方法：自2012-12/2015-06于广宁人民医院眼科门诊就诊及住院患者中，筛选出非增殖期合并具有临床意义的黄斑水肿78例78眼，随机分为联合组及单独治疗组，联合组(n=41)行玻璃体腔雷珠单抗0.02mL注射后10d行黄斑区格栅样光凝治疗； 单独组(n=37)仅行黄斑区格栅样光凝治疗。对两组患者治疗后6mo内最佳矫正视力、黄斑区中心凹厚度进行观察随访及比较。

结果：两组患者在随访结束时，联合组患者治疗有效率明显高于激光组，行秩和检验后得出差异具有统计学意义(P<0.05)。治疗后6mo联合组与单独组黄斑中心视网膜厚度(central macular thickness， CMT)均较治疗前下降(P<0.05)； 两组间对比，在术后1、3、6mo有显著统计学差异(P<0.05)。黄斑区格栅样光凝单独或联合雷珠单抗玻璃体腔内注射治疗糖尿病性黄斑水肿均能提高视力及改善黄斑水肿情况。但联合治疗效果明显优于单纯激光治疗。

结论：在未来的临床工作中，黄斑区格栅样光凝联合雷珠单抗治疗可作为基层医院糖尿病性黄斑水肿的首选治疗方法。

METHODS:Seventy-eight patients(78 eyes)with non-proliferative diabetic retinopathy(NPDR)and diabetic macular edema hospitalized in Department of Ophthalmology of Guangning People's Hospital from December 2012 to June 2015 were collected and randomly divided into two groups, combined therapy group and mono- therapy group. The 41 patients in combined therapy group received the intravitreal imjection of Ranibizumab then photocoagulation treatment at 10d after the injection. The 37 patients in mono-therapy group received the treatment of photocoagulation only. Pre- and post-treatment outcomes including best corrected visual acuity(BCVA)and central macular thickness(CMT)were compared. The period of follow-up was 6mo.

RESULTS:At the end of follow-up, the effective rate of the combined therapy group was better than that of mono-therapy group(P<0.05). In mono-therapy and combined therapy group, the CMT had been decreasing gradually after treatments(P<0.05). In the comparison of CMT between the two groups at 1, 3 and 6mo after treatments, the combined therapy group were better and the difference was statistically significant(P<0.05). Photocoagulation alone or combined with intravitreal injection of ranibizumab for the diabetic macular edema both have an effect on reducing the macular edema in a short time(in 6mo)and on improving the visual acuity, while the combined therapy has a better effect than the mono-therapy.

CONCLUSION:The grid pattern laser photocoagulation combined with intravitreal injection of ranibizumab will be the preferred therapy for DME in primary hospital in the future.