目的：观察全视网膜光凝术(PRP)联合抗血管内皮生长因子(VEGF)药物治疗重度非增殖性糖尿病性视网膜病变(NPDR)的疗效及对患者预后的影响。

方法：将120例227眼经荧光素眼底血管造影(FFA)和光学相干断层扫描(OCT)检查确诊的NPDR患者随机分为观察组(60例112眼)和对照组(60例115眼)，观察组患者采用PRP联合抗VEGF药物治疗，对照组患者单纯行PRP治疗。比较两组的临床疗效和并发症发生情况； 分析治疗前后两组的最佳矫正视力(BCVA)、黄斑中心厚度(CMT)及血清VEGF、血管生成素2(Ang-2)水平变化。

结果：观察组总有效率明显高于对照组(P<0.05)； 与治疗前比，治疗后2wk、1、3、6mo两组的BCVA均显著改善(P<0.05)，且观察组治疗后各时间点的BCVA均较对照组改善明显(P<0.05)。与治疗前比，观察组治疗后2wk开始CMT、血清VEGF及Ang-2水平显著下降(P<0.05)，对照组治疗后1mo开始CMT、血清VEGF及Ang-2水平显著下降(P<0.05)； 与对照组比，观察组治疗后各时间点的血清VEGF及Ang-2水平均较低(P<0.05)，CMT在治疗后1、3、6mo时明显较低(P<0.05)； 两组的总并发症发生率差异无统计学意义(P>0.05)。

结论：PRP联合抗VEGF药物治疗可有效改善NPDR患者的视力，减轻黄斑水肿，提高临床疗效。

METHODS: Totally 120 patients(227 eyes)with NPDR diagnosed by fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)were randomly divided into observation group(60 cases, 112 eyes)and control group(60 cases, 115 eyes). Patients in the observation group were treated by PRP combined with anti-VEGF drugs, while patients the control group were treated with PRP alone. The clinical efficacy and complications of the two groups were compared. Before and after treatment, the best corrected visual acuity(BCVA), central macular thickness(CMT), levels of serum VEGF and angiopoietin 2(Ang-2)in the two groups were analyzed.

RESULTS: The total effective rate of the observation group was significantly higher than that of the control group(P<0.05). Compared with before treatment, BCVA of the two groups in the time of 2wk, 1, 3 and 6mo after treatment improved significantly(P<0.05). And the BCVA of the observation group at each time point after treatment was better than that of the control group(P<0.05). Compared with before treatment, the CMT and the levels of VEGF and Ang-2 in the observation group decreased significantly starting at 2wk after treatment(P<0.05). While those in the control group decreased significantly starting at 1mo after treatment(P<0.05). The levels of VEGF and Ang-2 in the observation group at each time point after treatment was lower than that of the control group(P<0.05). CMT of the observation group were significantly lower than that of the control group in the time of 1, 3 and 6mo after treatment(P<0.05). There was no significant difference in the total complication rate between the two groups(P>0.05).

CONCLUSION: PRP combined with anti-VEGF drugs could effectively improve vision of NPDR patients, alleviate macular edema, and improve the clinical efficacy.