超声乳化术对糖尿病性白内障患者角膜内皮细胞的影响及危险因素分析

目的：：探讨白内障超声乳化术后对糖尿病性白内障患者角膜内皮细胞的影响及其损伤的危险因素。方法：收集2013-01/2015-10我院糖尿病性白内障患者186例224眼(糖尿病组)和单纯白内障患者190例227眼(对照组),行超声乳化白内障摘除并人工晶状体植入术。观察其术前和术后1d,1wk,1、3mo角膜内皮细胞密度、变异系数及六角形细胞百分比,并应用多元Logistic回归分析角膜内皮细胞损伤的危险因素。结果：两组患者术前角膜内皮细胞密度、变异系数及六角形细胞百分比差异无统计学意义(P>0.05)。糖尿病组术后各时间角膜内皮细胞密度及六角形内皮细胞百分比均明显低于术前和对照组,差异有统计学意义(P<0.05)。糖尿病组术后各时间内皮细胞变异系数均明显高于术前,且糖尿病组术后1wk,1、3mo内皮细胞变异系数均明显高于对照组,差异有统计学意义(P<0.05)。对照组术后1wk,1、3mo角膜内皮细胞密度及六角形内皮细胞百分比均明显低于术前,差异有统计学意义(P<0.05)。对照组术后1wk,1、3mo内皮细胞变异系数均明显高于术前(P<0.05)。单因素分析显示,年龄、浅前房、超声时间长、短眼轴、超声能量高、累积释放能量高、大量的灌注液及核硬度≥Ⅲ级与角膜内皮细胞损伤有关,差异均有统计学意义( P<0.05)。多元Logistic回归分析显示,年龄、超声时间长、超声能量高、累积释放能量高、核硬度≥Ⅲ级是角膜内皮细胞损伤的危险因素,其OR值及95% CI分别为1.742(1.056~2.682)、1.958(1.227~3.135)、2.064(1.274~3.256)、2.585(1.493~3.682)、2.193(1.348~3.316)。结论：糖尿病性白内障患者超声乳化术后角膜内皮细胞损伤较单纯白内障患者更重,年龄、超声时间长、超声能量高、累积释放能量高、核硬度≥Ⅲ级是其角膜内皮细胞损伤的危险因素。

Effect and risk factors for corneal endothelial cells after phacoemulsification in diabetic cataract patients

? AIM: To investigate the influence of phacoemulsification on corneal endothelial cells and its injury risk factors in diabetic cataract patients.?METHODS: From January 2013 to October 2015, 186 diabetic cataract patients ( 224 eyes ) as diabetes group and 190 patients with simple cataract ( 227 eyes ) as control group in our hospital were enrolled. All patients received phacoemulsification combined with intraocular lens implantation. Observation of corneal endothelial cell density, coefficient of variation and percentage of hexagonal cells preoperatively, 1d, 1wk, 1 and 3mo postoperatively were carried out, and multiple Logistic regression analysis for risk factors of corneal endothelial cell injury was taken.?RESULTS: There were no significant difference in the density of corneal endothelial cells, the coefficient of variation and the percentage of hexagonal cells between the two groups before surgery (P>0. 05). Each time point after operation corneal endothelial cell density and the percentage of hexagonal endothelial cells of diabetes group were significantly lower than the preoperative and those of control group ( P < 0. 05 ). Each time after operation endothelial cell coefficient of variation of diabetes group were significantly higher than the preoperative(P<0. 05). The endothelial cell coefficient of variation in diabetes group of the 1wk, 1 and 3mo after operation were significantly higher than those of the control group ( P<0. 05 ) . Corneal endothelial cell density and percentage of hexagonal cells of the control group at 1wk, 1 and 3mo after operation were significantly lower than the preoperative ( P<0. 05 ). The endothelial cell coefficient of variation of control group at 1wk, 1 and 3mo after operation were significantly higher than the preoperative(P<0. 05). Single factor analysis showed that age, shallow anterior chamber, long ultrasonic time, short eye axis, high energy ultrasonic, high cumulative released energy, a lot of perfusate and nuclear hardness ≥ grade Ⅲ associated with corneal endothelial cell injury ( P< 0. 05 ) . Multivariate Logistic regression analysis showed that age, long ultrasonic time, high ultrasonic energy, high cumulative released energy and nuclear hardness ≥ grade Ⅲ were the risk factors of corneal endothelial cell injury, the OR value and 95%CI were 1. 742 (1. 056-2. 682), 1. 958 (1. 227-3. 135), 2. 064(1. 274-3. 256), 2. 585(1. 493-3. 682), 2. 193 (1. 348-3. 316).?CONCLUSION: The injury of corneal endothelial cells after phacoemulsification in diabetic cataract patients is more serious than in patients with simple cataract. Age, long ultrasonic time, high ultrasonic energy, high cumulative released energy and nuclear hardness ≥grade Ⅲ are the risk factors of corneal endothelial cell injury.