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目的探讨黄斑区格栅样激光光凝(MLG)、雷珠单抗(R)联合MLG和曲安奈德(TA)联合MLG治疗糖尿病性黄斑水肿(DME)的疗效及安全性。方法选取2013年1月至2015年6月收治的102例DME患者作为研究对象。根据治疗方案的不同,将患者分为A组(31例,36眼)、B组(34例,44眼)和C组(37例,54眼)。A、B、C组分别行MLG术、R联合MLG术和TA联合MLG术。检测3组患眼的最小分辨视角的对数值(log MAR)、黄斑中央视网膜厚度(CMT)和眼底荧光渗漏情况;检测3组被研究眼对侧正常眼的log MAR和CMT;统计3组的不良反应情况。结果 3组治疗后的log MAR和CMT均明显低于治疗前(P均<0.05);治疗3个月时,B组的log MAR和CMT均明显低于C组(P<0.05),A组无渗漏的构成比在3组中最低(P<0.0167);治疗3个月和6个月时,A组的log MAR和CMT均明显高于其他两组(P均<0.05);治疗6个月时,B组和C组的水肿减轻构成比均明显高于A组(P均<0.0167);B组和C组的不良反应总发病率均明显高于A组(P均<0.0167)。结论 MLG、R联合MLG和TA联合MLG治疗DME的疗效均明确,其中以R联合MLG和TA联合MLG的疗效更为显著,但联合治疗的不良反应也明显增多。
Objective To investigate the efficacy and safety of macular grid-like laser photocoagulation (MLG), ranibizumab (R) combined with MLG and triamcinolone acetonide (TA) combined with MLG in the treatment of diabetic macular edema (DME). Methods A total of 102 DME patients admitted from January 2013 to June 2015 were selected as the study subjects. Patients were divided into group A (31 cases, 36 eyes), group B (34 eyes, 44 eyes) and group C (37 eyes, 54 eyes) according to the treatment plan. Patients in groups A, B and C underwent MLG surgery, R combined with MLG surgery and TA combined with MLG. Log MAR, central retinal thickness (CMT) and fundus fluorescein leakage in the three groups of eyes were measured. Log MAR and CMT in the contralateral normal eyes of the three groups were measured. Adverse reactions. Results The log MAR and CMT of group B were significantly lower than those of group C (all P <0.05) at 3 months after treatment, (P <0.0167). At 3 and 6 months of treatment, the log MAR and CMT of group A were significantly higher than those of the other two groups (all P <0.05). Treatment 6 In months, the edema reduction ratio of group B and C were significantly higher than that of group A (P <0.0167). The total incidence of adverse reactions in group B and C were significantly higher than that in group A (P <0.0167) . Conclusion MLG, R combined with MLG and TA combined with MLG in the treatment of DME have clear effects. Among them, combination of ML with MLG and TA combined with MLG is more effective, but the adverse reactions of combination therapy are also obviously increased.