老年糖尿病患者白内障术后视网膜病变的连续观察

目的评价白内障超声乳化摘出联合人工晶状体植入术后老年糖尿病患者的视力效果及视网膜病变的进展状况。方法对179例179眼老年糖尿病白内障患者行超声乳化白内障摘出联合人工晶状体植入术。术后对术眼及对侧非手术眼视网膜病变进行比较。结果术后最佳矫正远视力≥0．5者159眼，其中无糖尿病视网膜病变者78眼，单纯性糖尿病视网膜病变者80眼，增生性糖尿病视网膜病变者1眼；视力结果取决于视网膜病变特别是黄斑病变程度。术眼中79眼、非手术眼中27眼出现视网膜病变进展，表现为视网膜内出血，火焰状出血斑，硬性及棉絮状渗出斑不同程度的增多，视网膜水肿，黄斑病变加剧及进一步的新生血管形成。结论（1）早期手术效果好，与非糖尿病老年白内障术后无明显差别；（2）晚期手术效果差，白内障手术可加速糖尿病视网膜病变进展；（3）早期手术可提高视力，便于眼底观察及激光治疗。[眼科新进展2007；27（2）：140-141]     

糖尿病患者的后房型人工晶体植入术

为了提高糖尿病性视网膜病变患者的视力，对３８例有或无非增殖型视网膜病的糖尿病患者和３８例非糖尿病患者，共７６例９３只眼行白内障囊外摘除联合后房型人工晶体植入术。结果表明两组的术中，术后并发症的发生率差异无显著性。术后矫正视力达０．５以上者：糖尿病患者４７只眼中有２６只眼（５５．３％），非糖尿病患者４６只眼中有３０只眼（６５．２％），差异也无显著性（Ｐ〉０．０５）。观察结果提示对此类患者术后必须密切     

糖尿病性白内障的超声乳化术

目的 探讨糖尿病性白内障的超声乳化术对视力、角膜激光、视网膜病变的影响。方法 ８０例（８８眼）糖现性白内障在门诊施行超声乳化术。结果 术后１天视力０．６以上５４眼（６１．４％）,术后３月视力１．０以上５０眼（５６．８％）。术后角膜散光度数逐渐减少,由循规性散光向逆规性散光转变。并发症主要有前房纤维素性渗出及糖尿病性视网膜病变加重。结论 术后可极大的改善视力并且有利于观察病性进展,为进行眼底激光治疗     

糖尿病患者白内障后房型人工晶体植入的临床观察

本文回顾总结了自１９９０年１２月至１９９２年１１月间白内障囊外摘出及后房型人工晶体植入术的２２眼糖尿病患才的白内障，随访４－２６个月，２２眼中１７眼眼无糖尿病性视网膜病变，５眼术后视网膜病变有变化，其中１眼为增殖性视网膜病变伴严重玻璃体出血，１眼为糖尿病性黄斑病变发展为新生血管性青光眼，１６眼（７３％）最后矫正视力＞０．５，结果表明人工晶体的植人对糖尿病患者的白内障同样是一种有效而又安全的治疗方法     

糖尿病患者小切口白内障摘出人工晶状体植入

目的探讨糖尿病患者手法小切口白内障摘出联合人工晶状体植入的安全性和疗效。方法对112例（138眼）糖尿病患者施行手法小切口白内障摘出联合人工晶状体植入;并以114例（139眼）非糖尿病老年性白内障作对照组。术后对合并糖尿病视网膜病变的42眼中的36眼于术后1—2个月行视网膜激光光凝。结果随访6—12个月,术后3个月视力〉10．3者,糖尿病组合并视网膜病变者18眼,占42．86％;未合并视网膜病变者85眼,占88．54％。非糖尿病组视力≥0．3者129眼,占92．81％。糖尿病组合并视网膜病变者与非糖尿病组差异有统计学意义（χ2=52．75,P〈0．01）;未合并糖尿病视网膜病变者与非糖尿病组差异无统计学意义（χ2=1．27,P〉0．05）。结论对糖尿病患者白内障施行手法小切口白内障摘出联合人工晶状体植入术是安全的,为便于术后观察眼底,及时治疗视网膜病变提供了条件。     

