目的：观察自拟中药益气引水消肿方联合康柏西普及激光治疗糖尿病性黄斑水肿(DME)的临床疗效。

方法：选取2016-01/2018-10在我院眼科就诊的DME患者60例60眼，随机分为对照组给予玻璃体腔内注射康柏西普，中西医组在对照组的治疗基础上加用自拟益气引水消肿方，所有患者根据病情行光凝治疗。观察两组患者在治疗前和治疗后1、3、6mo最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)，以及治疗后6mo荧光素眼底血管造影(FFA)中黄斑荧光渗漏情况和黄斑水肿的复发率。

结果：对照组治疗前BCVA(LogMAR)为0.92±0.26，治疗后1、3、6mo BCVA分别为0.58±0.18、0.60±0.27、0.62±0.28，中西医组治疗前BCVA(LogMAR)为0.94±0.31，治疗后1、3、6mo BCVA分别为0.56±0.20、0.50±0.25、0.51±0.21； 对照组治疗前CMT为461.62±84.26μm，治疗后1、3、6mo CMT为299.92±43.18、290.60±39.36、311.10±42.78μm ，中西医组治疗前CMT为455.74±83.89μm，治疗后1、3、6mo CMT分别为288.96±40.20、265.86±32.55、270.38±31.60μm，两组患者在治疗后与治疗前相比BCVA和CMT均有所改善(P<0.05)。在治疗后1mo中西医组与对照组比较BCVA和CMT无差异(t=0.539、0.739，P>0.05)，在治疗后3、6mo中西医组BCVA和CMT有明显改善，与对照组相比有差异(t_治疗后3mo=2.891、2.992，P_治疗后3mo=0.004、0.021； t_治疗后6mo =3.733、3.643，P_治疗后6mo <0.01、0.005)，在治疗后6mo中西医组黄斑水肿复发率更低(χ²=4.344，P<0.05)。

结论：益气引水消肿方联合康柏西普及激光治疗DME可以改善视力、减轻黄斑水肿、减少水肿复发率。

METHODS: From January 2016 to October 2018, 60 eyes of 60 patients with diabetic macular edema were included in the prospective clinical control study. They were divided into control group and Chinese and Western medicine group according to the random number table method. The patients in control group were injected with anti-vascular drug into the vitreous cavity. After the injection, the patients were treated with photocoagulation. The patients in Chinese and Western medicine group were treated with the Yiqi Yinshui Xiaozhong decoction on the basis of the treatment of the control group. The best corrected visual acuity(BCVA), and macular foveal thickness(CMT)were observed before treatment and at 1, 3, and 6mo after treatment. The macular fluorescence leakage in fluorescein fundus angiography(FFA)and the recurrence rate of macular edema were observed at 6mo after treatment.

RESULTS: BCVA was 0.92±0.26 before treatment, 0.58±0.18, 0.60±0.27 and 0.62±0.28 at 1, 3 and 6mo after treatment, BCVA in the Chinese and Western medicine group BCVA was 0.94±0.31 before treatment, 0.56±0.20, 0.50±0.25, 0.51±0.21 after treatment; CMT in the control group was 461.62±84.26 before treatment, 299.92±43.18, 290.60±39.36, 311.10±42.78 at 1, 3 and 6mo after treatment, CMT in the Chinese and Western medicine group was 455.74±83.89 before treatment, 288.96±40.20, 265.86±32.55, 270.38±31.60 at 1, 3 and 6mo after treatment. Both groups had improved BCVA and CMT after treatment(P<0.05). There was no significant difference between BCVA and CMT in the Chinese and Western medicine group and the control group at 1mo after treatment(t=0.539, 0.739, P>0.05), BCVA and CMT after 3 and 6mo of treatment in the Chinese and Western medicine group improved significantly, and the difference was statistically significant compared with the control group(3mo after treatment t=2.891, 2.992, P=0.004, 0.021; 6mo after treatment t=3.733, 3.643, P<0.01, 0.005). The recurrence rate of macular edema at 6mo after treatment in the Chinese and Western medicine group was lower(χ²=4.344, P<0.05).

CONCLUSION: Combined application of the Yiqi Yinshui Xiaozhong decoction, anti-VEGF drugs and laser to treat diabetic macular edema can improve vision, reduce macular edema, reduce the recurrence rate of edema, and bring better prognosis for patients.