目的： 观察玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)联合超全视网膜光凝术(extra-panretinal photocoagulation，E-PRP)治疗视盘新生血管型糖尿病视网膜病变(diabetic neovascularization on the disc，DNVD)的临床疗效。

方法：对临床确诊的DNVD患者32例36眼进行IVR联合E-PRP治疗。对比观察治疗前后视力、视网膜神经纤维层厚度(retinal nerve fiber layer，RNFL)、视网膜新生血管消退等情况。

结果：治疗前BCVA经LogMAR转换后为0.89±0.35，治疗后6mo为0.42±0.13，与治疗前相比差异有统计学意义(P<0.01)。19眼(53%)BCVA提高2行及以上，14眼(39%)无变化，3眼(8%)视力下降>1行。IVR+E-PRP治疗后6mo时RNFL厚度为110.64±12.06μm，与治疗前及 IVR治疗后7d时RNFL厚度值相比，差异均有统计学意义(t=5.612、3.304，P<0.05)。IVR+E-PRP治疗后6mo时FFA检查32眼(89%)视盘新生血管消退，4眼(11%)新生血管无变化或加重。其中25眼(69%)经过一次E-PRP有效，7眼(19%)需追加1次激光，4眼(11%)最终未能控制病情行玻璃体手术。

结论：IVR联合E-PRP治疗可促使视盘新生血管消退，减轻血管渗漏和出血，提高了DNVD治疗的有效性和安全性。

METHODS: A total of 36 eyes of 32 patients with DNVD underwent IVR combined with E-PRP. The examinations of visual acuity, funds fluorescein angiography(FFA)and optical coherence tomography(OCT)were performed on all of the patients before and 6mo after the treatment; the result of the examinations before and after the treatment were compared and analyzed.

RESULTS: Before the treatment, best corrected visual acuity(BCVA, LogMAR)was 0.89±0.35, 6mo after treatment was 0.42±0.13; the difference was significant(P<0.01). After the treatment, BCVA was improved in 19 eyes(53%), unchanged in 14 eyes(39%)and decreased in 3 eyes(8%). Retinal nerve fiber layer(RNFL)was 110.64±12.06μm at 6mo after IVR+E-PRP, which was significantly different to those before treatment and 7d after treatment(t=5.612, 3.304; P<0.05). Neovascularization regressed in 32 eyes(89%), and unchanged or aggravated in 4 eyes(11%). The results of FFA after E-PRP showed that the one-off efficiency of E-PRP was 69%(25 eyes), 7 eyes(19%)need an additional laser, in which 4 eyes(11%)underwent vitreous surgery.

CONCLUSION: IVR combined with E-PRP as a treatment for DNVD may improve the regression of retinal neovascularization and the reduction of vascular permeability, and improve the therapeutic effect and safety.