增生性糖尿病视网膜病变合并白内障的联合手术治疗

目的探讨玻璃体手术联合晶状体超声乳化治疗增生性糖尿病性视网膜病变（PDR）合并白内障的临床疗效。方法分析19例（20只限）增生性糖尿病性视网膜病变合并不同程度白内障患者行白内障超声乳化联合玻璃体手术同时进行人工晶状体囊袋内植入的临床资料，观察术后视力改善程度及术中术后并发症。结果随访2—16个月，所有术眼人工晶状体位置良好，手术后20只限中有16只限（80％）视力有不同程度的提高，其中视力提高二行以上13只限（65％）；视力较术前无改善4只限（20％）。术后视力恢复不佳的原因主要与不同程度的糖尿病黄斑病变、视网膜广泛缺血有关。术后并发症包括高眼压、虹膜后粘连、玻璃体腔再出血、视网膜再脱离、晶状体后囊混浊及新生血管性青光眼等。结论玻璃体手术联合白内障超声乳化人工晶状体植入术治疗增生性糖尿病性视网膜病变合并白内障是安全和有效的，可使大多数患者视力改善，且无明显并发症。     

超声乳化人工晶状体植人联合玻璃体切除术治疗增生型糖尿病视网膜病变

目的评价晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法回顾性分析合并不同程度白内障的增生型糖尿病视网膜病变6l例（66眼）。其中PDRlV期20眼,V期33眼,Ⅵ期13眼。实施晶状体超声乳化、囊袋内人工晶状体植人联合玻璃体切除术。观察术后视力改善程度和术中术后并发症。结果术后视力改善：PDR1V期19眼（95．0％）,V期28眼（84．8％）,Ⅵ期13眼（38．5％）。术后视力低下者多伴有明显的糖尿病黄斑病变。术中术后主要并发症包括：医源性裂孔7眼（10．6％）;玻璃体积血,术中17眼（25．8％）,术后7眼（10．6％）;角膜上皮延期愈合9眼（13．6％）;角膜水肿8眼（12．1％）。结论超声乳化、人工品状体植入联合玻璃体切除术治疗合并不同程度白内障的增生型糖尿病视网膜病变是安全有效的,可使大多数患者视力改善,避免玻切术后并发白内障再次手术。糖尿病黄斑病变是影响术后视力提高的主要原因。     

白内障超声乳化术后糖尿病视网膜病变的激光治疗

目的 观察白内障超声乳化术后糖尿病视网膜病变激光治疗的时机及疗效。方法 对58例102只眼行白内障超声乳化术的糖尿病视网膜病变患者，在眼底荧光血管造影（FFA）指导下，早期予以激光光凝。结果 光凝治疗后，58例102眼术后随访均满1y。其中视力提高25眼，占24．50％，视力不变64眼，占62．75％，视力下降13眼，占12．75％，总有效率87．25％。由于先处理已存在的黄斑水肿，未见全视网膜光凝术后黄斑水肿加重。结论 适时的白内障超声乳化摘除，术后早期进行激光光凝，能有效的控制糖尿病视网膜病变的进展，稳定视力。FFA是进行正确有效激光重要参考依据。     

糖尿病患者人工晶状体植入后后囊混浊及眼底改变

目的 观察糖尿病患者白内障囊外摘除及人工晶状体植入术后后囊混浊及眼底改变。方法 对108例(117眼)糖尿病患者的白内障采用6-7mm角巩膜切口行ECCE及后房型IOL植入术,术后5月观察视力、晶状体后囊及眼底改变。结果108例糖尿病患者平均糖尿病病程7.9年,白内障平均病程2.5年。117眼白内障术后5月内观察:后囊混浊18眼(15.4％)。术后视力≥0.5者76眼(65.0％),36眼为0.05～0.4(30.8％),5眼<0.05(4.3％)。眼底检查发现108眼患糖尿病性视网膜病变,其中Ⅲ期58眼、Ⅳ-Ⅴ期24眼、Ⅵ期2眼,黄斑水肿10眼。结论 术后后囊混浊发生率为15.4％,糖尿病性视网膜病变发生率92.3％,而糖尿病病程5年以上者眼底病变发生率高达94.4％(102眼),其中Ⅲ期及以上者达78.7％(Ⅲ期53.7％、Ⅳ-Ⅴ期22.2％、Ⅵ期1.9％),黄斑水肿9.2％,后囊混浊及眼底改变均影响术后视力,但后者是最主要的原因。     

