目的：探讨玻璃体腔内注射康柏西普(IVC)联合全视网膜光凝(PRP)治疗合并黄斑水肿(DME)的重度非增殖性糖尿病性视网膜病变(SNPDR)患者的给药时机。

方法：前瞻性病例对照研究。选取2017-05/2018-10于我院确诊的合并DME的SNPDR患者85例85眼， 随机分为三组：对照组29眼仅予以PRP治疗； IVC组28眼在IVC后1wk予以PRP； PRP组28眼在PRP后1wk予以IVC。随访12mo，观察治疗前及治疗后1、3、6、12mo最佳矫正视力(BCVA)、黄斑区中心凹厚度(CMT)变化，记录IVC频次。

结果：三组患者治疗后的BCVA较治疗前改善，CMT较治疗前降低(P<0.05)。治疗后IVC组和PRP组BCVA优于对照组，CMT低于对照组(P<0.05)。治疗后3mo，ICV组BCVA(0.24±0.18，LogMAR)下降均较PRP组(0.38±0.29，LogMAR)明显(P<0.05)。治疗后1、3mo，ICV组CMT(313.89±61.69、287.64±43.94μm)下降均较PRP组(347.50±56.55、318.04±49.33μm)明显(P<0.05)。IVC给药频次为IVC组3.07±1.33次、PRP组3.93±1.60次(P<0.05)。

结论：治疗合并DME的SNPDR患者，IVC联合PRP治疗优于单纯PRP治疗，且在PRP治疗之前予以抗VEGF药物，短期内BCVA提高、黄斑水肿减轻，长期观察可减少IVC次数，降低感染风险，减轻经济负担。

METHODS: Totally 85 SNPDR patients(85 eyes)with DME diagnosed in our hospital from May 2017 to October 2018 were randomly divided into control group(n=29 cases), IVC group(n=28 cases), PRP group(n=28 cases). The control group was treated with PRP only; the IVC group was given PRP 1wk after IVC; the PRP group was given IVC 1wk after PRP. The follow-up time was 12mo. Changes of the best corrected visual acuity(BCVA)and central macular thickness(CMT)were observed before and 1, 3, 6, 12mo after treatment, and the frequency of IVC were recorded.

RESULTS: Compared with before treatment, the BCVA of the three groups after treatment improved, and the CMT decreased(P<0.05). after treatment, the BCVA of the IVC group and the PRP group was better than the control group, and the CMT was lower than the control group(P<0.05). 3mo after treatment, BCVA(0.24±0.18, LogMAR)in the ICV group decreased more than that in the PRP group(0.38±0.29, LogMAR)(P<0.05). At 1 and 3mo after treatment, CMT in the ICV group(1mo 313.89±61.69um, 3mo 287.64±43.94μm)decreased more than that in the PRP group(1mo 347.50±56.55μm, 3mo 318.04±49.334μm), and the difference was significant difference(P<0.05). The frequency of IVC was(3.07±1.33)times in the IVC group and(3.93±1.60)times in the PRP group(P<0.05).

CONCLUSION: In SNPDR patients with DME, IVC combined with PRP is better than PRP alone. Anti-VEGF drugs before PRP can obtain better BCVA, reduce macular edema in the short-term observation. In long-term observation, it can also reduce the frequency of IVC, the risk of infection and the financial burden.