目的：探讨氩激光视网膜光凝术联合羟苯磺酸钙治疗糖尿病性视网膜病变(DR)的临床价值。

方法：前瞻性研究。纳入2017-08/2019-08我院收治的DR患者182例326眼，按随机数字表法分为观察组行氩激光视网膜光凝术联合羟苯磺酸钙治疗(91例164眼)与对照组仅行氩激光视网膜光凝术(91例162眼)，治疗前、治疗6mo均进行闪光视网膜电图检查，记录a、b波振幅、峰值时间变化； 并检测两组患者最佳矫正视力(BCVA)、视网膜新生血管荧光素渗漏面积、黄斑中心凹厚度(CMT)及视网膜微循环参数的变化，记录两组患者视网膜水肿、出血及渗出吸收时间，统计两组患者术后并发症发生率。

结果：治疗6mo，两组患者a、b波振幅均较治疗前降低(P<0.001)，观察组 b波振幅高于对照组(P<0.05)，但 a、b波峰值时间及a波振幅比较无差异(P>0.05)； 治疗6mo，两组患者均较治疗前BCVA改善，黄斑区渗漏面积、CMT降低(P<0.001)，观察组BCVA优于对照组，黄斑区渗漏面积、CMT低于对照组(P<0.001)，视网膜中央动脉峰值血流速度、平均血流速度高于对照组，血管阻力指数及搏动指数低于对照组(P<0.001)，水肿、出血及渗出吸收时间短于对照组(P<0.001)； 两组患者手术并发症发生率无差异(P>0.05)。

结论：氩激光视网膜光凝术联合羟苯磺酸钙治疗DR疗效优于单独应用氩激光视网膜光凝，可促进视力改善，减少荧光素渗漏，促进视网膜水肿、出血及渗出吸收，有助于改善视网膜微循环，抑制新生血管再生。

METHODS:A prospective study from August 2017 to August 2019 was conducted. Totally 182 patients(326 eyes)with DR were divided into two groups. The observation group received fundus retinal argon laser photocoagulation combined with calcium dobesilate, and the control group received fundus retinal argon laser photocoagulation. Flash electroretinography was performed before treatment and after treatment, and changes in a and b waves were recorded. Changes in the best corrected visual acuity(BCVA), retinal neovascularization fluorescein leakage area, central macular thickness(CMT)and retinal microcirculation parameters were detected. The absorption time of retinal edema, bleeding and exudation was recorded, and the incidence of postoperative complications was counted.

RESULTS: At 6mo after treatment, a-wave and b-wave amplitudes of the two groups were decreased(P<0.001). The b-wave amplitude of observation group was larger than that of the control group(P<0.05). There were no statistically significant differences in a-wave and b-wave peak time and amplitudes between the two groups(P>0.05). The BCVA of the two groups was increased, and the macular leakage area and CMT were reduced(P<0.001). Compared with the control group, the BCVA of the observation group was higher, the macular leakage area and CMT were smaller, peak blood flow velocity and average blood flow velocity of the central retinal artery were higher, and the vascular resistance index and pulsatility index were lower(P<0.001). The absorption time of edema, bleeding and exudation was shorter in observation group than in the control group(P<0.001). There was no significant difference in the incidence of surgical complications between the two groups(P>0.05).

CONCLUSION: Fundus retinal argon laser photocoagulation combined with calcium dobesilate is superior to retinal photocoagulation alone in the treatment of DR. The former can promote the improvement of visual acuity, reduce fluorescein leakage, and promote the absorption of retinal edema, bleeding and exudation, which is conductive to improving retinal microcirculation and inhibiting neovascularization.