方法：将白内障合并糖尿病黄斑水肿患者44例52眼随机分为两组：对照组行白内障超声乳化联合人工晶状体植入手术； IVTA组在对照组手术的基础上，联合IVTA治疗。所有患眼均接受裂隙灯显微镜、光相干断层(OCT)、最佳矫正视力(BCVA)及间接检眼镜检查。比较各组治疗前后平均最小分辨角对数(LogMAR BCVA)及黄斑中心凹厚度(CMT)变化。并对手术治疗6mo后平均LogMAR BCVA和各因素进行相关性分析。采用多因素线性回归分析法分析术后6mo视力恢复的影响因素。

结果：各组治疗1、3、6mo后LogMAR BCVA均明显改善，差异具有统计学意义(F= 3.351、4.588，P= 0.022、0.005)，但两组间无统计学差异(P>0.05)。手术后1、3mo后，IVTA组CMT显著低于对照组(t=3.402、2.083，P=0.001、0.042)，手术后6mo时无明显差别。手术后6mo平均LogMAR BCVA与ELM(中心凹外界膜)状态负相关(r=-0.611，P=0.006)。多因素线性回归分析结果显示，手术后6mo视力恢复与中心凹外界膜ELM状态(B=0.333，P=0.030)和糖尿病病程(B=-0.307，P=0.005)具有相关性。

结论：超声乳化手术联合IVTA治疗白内障合并糖尿病黄斑水肿，可在短期内减轻黄斑水肿，改善视力。IVTA对改善黄斑水肿的作用更为明显。

METHODS: Forty-four patients(52 eyes)with cataract and diabetic macular edema were randomly divided into two groups: the control group and the IVTA group. Twenty-six eyes in the control group underwent phacoemulsification and intraocular lens implantation. Additionally, 26 eyes in the IVTA group were treated with IVTA at completion of the surgery. Results of best corrected visual acuity(BCVA), optical coherence tomography(OCT)and ophthalmological examination were analyzed. Before and after the treatment, differences of Logarithm of the minimum angle of resolution(LogMAR BCVA)in groups were compared, as well as the central macular thickness(CMT). Correlations between LogMAR BCVA and other factors were analyzed by Pearson correlation analysis. Six months after the operation, multivariate liner regression analysis was taken to evaluate the correlations between LogMAR BCVA and affecting factors.

RESULTS:LogMAR BCVA in both groups were improved significantly at 3 time points(1, 3 and 6mo respectively)after the surgery(F=3.351,4.588, P=0.022,0.005). No significant difference in LogMAR BCVA between groups were found(P>0.05). One month or 3mo after the surgery(but not 6mo), the IVTA group showed thinner CMT than the control group(t=3.402,2.083, P=0.001, 0.042). Six months after the operation, the mean LogMAR BCVA negatively correlated with the ELM state of the patients(r=-0.611, P=0.006). Results of multivariate liner regression analysis showed that the visual recovery in 6mo after the surgery was affected by the external limiting membrane status(B=0.333,P=0.030)and the duration of diabetes(B=-0.307, P=0.005).

CONCLUSION: Phacoemulsification combined with IVTA is effective in treating patients with cataract and diabetic macular edema by reducing edema and improving their visual acuity. But IVTA is more effective in reducing edema than improving LogMAR BCVA.