联合治疗糖尿病性黄斑水肿的效果观察

Observation on the efficacy of combinded treatment for diabetic macular edema

目的 观察黄斑区格栅样光凝术与联合或不联合玻璃体内注射雷珠单抗治疗糖尿病性黄斑水肿（DME）的临床效果.方法 回顾性分析接受治疗的DME 120例（120眼）的临床资料,采用随机数字表法分将患者为单纯光凝组（60眼）,仅黄斑区行格栅样光凝治疗;联合治疗组（60眼）,行玻璃体内注射雷珠单抗2周后黄斑区行格栅样光凝治疗.比较治疗前和治疗后1、3、6个月两组患者视力、黄斑中心区视网膜厚度（CMT）、光凝能量.结果 治疗前两组的视力及CMT差异均无统计学意义（P＞0.05）.治疗后两组患者视力及CMT与术前相比差异有统计学意义（P〈0.05）.联合治疗组患者术后1、3、6个月的视力（BCVA）均优于单纯光凝组（t=7.059、8.821、6.826,均为P〈0.05）,联合治疗组患者术后各时间点CMT均低于单纯光凝组,差异有统计学意义（t=8.154、6.421、5.689,均为P〈0.05）.单纯光凝组的光凝能量为（97.95±6.75） mW,联合治疗组的光凝能量为（84.25 ±9.89）mW.结论 玻璃体内雷珠单抗联合黄斑区格栅样光凝术与单纯光凝术相比,更有助于提高DME患者视力,减轻黄斑水肿.

Objective To observe the clinical efficacy of macular grid photocoagulation combined with or without intravitreal injection of Ranibizumab for diabetic macular edema （DME）.Methods The data of 120 eyes of 120 patients with DME were analyzed retrospectively,they were randomly divided into two groups.The control group,60 eyes received standard macular grid photocoagulation.The combined therapy group,60 eyes received standard macular grid photocoagulation 2 weeks after intravitreal Ranibizumab injection.The visual acuity,central macular thickness （CMT） and photocoagulation energy before and 1,3,6 months after treatment were compared between the two groups.Results The difference in BCVA and CMT before treatment were not statistically significant between the two groups （P 〉 0.05）.The difference of BCVA and CMT in the two groups were statistically significant between before and after treatment （P 〈 0.05）.The BCVA of the combined therapy group were better than that of the control group at 1,3,6 months after treatment （t =7.059,8.821,6.826,P 〈0.05）.The CMT of the combined therapy group were thinner than that of the control group at 1,3,6 months after treatment （t =8.154,6.421,5.689,P 〈 0.05）.The photocoagulant energy in the control group was （97.95 ± 6.75） mW.The photocoagulation energy in the combined treatment group was （84.25 ± 9.89） mW.Conclusion The intravitreal Ranibizumab injection combined with macular grid photocoagulation can improve the vision and reduce macular edema in DME patients greatly.