目的：探究玻璃体腔注射阿柏西普联合改良黄斑区栅格样光凝及全视网膜光凝治疗糖尿病性黄斑水肿(DME)的效果。

方法：回顾性研究。收集2022年2月至2025年2月医院收治的DME患者临床资料，根据治疗方式不同分为对照组(采用单纯改良黄斑区栅格样光凝联合全视网膜光凝治疗)与联合组(在对照组基础上，术前3 d行单次玻璃体腔注射阿柏西普)，所有患者治疗结束后均接受至少6 mo随访。比较两组手术前后最佳矫正视力及眼压、视网膜微循环指标水平变化情况，记录两组术后并发症发生情况，观察两组手术前后的生活质量。

结果：纳入DME患者300例300眼，联合组150例150眼，男80例，女70例，平均年龄58.89±6.19岁； 对照组150例150眼，男86例，女64例，平均年龄57.88±5.91岁。术后1、3、6 mo，两组最佳矫正视力(BCVA)均优于术前(均P<0.01)，且联合组术后各时间点BCVA均优于对照组(P<0.001)。对照组术后1 mo眼压高于联合组(P<0.001)，其余术后时间点两组间眼压比较无差异(均P>0.05)。术后1、3、6 mo，两组患眼视网膜中央动脉阻力指数(RI)均低于术前，两组舒张末期血流速度(EDV)、收缩期血流峰值(PSV)均高于术前(均P<0.01)，两组视网膜新生血管(RNV)渗漏面积、黄斑中心凹旁厚度(PMT)、黄斑中心厚度(FMT)、中心视网膜厚度(CRT)、中心凹无血管区面积(FAZ)均小于术前(均P<0.01)，且联合组术后各时间点RI均低于对照组，联合组术后各时间点EDV、PSV均高于对照组(均P<0.001)，联合组术后RNV渗漏面积、PMT、FMT、CRT、FAZ均小于对照组(均P<0.01)。术后，两组美国国家眼科研究所视功能相关生命质量量表(NEI-VFQ-25)评分均升高，且联合组高于对照组(P<0.001)。联合组术后黄斑水肿消除率及视力改善或不变率均高于对照组，术后并发症发生率低于对照组(P<0.05)。

结论：采用玻璃体腔注射阿柏西普联合改良黄斑区栅格样光凝及全视网膜光凝治疗DME患者的效果显著，能促进视网膜微循环改善，提高其视力，并能有效稳定术后眼压，减少术后并发症的发生，最终提高生活质量。

METHODS: This study was a retrospective study. The clinical data of DME patients admitted to the hospital from February 2022 to February 2025 were collected. According to different treatment methods, patients were divided into control group(treated with modified macular grid laser photocoagulation and panretinal photocoagulation alone)and combined group(treated with single intravitreal injection of aflibercept preoperative 3 d preoperatively on the basis of the control group). All patients were followed up for at least 6 mo after treatment. Changes in best-corrected visual acuity(BCVA), intraocular pressure(IOP)and retinal microcirculation parameters were compared between the two groups pre- and postoperatively. The postoperative complications of the two groups were recorded, and the quality of life of the two groups before and after treatment was observed.

RESULTS: Totally 300 DME patients(300 eyes)were enrolled, including 150 patients(150 eyes)in the combined group(80 males and 70 females, with a mean age of 58.89±6.19 y)and 150 patients(150 eyes)in the control group(86 males and 64 females, with a mean age of 57.88±5.91 y). At 1, 3, and 6 mo after surgery, BCVA of both groups was better than before surgery(all P<0.01), and the BCVA of the combined group was better than that of the control group at all time points after surgery(P<0.001). The IOP of the control group was higher than that of the combined group at 1 mo after surgery(P<0.001), while there was no statistical significant difference in IOP between the two groups at other postoperative time points(all P>0.05). At 1, 3, and 6 mo after surgery(all P<0.01), the resistance index(RI)of the central retinal artery in both groups of affected eyes was lower than before surgery. The end-diastolic velocity(EDV)and peak systolic velocity(PSV)of blood flow in both groups were higher than before surgery. The leakage area of retinal neovascularization(RNV), parafoveal macular thickness(PMT), foveal macular thickness(FMT), central retinal thickness(CRT), and foveal avascular zone area(FAZ)in both groups were lower than before surgery(all P<0.01), and the RI of the combined group was lower than that of the control group at all time points after surgery. The EDV and PSV of the combined group were higher than those of the control group at all time points after surgery(all P<0.001). The RNV leakage area, PMT, FMT, CRT, and FAZ were all smaller than those in the control group(all P<0.01). After surgery, the scores of the National Eye Institute Visual Function Related Quality of Life Questionnaire(NEI-VFQ-25)in both groups were increased, and the combined group was higher than the control group(P<0.001). The postoperative macular edema elimination rate and visual acuity improvement or retention rate of the combined group were higher than those of the control group, and the incidence of postoperative complications was lower than control group(P<0.05).

CONCLUSION:Intravitreal aflibercept combined with modified macular grid laser photocoagulation and panretinal photocoagulation achieves significant efficacy in the treatment of DME patients, which can promote the improvement of retinal microcirculation, enhance the visual acuity, effectively stabilize postoperative IOP, reduce the occurrence of postoperative complications, and ultimately improve the quality of life.