目的：观察玻璃体腔注射avastin联合黄斑格栅样光凝治疗糖尿病黄斑水肿（diabetic macular edema，DME）的效果。 方法：经眼底荧光造影（FFA）及相干光断层扫描（OCT）确诊为糖尿病黄斑水肿的患者21例29眼，给予玻璃体腔注射avastin 1.5mg后1wk行黄斑格栅样光凝。所有患者治疗前及治疗后1，3，6，12mo均行眼底、最佳矫正视力(best corrected visual acuity,BCVA)、OCT检查，随访时间6~12mo。 结果：末次随访时，自觉症状（包括视物变形、中心暗影）消失或改善者24眼（83%）,不变者5眼(17%)。视力提高2行以上者21眼（72%），视力提高1~2行者6眼（21%），视力不变者2眼(7%)，无视力下降者。其中，术前BCVA：0.05～0.3（logMAR值:平均0.66±0.19），术后BCVA：0.05～0.8（logMAR值:平均0.31±0.18）（P＜0.01）。术前平均眼压为14.33±0.62mmHg，术后平均眼压为15.28±0.49 mmHg（P＞0.05）。OCT检查示25眼黄斑水肿明显改善（86%）,其中减少30%以上者20眼（69%），减少29%~10%者7眼（24%），减少10%以下者2眼（7%）。黄斑中心凹视网膜厚度：术前平均为：45072±74.22μm,术后平均为：283.55±44.43μm（P＜0.01）。 结论：玻璃体腔注射avastin联合黄斑格栅样光凝治疗糖尿病黄斑水肿疗效显著，可明显提高视力，消除或改善黄斑水肿。但尚需进一步大样本的临床随机对照研究来证实。

To investigate the effects of intravitreal avastin combined with macular grid photocoagulation for diabetic macular edema(DME)． METHODS: Totally 21 DME cases (29 eyes) were treated with intravitreal 1.5mg avastin followed by macular grid photocoagulation a week later in this nonrandomized, interventional case series. The best-corrected visual acuity (BCVA) was measured and the optical coherence tomography (OCT) findings were examined before and after 1, 3, 6,12 months treatment. The follow-up time varied from 6 months to 12 months (average 7.5 months). RESULTS: The mean BCVA（logMAR）was 0.66±0.19 before treatment and 0.31±0.18 at the last visit (P<0.01). The BCVA improved more than two lines in 21 eyes (72%), improved one or two lines in 6 eyes (21%) and stabilized (no change) in 2 eyes (7%) and none decreased. Macular edema significantly improved in 25 eyes (accounting for 86%), reduced by 30% or more in 20 eyes (accounting for 69%), decreased by 29%-10% in 7 eyes (accounting for 24%), and decreased by 10%-0 in 2 eyes (accounting for 7%).The central macular thickness (CMT) on OCT images decreased from 450.72±74.22μm at baseline to 283.55±44.43μm after treatment(P<0.01). No complication occurred. CONCLUSlON: Combination treatment with intravitreal avastin and macular grid photocoagulation was well tolerated, with an significantly improvement in BCVA, and OCT. This suggests combination treatment with intravitreal avastin and macular grid photocoagulation for diabetic macular edema merits further investigation.

中国深圳市科技计划资助项目（No.201103371）