠单抗联合激光治疗组30例48眼，单纯激光组28例45眼。联合治疗组在玻璃体腔注射雷珠单抗后1wk，复查FFA，随后进行全视网膜光凝。单纯激光组仅行全视网膜光凝。观察和记录两组患者治疗后1、4、8wk时的最佳矫正视力，OCT测量黄斑厚度。

结果：治疗后1、4、8wk时，两组间最佳矫正视力、黄斑中心厚度差异均有统计学意义(P<0.05)。单纯激光组治疗后1wk后，视力有所下降，黄斑中心厚度增加。治疗后4、8wk时，视力逐渐改善，黄斑厚度降低。注药后1wk，FFA显示联合治疗组所有眼视网膜渗漏改善，新生血管膜不同程度退缩。未见眼内注射和眼底激光导致的相关并发症等情况。

结论：雷珠单抗联合激光治疗，早期即可改善患者视力，减轻黄斑水肿。抗VEGF治疗和激光光凝可在一定程度上起到协同作用。前者拮抗已经高表达的VEGF，改善黄斑水肿和微血管功能，增强激光疗效。有效的光凝又可进一步改善视网膜缺血缺氧状态，抑制VEGF的过多表达。

METHODS: From December 2014 to August 2015, synchronous PDR patients with macular edema were divided into two groups. Thirty patients(48 eyes)were treated with Ranibizumab and laser, and 28 patients(45 eyes)were treated with laser alone. In the combined treatment group, FFA was reexamined 1wk after intravitreal injection of Ranibizumab. The patient then received panretinal photocoagulation(PRP). PRP was performed in the laser group alone. The best corrected visual acuity(BCVA)at 1, 4 and 8wk after treatment was observed and recorded. Macular thickness was measured by OCT.

RESULTS: The BCVA and macular thickness were significantly different between the two groups at 1, 4 and 8wk after treatment(P<0.05). In the laser alone group, the visual acuity decreased and the thickness of the macular thickness increased after 1wk. After treated 4 and 8wk, visual acuity improved, macular thickness decreased. After 1wk of intravitreal injection, FFA showed retinal leakage improvement in all eyes in the combined treatment group, with neovascularization retracted in varying degrees.

CONCLUSION:Ranibizumab combined with photocoagulation, can improve early vision, and reduce macular edema. Anti-VEGF therapy and photocoagulation may play a synergistic role to some extent. Drugs antagonized VEGF, improved macular edema and microvascular function. It can enhance the laser effect.Effective photocoagulation can further improve retinal ischemia and hypoxia, inhibit the excessive expression of VEGF.