目的：探讨球后及玻璃体腔注射曲安奈德联合激光治疗糖尿病黄斑性水肿(DME)的临床疗效及其疗效对比。

方法：将40例62眼DME患者随机分两组，每组31眼，一组采用球后注射曲安奈德(RBTA)进行治疗，另一组采用玻璃体腔注射曲安奈德(IVTA)，两组均在1mo后采用法国光太532nm眼底激光仪对局限性黄斑水肿进行局部视网膜激光治疗，对弥散性黄斑水肿及囊样黄斑水肿进行格栅样视网膜激光治疗，随访1wk，1、3、6mo观察视力、眼压、眼底、黄斑水肿情况及其并发症。

结果：两组患者治疗后随访1wk，1、3、6mo过程中平均最佳矫正视力提高、黄斑水肿减轻，同治疗前比较差异有统计学意义(P<0.05)，组间差异均无统计学意义(P>0.05)。其中RBTA组患者中显效12眼，有效16眼，无效3眼； IVTA组患者中显效12眼，有效17眼，无效2眼； RBTA组显效率39%，总有效率90%； IVTA组显效率39%，总有效率94%。随访期间无视网膜脱离、眼内炎、眼内出血及其他并发症发生。

结论：曲安奈德联合激光治疗DME具有一定疗效，不良反应少，能够有效地提高患者视力、减轻黄斑水肿等特点，是治疗DME的有效方法之一。球后注射与玻璃体腔注射曲安奈德两种注射方式对治疗DME的疗效无明显差异。

METHODS: Sixty-two eyes in 40 DME patients were divided into two groups(Group A and Group B)randomly. Thirty-one eyes in Group A were treated with retrobulbar injection of triamcinolone acetonide(RBTA)and 31 eyes in Group B were treated with intravitreous injection of triamcinolone acetonide(IVTA). Eyes with limited macular edema were treated by local direct retinal laser, those with diffuse and cystic macular edema were treated by grid retinal laser using Vitra 532nm fundus lasers at 1mo after injection. Visual acuity, intraocular pressure, fundus, macular edema and complications were recorded after 1wk, 1, 3 and 6mo in the follow-up study.

RESULTS: The mean best corrected visual acuity was improved and macular edema subsided after treatment in the two groups in the follow-up study at 1wk, 1, 3 and 6mo(P<0.05), while there had no significant difference between groups(P>0.05). In Group A, significant efficiency rate was 39%(12/31), total effective rate was 90%(28/31). In Group B, significant efficiency rate was 39%(12/31), total effective rate was 94%(29/31). The follow-up study showed no retinal detachment, endophthalmitis, intraocular hemorrhage and other complications.

CONCLUSION: Triamcinolone acetonide injection combined with laser photocoagulation is an effective method for treatment of DME with significant effect, less adverse reactions, patient's vision improved effectively and macular edema reduced. No significant difference was noted in the treatment of DME between RBTA and IVTA.