目的：研究地塞米松玻璃体内植入剂与康柏西普治疗不同光相干断层扫描(OCT)分型糖尿病性黄斑水肿(DME)的有效性及安全性。

方法：前瞻性研究。选取2021-01/2023-03本院收治的DME患者160例160眼，根据OCT特征分为浆液性视网膜脱离(SRD)51眼、黄斑囊性水肿(CME)55眼、视网膜弥漫性增厚(DRT)54眼。采用随机数字表法分为地塞米松玻璃体内植入剂组80例80眼和康柏西普组80例80眼。比较不同治疗方式治疗不同分型患者间治疗前，治疗2、3、6 mo患眼最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)和眼压以及不良反应。

结果：所有患者均完成随访。两组患者BCVA、CMT和眼压治疗后2、3、6 mo较治疗前均有差异(均P<0.05)。地塞米松玻璃体内植入剂组和康柏西普组治疗不同分型DME患者的BCVA、CMT、眼压治疗后与治疗前比较均有差异(均P<0.05)。地塞米松玻璃体内植入剂组治疗DRT和SRD分型患者BCVA在治疗后3、6 mo均较康柏西普组改善(均P<0.05)。地塞米松玻璃体内植入剂组治疗后6 mo DRT分型患者的CMT低于康柏西普组(P<0.05)。随访期间所有患者均未出现白内障加重以及视网膜脱离等不良事件。

结论：地塞米松玻璃体内植入剂与康柏西普治疗均可改善不同OCT分型DME患者的视功能和黄斑区视网膜形态，安全性较好，但地塞米松玻璃体内植入剂治疗DRT分型较康柏西普好。

METHODS: A total of 160 DME patients(160 eyes)admitted to our hospital from January 2021 to March 2023 were prospectively selected, and the patients were randomly divided into dexamethasone intravitreal implant group and conbercept group, with 80 cases(80 eyes)in each group, and DME patients were divided into 51 eyes with serous retinal detachment(SRD), 55 eyes with cystoid macular edema(CME), and 54 eyes with diffuse retinal thickening(DRT)according to OCT characteristics. The best corrected visual acuity(BCVA), central macular thickness(CMT), intraocular pressure and adverse reactions were compared before treatment and at 2, 3 and 6 mo postoperatively.

RESULTS: There were differences in BCVA, CMT and intraocular pressure between the two groups at 2, 3 and 6 mo compared with those before operation(all P<0.05). There were differences in BCVA, CMT and intraocular pressure between the dexamethasone intravitreal implant group and the conbercept group in the treatment of patients with different types of DME(all P<0.05). The BCVA of patients with DRT and SRD types in the dexamethasone intravitreal implant group was improved at 3 and 6 mo after treatment compared with that in the conbercept group(all P<0.05). At 6 mo after treatment, the CMT of patients with DRT type in the dexamethasone intravitreal implant group was lower than that in the conbercept group(P<0.05). During the follow-up period, none of the patients experienced adverse events such as cataract exacerbation or retinal detachment.

CONCLUSION: Both dexamethasone intravitreal implant and conbercept treatment can improve visual function and macular retinal morphology in patients with different OCT subtypes of DME with good safety, but the dexamethasone intravitreal implant is better than conbercept in the treatment of DRT type.