手法小切口白内障手术与超声乳化术后糖尿病患者黄斑厚度的对比

目的 比较手法小切口白内障手术与超声乳化手术对Ⅱ型糖尿病患者黄斑中心凹厚度的影响.方法 56例（56只眼）合并Ⅱ型糖尿病患者的白内障随机分成两组,分别施行手法小切口白内障手术及超声乳化吸出手术.所有患者术前均行眼底检查及眼底照像,术前1个月、术后1周、4周、6周、3个月OCT测量黄斑中心凹厚度,并分析此厚度与最佳矫正视力的相关性.结果 26只眼手法小切口白内障手术,30只眼超声乳化吸出手术,两组患者术后黄斑水肿发生率差异无统计学意义.术后1周,手法组黄斑中心凹视网膜神经上皮层厚度明显高于超乳组（t=4.602,P=0.006）,最佳矫正视力明显低于超乳组（χ2=9.753,P=0.009）,4周后两组黄斑中心凹视网膜神经上皮层厚度和最佳矫正视力差异均无统计学意义.最佳矫正视力与黄斑中心凹视网膜神经上皮层厚度呈现负相关.结论 虽然Ⅱ型糖尿病患者的白内障手法小切口白内障手术和超声乳化吸出术后黄斑水肿发生率无差异,但是术后短期内手法小切口手术对黄斑中心凹视网膜神经上皮层厚度影响较大,并暂时影响最佳矫正视力.

Comparison of postoperative macular thickness in diabetic patients after phacoemulsification or manual small-incision cataract surgery

Objective To compare the macular central foveal thickness in cataract patients with type Ⅱ diabetes after phacoemulsification or manual small incision cataract surgery.Methods Fifty-six eyes of 56 cataract patients with type Ⅱ diabetes were randomly divided into two groups.Patients were treated by phacoemulsificaiton or manual small incision cataract surgery,respectively.All patients underwent fundus examination and fundus photography before operation.The foveal thickness measurement by OCT was performed on 1 month before surgery and 1 week,4 weeks,6 weeks and 3 months after operation.The correlation between foveal thickness and postoperative best corrected visual acuity was analyzed.Results The manual small incision cataract surgery was performed on 26 eyes and phacoemulsification cataract surgery was performed on 30 eyes.No significant difference in postoperative macular edema was found between the two groups.One week after operation,compared with the phacoemulsification group,the retinal neuroepithelial thickness in central fovea of macula in manual small incision surgery group was significantly higher （t =4.602,P =0.006）,the best corrected visual acuity was significantly lower （x2 =9.753,P =0.009）.Four weeks after operation,neither the retinal neuroepithelial thickness nor the best corrected visual acuity between two groups was significantly different.A negative correlation was found between the postoperative retinal neuroepithelial thickness and the best corrected visual acuity.Conclusion Although the incidence of postoperative macular edema in the two groups was not significantly different from each other,the postoperative retinal neuroepithelial thickness and the best corrected visual acuity were obviously infected by manual small incision surgery in short term after operation.