目的：探讨雷珠单抗联合577nm多点扫描矩阵激光光凝治疗糖尿病性黄斑水肿(DME)患者临床疗效。

方法：选取2017-01/2018-06我院收治的DME的患者94例127眼。按治疗方法的不同分为：单一组：仅通过玻璃体腔注射雷珠单抗治疗DME； 联合组：玻璃体腔注射雷珠单抗联合577nm多点扫描矩阵激光治疗DME。观察两组患者完成3次雷珠单抗注射后1mo治疗效果； 分别在治疗前、完成3次雷珠单抗注射后1、3、6mo检查两组患者的视力改善情况； 采用光学相干断层扫描(OCT)检测两组患者黄斑中心凹厚度(CMT)； 使用眼底荧光血管造影(FFA)检测视网膜新生血管渗漏面积以及术后并发症情况。

结果：两组患者完成3次雷珠单抗注射后1mo，联合组患者的治疗有效率(100%)高于单一组(97%)(P>0.05)。治疗前两组患者BCVA分别为0.57±0.20、0.56±0.18(P>0.05)，完成3次雷珠单抗注射后1、3、6mo患者单一组BCVA分别为0.39±0.05、0.23±0.06、0.18±0.05，联合组BCVA分别为0.28±0.08、0.18±0.07、0.12±0.06，联合组患者BCVA优于对照组(P<0.001)。治疗前两组患者CMT分别为389±42.54、386±38.25μm(P>0.05)，完成3次雷珠单抗注射后1、3、6mo单一组CMT分别为333.84±38.18、297.12±27.10、278.15±26.24μm，联合组CMT分别为315.04±39.07、274.35±28.63、253.65±25.91μm，联合组患者CMT改善情况优于单一组(P<0.001)。治疗前两组患者视网膜新生血管渗漏面积分别为22.31±3.26、21.98±3.18mm²(P>0.05)，完成雷珠单抗注射后3、6mo，单一组渗漏面积分别为18.34±2.19、7.81±1.28mm²，联合组渗漏面积分别为14.92±1.98、5.39±1.42mm²(P<0.001)。单一组患者共3眼出现并发症，联合组患者共4眼出现并发症，两组患者并发症发生率比较无差异(P>0.05)。

结论：雷珠单抗联合577nm多点扫描矩阵激光光凝对DME患者均有治疗效果且安全，联合治疗长期效果要优于单独行玻璃体腔注射雷珠单抗。

METHODS:Totally 127 eyes of 94 patients(January 2017-June 2018)with DME were selected. According to the different treatment methods, RA group was divided into two groups. RA group was only treated with razumab group: the patients in this group were treated with razumab injection; RL group: razumab combined with 577nm multi-point scanning matrix laser group: the patients in this group were treated with razumab combined with 577nm multi-point scanning matrix laser photocoagulation. To observe the treatment effect of RA group and RL group 1mo after three times of leizhumab injection; to check the visual improvement of RA group and RL group before treatment and 1mo, 3mo and 6mo after three times of leizhumab injection; to detect the macular fovea thickness(CMT)of RA group and RL group by optical coherence tomography(OCT); to detect the retinal neogenesis by FFA Vascular leakage area and postoperative complications.

RESULTS: The effective rate(100%)of the patients in the combined group was higher than that in the single group(97%), but the difference was not statistically significant(P>0.05). Before treatment, the BCVA of the two groups of patients were 0.57±0.20 and 0.56±0.18(P>0.05). After completing three injections of ranibizumab, the BCVA of the single group of patients at 1, 3, and 6mo were 0.39±0.05, 0.23±0.06,0.18±0.05, the BCVA of the combined group were 0.28±0.08,0.18±0.07, 0.12±0.06, the BCVA of the combined group was better than the control group(P<0.001). Before treatment, the CMT of the two groups of patients were 389±42.54 and 386±38.25, respectively(P>0.05).After completing three injections of ranibizumab, the CMT of the single group at 1, 3,and 6mo were 333.84±38.18, 297.12±27.10, 278.15±26.24μm, the CMT of the combined group were 315.04±39.07, 274.35±28.63, 253.65±25.91μm, the improvement of the CMT of the combined group was better than that of the single group(P<0.001). Before treatment, the leakage area of retinal neovascularization in the two groups was 22.31±3.26 and 21.98±3.18mm²(P>0.05). After the injection of ranibizumab was completed 3 and 6mo, the single group leaked The areas were 18.34±2.19, 7.81±1.28mm², and the leakage area of the combined group were 14.92±1.98, 5.39±1.42mm², respectively(P<0.001). Complications occurred in 3 eyes of a single group of patients and complications in 4 eyes of a combined group(P>0.05).

CONCLUSION: Leizhumab and 577nm multi-point scanning matrix laser photocoagulation are effective and safe in the treatment of DME patients, but the long-term effect of leizhumab combined with 577nm multi-point scanning matrix laser group is better than that of single line intravitreal injection of leizhumab.