增生型糖尿病性视网膜病变前后段联合手术的临床研究

目的观察后部玻璃体切除联合超声乳化及人工晶状体植入术（简称“后三联手术”）治疗糖尿病性视网膜病变的疗效。方法对44眼行后三联手术的糖尿病性视网膜病变进行回顾性分析，并与行单纯玻璃体切除术的50眼糖尿病性视网膜病变进行对比。结果术后随访2～20月，后三联手术组术后视力0．06以上者43眼（97．73％），0．3以上10眼（22．73％），0．5以上10眼（22．73％）；单纯玻璃体切除组术后视力0．06以上者44眼（88．00％），0．3以上8眼（16．00％），0．5以上6眼（12．00％），随访期间22眼（44．00％）二次行白内障手术。结论后部玻璃体切除联合超声乳化人工晶状体植入术治疗增生期糖尿病性视网膜病变是可行的。     

Diabetic retinopathy before and after cataract surgery.

AIMS/BACKGROUND: Increased retinopathy progression has been reported after cataract surgery in patients with diabetes mellitus. To assess the influence of cataract surgery on visual acuity and retinopathy progression, all diabetic patients who were subjected to cataract surgery during 1991-3 have been followed up at the Department of Ophthalmology in Helsingborg. The average follow up time was 2 years. METHODS: One eye of each of 70 patients was included in the study, 35 monocularly and 35 binocularly operated on. Sixteen of the 70 patients had proliferative diabetic retinopathy (PDR) at baseline. The Wisconsin scale was used for the grading of retinopathy. The degree of glycaemic control was assessed by measurements of HbA1c. RESULTS: Most patients obtained improved visual acuity; a postoperative visual acuity of 0.5 or better was achieved in 89% of diabetic surgical eyes. Progression of the retinopathy occurred in 30 out of the 70 eyes, and was associated with mean level of HbA1c (p = 0.04), duration of diabetes (p = 0.02), insulin treatment (p = 0.001), and presence of retinopathy at baseline (p = 0.01). Patients who progressed had a significantly higher incidence of macular oedema (p = 0.006) than those who did not progress. No significant differences were found when operated and non-operated eyes were compared in the 35 patients with monocular surgery. Two patients in this group, however, ended up with macular oedema and worse vision in the operated eye than in the eye which was not operated on. Both patients had background retinopathy before surgery. CONCLUSIONS: Patients in this study, also those with PDR, obtained good visual acuity, better than in most previous studies. Poor glycaemic control was a factor of importance for the progression of diabetic retinopathy after cataract surgery.     

Extracapsular cataract surgery with posterior chamber lens implantation in patients with diabetes mellitus - retrospective study on 145 patients

BACKGROUND: The purpose of this paper is to investigate whether cataract surgery in patients with diabetes mellitus influences the progression of diabetic retinopathy, diabetic macular oedema and anterior segment complications. PATIENTS AND METHODS: 145 consecutive patients with type-II-diabetes mellitus underwent an extracapsular cataract surgery with implantation of a posterior chamber lens. 88 patients (119 eyes have been operated) could be followed up for an average of 19 months and 58 patients (88 eyes have been operated) could be followed up for an average of 38 months. Evaluation of the data included the preoperative retinal findings, intraoperative and early postoperative complications and problems, the progression of diabetic fundus changes, the progression of visual acuity and late complications. RESULTS: Insufficient pupil dilatation (25.2 %) was the most frequent intraoperative complication. Among early postoperative complications anterior segment inflammation was most frequent (10.1 %). During the follow-up period the diabetic retinopathy in the operated eyes showed a progression which was statistically not different from that in the non-operated eyes. After an average of 19 months the diabetic retinopathy deteriorated in 22.7 % of the operated eyes and in 17.5 % of the non-operated eyes. After an average of 38 months the diabetic retinopathy deteriorated in additional 12.5 % of the operated and 11.1 % of the not-operated eyes. A diabetic macular oedema was present after an average of 19 months in 6.8 % of the operated 119 eyes and after an average of 38 months in 6.7 % of the operated 88 eyes. In the non-operated partner-eyes no diabetic macular edema developed during the follow-up period. The main late-complication during the whole follow-up period was the development of a capsular fibrosis in 52.3 % of the operated eyes. Postoperative visual acuity at the end of the first follow-up period (average 19 months) was >/= 0.5 in 85.7 % of the operated eyes and at the end of the second follow-up period (average 38 months) in 81.8 % of the operated eyes. CONCLUSION: Extracapsular cataract surgery in patients with diabetes mellitus is a procedure with good results, of high reliability and a slightly higher rate of complications than in non-diabetic patients. Extracapsular cataract surgery does not give rise to progression of diabetic retinopathy.     

Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema

BACKGROUND: Compared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients--especially in those with diabetic retinopathy. This prospective study was planned to evaluate visual outcome, progression of diabetic retinopathy, and incidence of clinically significant macular oedema (CSME) in a homogenous group of patients with non-proliferative diabetic retinopathy (NPDR) without CSME at baseline 1 year after cataract surgery. METHODS: Over a period of 18 months, all consecutive patients with mild-to-moderate diabetic retinopathy who had cataract surgery with phacoemulsification and posterior chamber lens implantation were prospectively followed up. Outcomes were assessed 1 year postoperatively and included visual acuity (VA), progression of retinopathy, and incidence of CSME. Progression of retinopathy and incidence of CSME were compared to the non-operated fellow eyes. RESULTS: Of 50 patients included, 42 completed the 1-year follow-up. VA improved in 85% of patients, and was better than 0,5 in 71%. Progression of retinopathy occurred in 12% of eyes after cataract surgery and in 10.8% of non-operated fellow eyes. No patient developed proliferative diabetic retinopathy in the operated eye. CSME occurred in 13 operated eyes (31%), five of them with retinal ischemia, and in five non-operated eyes (13.5%). Patients with ischemic macular oedema had the worst prognosis regarding VA. CONCLUSION: Modern cataract surgery seems to have no influence on the progression of diabetic retinopathy. A visual improvement is achieved in the majority of patients with NPDR, but poorer visual outcome is observed in patients developing macular oedema.     

Progression of nonproliferative diabetic retinopathy and visual outcome after extracapsular cataract extraction and intraocular lens implantation.

Twenty-one patients with symmetric nonproliferative retinopathy who underwent extracapsular cataract extraction and intraocular lens implantation were followed up postoperatively for an average (+/- standard deviation) of 18 +/- 7 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity, and factors predictive of progression of retinopathy and final visual acuity. Progression of retinopathy, defined as the development of clinically significant macular edema, an increase in intraretinal hemorrhages or hard exudate, or the development of proliferative diabetic retinopathy, was assessed in both eyes of 19 patients; in two remaining patients, dense preoperative cataract in the fellow eye precluded comparison of retinopathy progression in the operated-on eye to progression in the fellow eye. Overall, retinopathy progressed in 14 of 19 operated-on eyes (74%). Cataract extraction was highly associated with asymmetric progression of nonproliferative retinopathy; it progressed only in the operated-on eye in seven of 19 patients (37%), but in no patients did progression occur in the fellow eye alone (P = .0078). Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men (P = .005). Visual acuity improved in 19 of 21 operated-on eyes (86%); however, only 11 eyes (52%) achieved a visual acuity of 20/50 or better and only six eyes (14%) achieved a visual acuity of 20/25 or better. In only five eyes was the final visual acuity in the operated-on eye more than two lines better than the final visual acuity in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postoperative fibrinoid reaction in extracapsular surgery with intraocular lens implantation in diabetic retinopathy patients

IOL implantation in diabetic retinopathy patients is still controversial. To ascertain the frequency of inflammatory complications in diabetic patients and the influence of such surgery on the evolution and treatment of diabetic retinopathy, the authors have reviewed 198 consecutive diabetic eyes (120 operated patients) with extracapsular cataract extraction and posterior chamber intraocular lens implantation.

The mean follow-up period was 26 months with a range from 19 to 36 months. Postoperative visual acuity was 0.45. The incidence of inflammatory reaction with fibrinoid component was 3.03% vs 2.5% in a matched control group.

