糖尿病患者白内障超声乳化术后角膜内皮的变化

目的:应用共聚焦显微镜观察糖尿病患者行白内障超声乳化术前后角膜内皮的变化。方法:随机选取年龄相关性白内障合并糖尿病患者(糖尿病组)50例56眼和单纯年龄相关性白内障患者50例60眼(对照组),行白内障超声乳化摘除联合折叠式人工晶状体植入术。术前及术后1wk;1,3mo应用共聚焦显微镜分别对中央角膜厚度、内皮细胞密度、内皮细胞变异系数及六角形内皮细胞百分比进行观察,分析结果。结果:两组术前中央角膜厚度、内皮细胞密度、内皮细胞变异系数、六角形内皮细胞百分比差异无统计学意义(P>0.05);跟术前相比,术后两组角膜厚度、内皮细胞变异系数均增加,内皮细胞密度、六角形细胞百分比均呈下降趋势;术后1wk;1,3mo糖尿病组中央角膜厚度均高于对照组(P<0.05),内皮细胞密度均低于对照组(P<0.05);术后1wk;1,3mo糖尿病组六角形内皮细胞百分比明显低于对照组(P<0.01),内皮细胞变异系数明显高于对照组(P<0.01)。结论:合并糖尿病的年龄相关性白内障患者超声乳化术后角膜内皮的损伤更严重,且创伤愈合的速率和效率均差于单纯相关性白内障患者。

Changes of corneal endothelium in diabetes patients after cataract phacoemulsification surgery by confocal microscopy

AIM: To observe the changes of corneal endothelium in diabetes patients before and after cataract phacoemulsification surgery with confocal microscopy for exploring the variation and influencing factors.

METHODS: Phacoemulsification were randomly divided into 50 aged-related cataract patients with diabetes mellitus(56 eyes, diabetes group)and 50 patients with senile cataract(60 eyes, control group). Cataract phacoemulsification and intraocular lens implantation were performed, central corneal thickness, the corneal endothelial cell density, coefficient of variation and percentage of hexagonal cell were measured before surgery, 1 week, 1 month and 3 months after surgery by confocal microscopy.

RESULTS: Before surgery, there was no statistical difference between the two groups of central corneal thickness, corneal endothelial cell density, coefficient of variation and percentage of hexagonal cell(P>0.05). Compared with pre-operation, the central corneal thickness and coefficient of variation were increased post-operation, but the corneal endothelial cell density and percentage of hexagonal cell decreased gradually. The central corneal thickness of diabetes group was more significantly than control group 1 week, 3 months after surgery(P<0.05), and the corneal endothelial cell density was less significantly than control group(P<0.05). One week, 3 months after surgery, the percentage of hexagonal cell was less than control group(P<0.01). The coefficient of variation was significantly higher than control group(P<0.01).

CONCLUSION: Aged-related cataract patients with diabetes mellitus were much more poor tolerability on cataract phacoemulsification surgery. Compared with senile cataract patients, the corneal endothelium injury was more serious and the velocity and validity of recovery were lower comparatively.