Visual and Anatomical Outcomes of Intravitreal Ranibizumab Combined with Focal/Grid Macular Laser for Center-Involved Diabetic Macular Edema: A Real-World Retrospective Cohort Study

Center-involved diabetic macular edema (CI-DME) is a major cause of vision loss in non-proliferative diabetic retinopathy. Anti-VEGF therapy is standard, but adjunctive focal/grid macular laser may reduce treatment burden in selected eyes. This study evaluated ranibizumab combined with individualized focal/grid laser in Chinese patients with CI-DME. In this retrospective propensity-matched cohort study, 196 eyes with NPDR-related CI-DME received ranibizumab plus focal/grid macular laser (n = 98) or focal/grid laser alone (n = 98) and were followed for 6 months. Baseline OCT and fluorescein angiography were reviewed to characterize DME morphology. The primary outcome was change in best-corrected visual acuity (BCVA); secondary outcomes included central macular thickness (CMT), ≥0.2 LogMAR gain, injection frequency, and adverse events. At month 6, BCVA improved more in the combination group than in controls (−0.17 ± 0.12 vs. −0.10 ± 0.09 LogMAR; p = 0.002). A ≥ 0.2 LogMAR gain occurred in 57.6% versus 31.8% of eyes (p = 0.001). CMT reduction was also greater with combination therapy (152.3 ± 71.5 μm vs. 86.7 ± 68.2 μm; p < 0.001), and ≥20% CMT reduction occurred in 65.2% versus 38.4% of eyes. Nearly half of combination-treated eyes required no additional injections beyond the initial three. Adverse events were rare and similar. Ranibizumab combined with individualized focal/grid macular laser improved visual and anatomical outcomes, reduced injection burden, and showed acceptable safety in selected CI-DME eyes.