化瘀明目饮对糖尿病患者白内障术后黄斑区的保护作用

目的　探讨口服化瘀明目饮对糖尿病患者白内障超声乳化吸出联合人工晶状体（ｉｎｔｒａｏｃｕｌａｒｌｅｎｓ，ＩＯＬ）植入术后黄斑区的保护作用。方法　将我院眼科２０１３年１月至２０１５年１月行白内障手术合并糖尿病患者９２例（１００眼）随机分为治疗组和对照组。对照组５０例（５０眼）术后应用妥布霉素地塞米松眼液治疗，治疗组４２例（５０眼）在对照组治疗方法的基础上术后化瘀明目饮口服４周。两组分别于术前及术后１周、１个月、３个月对患者进行眼部常规检查，包括最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＢＣＶＡ）、眼压、眼底检查，并利用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＯＣＴ）测量黄斑中心凹视网膜厚度和黄斑区总容积。结果　两组白内障患者术后视力均较术前显著提高，差异均有统计学意义（ｔ＝２．８５３、２．６１０，均为Ｐ＜０．０１）。治疗组术后ＢＣＶＡ的恢复情况显著优于对照组（Ｚ＝－２．０７４、－２．５８７、－２．２６４，均为Ｐ＜０．０５）。两组术后１周、１个月、３个月黄斑中心凹视网膜厚度和黄斑总容积均较术前增加（均为Ｐ＜０．０５），治疗组术后１周、１个月黄斑中心凹视网膜厚度低于对照组，差异均有统计学意义（ｔ＝－２．３４３，Ｐ＜０．０５；ｔ＝－２．９９２，Ｐ＜０．０１），治疗组术后３个月黄斑中心凹视网膜厚度较对照组降低，差异无统计学意义（ｔ＝－１．７３９，Ｐ＞０．０５）。治疗组术后１个月有３眼（６％）出现黄斑水肿，对照组术后１个月有９眼（１８％）出现黄斑水肿，两组黄斑水肿的发生率差异有统计学意义（Ｐ＜０．０５）。结论　化瘀明目饮可防止糖尿病患者白内障术后黄斑中心凹视网膜厚度增加，有效降低术后黄斑水肿的发生率。

Protective effects of huyumingmu decoction on macular area after phacoemulsification in diabetic patients

Objective To investigate the protective effects of huayunungmu decoction on macular area after phacoemulsification with IOL implantation in diabetic patients. Methods Ninety-two diabetic patients with cataract ( 100 eyes) treated with phacoemulsification in our hospital from January 2013 to January 2015 were randomly divided into the treatment group and the control group. The control group ( 50 cases ,50 eyes) was treated with tobramycin and dexamethasone eye drops after operation; On this basis .the treatment group (42 cases ,50 eyes) used oral Huayunungmu decoction at I day after operation for 4 weeks. The routine ophthalmic exanunation including best corrected visual aaity( BCVA) .intraocular pressure and fundus examination were performed . and optical coherence tomography ( OCT) was used to detect the central foveal thickness and total volume of the macula before operation and at I week,l month,3 months after operation. Results The postoperative BCVA in the two groups was improved sigruficantly ( t = 2. 853 ,2. 610 . all P < 0. 01 ) . BCVA improvement at postoperative I week.l month,3 months in the treatment group was better than that in the control group ( z = - 2. 074 , - 2. 587 , - 2. 264 . all P < 0. 05 ) . The central foveal retinal thickness at postoperative I week. I months in the treatment group was significantly lower than that in the control group ( t = - 2. 343 ,P < 0. 05 ; t = - 2. 992 ,P < 0. 01 ) . The central foveal retinal thickness at postoperative 3 months in the treatment group was lower than that in the control group ,but the difference was not significant ( t = - 1. 739 .P > 0. 05 ) . The incidence rate of macular edema at postoperative I months in the treatment group was 6. 00% .which was markedly lower than 18. 00% in the control group (P < 0. 05 ) . Conclusion Huayumingmu decoction can prevent the increase of postoperative central foveal thickness and effectively reduce the incidence of macular edema after phacoemulsification in diabetic patients.