Ⅱ型糖尿病患者白内障术后5年角膜内皮细胞的形态学变化

目的观察Ⅱ型糖尿病患者白内障超声乳化手术后5年角膜内皮细胞的形态学变化。设计回顾性病例系列。研究对象选取2008年1月至2008年12月在北京友谊医院行晶状体超声乳化手术的白内障患者71例（87眼）。方法合并Ⅱ型糖尿病的白内障患者38例（44眼）为糖尿病组，单纯老年性白内障患者33例（43眼）作为对照组。所有患者均行白内障超声乳化联合人工晶状体植入术，分别于术前及术后5年采用角膜内皮镜观察角膜内皮数量及形态学的变化。主要指标角膜内皮细胞密度、平均内皮细胞面积、变异系数。结果术前，糖尿病患者与对照组相比内皮细胞密度、平均内皮细胞面积、变异系数均无明显差异（P〉0．05）。糖尿病患者术后5年与术前相比，角膜内皮细胞密度降低，平均内皮细胞面积增加，变异系数增加（P均〈0．01）。对照组患者术后5年与术前相比，变异系数增加（P〈0．01），角膜内皮细胞密度和平均内皮细胞面积无明显差异（P均〉0．05）。术后5年，糖尿病患者的内皮细胞密度明显低于对照组（P〈0．01），平均内皮细胞面积明显高于对照组（P〈0．05），变异系数与对照组无统计学差异（P〉0．05）。结论本小样本的回顾性病例研究显示，与正常人相比，糖尿病患者白内障术后角膜内皮细胞损伤重，修复慢,需要长期随访。

Corneal endothelial cell changes in 5 years after cataract surgery in patients with type 2 diabetes mellitus [

Objective To explore the changes of corneal endothelial cells in 5 years after phacoemulsification in patients with type 2 diabetes mellitus by corneal endothelial microscope. Design Retrospective case series. Participants 71 cataract patients who were underwent phacoemulsification in Beijing Friendship Hospital from Jan. to Dec. 2008. Methods Cataract patients underwent phacoemulsification were divided into diabetic group （38 cases, 44 eyes） and control group （33 cases, 43 eyes）. Routine examinations were done and the parameters of corneal endothelial cells were recorded by corneal endothelial microscope at pre-operation and five years post-operatively. Main Outcome Measures Cell density （CD）, average area of endothelial cell （AVE）, and coefficient of variation （CV）. Results There were no significant differences with respect to the average CD, AVE, and CV at pre-operation between two groups （all P〉 0.05）. In diabetic group, the CD was significantly lower, the AVE was significantly higher, and CV was significantly increased in five years post-operatively than at pre-operation （all P〈0.01）. In control group, the CV was significantly increased in five years post-operative than in pre-operation （P〈0.01）, while there were no significant differences of the average CD and AVE at five years post-operatively from at pre-operation （P〉0.05）. After 5 years, the CD of the diabetes group was significantly lower than that of the control group （P〈 0.01）, and the AVE was significantly higher than that of the control group （P〈0.05）, while CV had no significant differences between two groups. Conclusion This small sample retrospective case series study shows that the ＂damage of corneal endothelial cell after phacoemulsification in patients with diabetes are more servere and continue longer time than in normal people and should be followed-up for a long time even more than 5 years.