糖尿病患者行白内障超声乳化术后视力及眼底的变化

目的 通过观察2型糖尿病患者行白内障超声乳化摘除及人工晶体植入术后视力及眼底的变化以评估糖尿病视网膜病变(DR)进展的相关危险因素。 方法 选取50例2型糖尿病伴非增殖型糖尿病视网膜病变(NPDR)且需单眼行白内障超声乳化及人工晶体植入术患者为研究对象,手术眼为手术组,非手术眼为非手术组。术后1、7 d及1、3个月,分别行最佳矫正视力(BCVA)及黄斑区光学相干断层扫描(OCT);术后3个月行FFA检查,分析DR进展的相关危险因素。 结果 手术组术后1 d~3个月视力明显改善(P<0.01),术后3个月BCVA呈下降趋势。手术组术后黄斑水肿发生率及DR进展率明显高于非手术组,差异有统计学意义(P<0.05或P<0.01)。Logistic回归分析结果显示,糖化血红蛋白(HbA1c)(OR=21.423)、糖尿病病程(OR=9.061)、NPDR程度(OR=2.486)为DR进展的危险因素。 结论 2型糖尿病NPDR患者行超声乳化及人工晶体植入术后BCVA明显改善,于术后3个月呈轻微下降趋势。糖尿病病程长、血糖控制差、术前DR加重是术后DR进展的危险因素。

Variation of visual acuity and fundus in type 2 diabetic patients after phacoemulsification surgery

Objective To evaluate the risk factors of diabetic retinopathy (DR)progression by observing the variation of visual acuity and fundus in type 2 diabetic patients after phacoemulsification and intraocular lens implantation. Methods A total of 50 patients with type 2 diabetes mellitus accompanied by non-proloferative diabetic retinopathy (NP DR)who needed to undergo phacoemulsification and intraocular lens implantation for the single eye were collected as research objects.Operative eyes and non-operatives were respectively as surgery and non-surgery groups.On 1,7 days and 1,3 months after surgery,both the best corrected visual acuity (BCVA)and optical coherence tomography (OCT)in macular region were conducted,and fundus fluorescein angiography (FFA)was also performed 3 months af-ter surgery.The DR progression-related risk factors were analyzed.Results The visual acuity in surgery group im-proved obviously 1 d-3 months after surgery (P <0.01),but BCVA 3 months after surgery had the decreasing trend. The incidence of postoperative macular edema and DR progression rate in surgery group were higher than in non-surgery group,with statistical significance (P <0.05 or P <0.01).Logistic regression analysis research results displayed that glycosylated hemoglobin (OR =21.423),course of diabetes mellitus (OR =9.061)and NP DR degree (OR =2.486) were the risk factors of DR progression.Conclusion The BCVA of patients with NP DR in type 2 diabetes mellitus im-proves dramatically after phacoemulsification and intraocular lens implantation,but decreases slightly 3 months after sur-gery.Long course of diabetes mellitus,worse control of blood glucose and preoperative aggravation of DR are the risk factors of postoperative DR progression.