Intensive topical corticosteroid treatment was effective in controlling the inflammatory reaction in all cases within one to three days. The diabetic retinopathy did not show an increase in progression after IOL implantation but in one case with severe postoperative inflammatory reaction. Photocoagulation postoperatively was indicated in all cases, being effective in all but the case in which retinopathy got worse; this case required vitrectomy with endophotocoagulation because of vitreous haziness. Visual acuity improved following cataract surgery regardless of the incidence of inflammation or the type of diabetic retinopathy.     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

Postoperative fibrinoid reaction in extracapsular surgery with intraocular lens implantation in diabetic retinopathy patients

IOL implantation in diabetic retinopathy patients is still controversial. To ascertain the frequency of inflammatory complications in diabetic patients and the influence of such surgery on the evolution and treatment of diabetic retinopathy, the authors have reviewed 198 consecutive diabetic eyes (120 operated patients) with extracapsular cataract extraction and posterior chamber intraocular lens implantation. The mean follow-up period was 26 months with a range from 19 to 36 months. Postoperative visual acuity was 0.45. The incidence of inflammatory reaction with fibrinoid component was 3.03% vs 2.5% in a matched control group. Intensive topical corticosteroid treatment was effective in controlling the inflammatory reaction in all cases within one to three days. The diabetic retinopathy did not show an increase in progression after IOL implantation but in one case with severe postoperative inflammatory reaction. Photocoagulation postoperatively was indicated in all cases, being effective in all but the case in which retinopathy got worse; this case required vitrectomy with endophotocoagulation because of vitreous haziness. Visual acuity improved following cataract surgery regardless of the incidence of inflammation or the type of diabetic retinopathy.     

糖尿病患者人工晶体植入术

糖尿病性白内障行囊外摘出联合后房型人工晶体植入术37例39眼,以45例51眼非糖尿病性白内障作为对照.最终视力糖尿病眼87.2%≥0.5,非糖尿病眼92.2%≥0.5,两组无显著性差异(P>0.05).术后糖尿病眼有17.9%糖尿病性视网膜病变有所发展.糖尿病眼术后眼前段并发症发生率明显高于非糖尿病眼,尽管如此,只要早期发现,合理治疗,结果仍是好的.     

Midterm visual outcome and progression of diabetic retinopathy following cataract surgery. Midterm outcome of cataract surgery in diabetes

OBJECTIVE: To assess the influence of cataract surgery on progression of diabetic retinopathy and visual acuity. METHODS: 37 patient eyes with mild to moderate diabetic retinopathy at baseline underwent phacoemulsification and intraocular posterior chamber lens implantation. They were examined 3.3 +/- (SD) 0.7 years after surgery. RESULTS: 83.8% of the eyes showed a better final visual acuity, and 67.6% achieved a final visual acuity of 0.5 or better. The retinopathy remained unchanged in 83.8% and progressed in 16.2% of the eyes. No eye progressed to proliferative retinopathy. CONCLUSION: Phacoemulsification and implantation of a posterior chamber intraocular lens is a safe procedure for patients with mild to moderate diabetic retinopathy.     

A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes

AIM: To determine if uncomplicated phacoemulsification cataract surgery is associated with an accelerated rate of progression of diabetic retinopathy or maculopathy postoperatively. METHODS: A prospective trial of 50 type 2 diabetics undergoing monocular phacoemulsification cataract surgery by a single consultant surgeon. The grade of diabetic retinopathy and diabetic maculopathy in the operated and non-operated fellow eye was assessed preoperatively and for 12 months postoperatively. RESULTS: Overall, retinopathy progression was observed in 11 patients. In seven the retinopathy progressed in both eyes, in three it progressed in the operated eye alone, and in one it progressed in the fellow eye alone. Macular oedema was observed in 13 eyes postoperatively. Four had transient pseudophakic cystoid macular oedema and nine true diabetic maculopathy. Where maculopathy progressed it did so symmetrically in five patients, it progressed in the operated eye alone in four patients, and the fellow eye alone in two patients. There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively. In both the operated (OE) and non-operated (NoE) eyes retinopathy progression was associated with a higher mean HbA(1)C (OE p=0.003; NoE p=0.001) and insulin treatment (OE p=0.008, NoE p=0.04). CONCLUSION: Uncomplicated phacoemulsification cataract surgery does not cause acceleration of diabetic retinopathy postoperatively and any progression that is observed probably represents the natural history of the disease. Although macular oedema is common after cataract surgery it may follow a benign course and in many patients the development of clinically significant macular oedema postoperatively probably represents natural disease progression rather than being a direct effect of surgery.