目的：评价玻璃体腔注射抗血管内皮生长因子(anti-vascular endothelial growth factor，anti-VEGF)药物康柏西普(conbercept)联合视网膜光凝治疗糖尿病性视网膜病变(diabetic retinopathy，DR)合并糖尿病黄斑水肿(diabetic macular edema，DME)的疗效。

方法：前瞻性病例研究。选取2015-08/2016-06确诊的DR伴DME、有完整随访记录的患者48例80眼，其中非增殖期DR(non-proliferative DR，NPDR)中度者4例5眼，NPDR重度者38例65眼，处于增殖期DR(proliferative DR，PDR)者6例10眼。采用随机数字表法将患者分为联合组和激光组。联合组进行玻璃体腔注射康柏西普(intravitreal conbercept，IVC)和全视网膜光凝(panretinal photocoagulation，PRP)，激光组行黄斑区格栅样光凝和PRP。观察两组患者完成PRP后1wk，1、3、6、12mo的最佳矫正视力(best corrected visual acuity，BCVA)、黄斑中心厚度(central macular thickness，CMT)、激光能量及术后并发症的发生情况。

结果：BCVA：在各个随访时间点，联合组治疗后各时间点BCVA明显优于激光组。联合组PRP后1wk，1、3mo视力较上次观察时间点视力提高，6、12mo与上次观察时间点相比，视力保持稳定； 激光组PRP后1、3mo视力较上次观察时间点提高； 1wk，6、12mo与上次观察时间点相比，视力保持稳定。CMT：在各个随访时间点，联合组治疗后各时间点CMT均低于激光组。联合组PRP后1wk，1、3mo的CMT较上次观察时间点降低明显，6、12mo与上次观察点相比，保持稳定； 激光组PRP后1、3mo的CMT较上次观察时间点降低； 1wk，6、12mo与上次观察时间点相比，CMT保持稳定。PRP所用能量：两组患者在观察期间，均未发现激光光斑融合； 联合组PRP所用激光能量明显低于激光组。两组患者均无严重并发症发生。

结论：玻璃体腔注射康柏西普联合PRP治疗非增殖期中重度和增殖期DR合并DME，可有效提高患者视力，减轻视网膜水肿，长期疗效有待于进一步观察。

METHODS: Prospective case study. Totally 48 patients(80 eyes)diagnosed as DR with DME randomized to combined group and laser group. Among them, there were 4 patients with 5 eyes in the moderate stage of non-proliferative DR(NPDR), 38 patients with 65 eyes in the severe stage of NPDR, and 6 cases with 10 eyes in the stage of proliferative DR(PDR). Intravitreal conbercept(IVC)and pan retinal photocoagulation(PRP)were performed in the combined group; the macular grid pattern laser photocoagulation and PRP were performed in the laser group. Best corrected visual acuity(BCVA),central macular thickness(CMT)and laser energy were tested at baseline and repeated at 1wk, 1, 3, 6, and 12mo after PRP.

RESULTS: Repeated measures showed an effect of treatment in combined group. Combined group induced increased BCVA at 1wk, 1 and 3mo after PRP, and remained stable in 6 and 12mo after PRP. Laser group induced increased BCVA at 1 and 3mo after PRP, and remained stable in 1wk, 6 and 12mo after PRP. Combined group induced decreased CMT at 1wk, 1 and 3mo post PRP, and remained stable in 6 and 12mo after PRP. Laser group induced decreased CMT at 1 and 3mo after PRP, and remained stable in 1wk, 6 and 12mo post PRP. There was no laser spot fusion was observed in the two groups during the follow-up. Laser energy in the combined group was lower than that in the laser group. No complications were observed during the follow-up.

CONCLUSION: IVC and retinal photocoagulation significantly improves visual and anatomic outcomes in patients with DR complicated with DME. Long-term efficacy remains to be seen.