糖尿病患者白内障术后的急性前房反应

Acute inflammation in anterior chamber after cataract surgery in diabetes

目的:探讨糖尿病患者白内障术后急性前房反应的发病机制及影响因素。方法:回顾性分析并总结我院14例15眼糖尿病患者白内障超声乳化联合人工晶状体植入术后出现急性前房反应的临床资料及随访结果。结果:部分患者在术后第1d即出现明显的急性前房反应,表现为不同程度的房水闪辉、色素播散,严重者后期可出现人工晶状体前膜及虹膜后粘连。术后经局部应用散瞳、皮质类固醇以及全身应用抗生素药物治疗后,前房反应改善,视力出现不同程度的提高,无其他严重并发症。在伴有糖尿病视网膜病变(diabeticretinopathy,DR)的患者中病程明显冗长。随访发现术后1a视力稳定在0.5以上者11眼(73%)。结论:糖尿病患者白内障术后出现急性前房反应与其身体状况的特殊异质性有关。对此类患者施行手术需要严格进行术前准备,控制和稳定血糖水平,选用生物相容性强的如肝素化人工晶状体或低创性的可折叠人工晶状体,皆可降低急性前房反应的发生率。术后的积极处理可望取得良好的手术效果。

AIM： To study the acute inflammation surgery in diabetes. mechanism and related factors of n anterior chamber after cataract METHODS： Forteen diabetes （15 eyes） with acute inflammation in anterior chamber after phacoemusification combined with intraocular lens （IOL） implantation were chosen for retrospective analysis and summary,with reference with follow-up results. RESULTS： Significant inflammation in anterior chamber appeared on the first day after cataract surgery, signed as different levels of anterior chamber flare and pigment diffusion. And some severe patients developed membrane before IOLs and posterior synechia in late period. With use of mydriatics, corticosteroid partially and antibiotic agent after surgery, the inflammation in anterior chamber alleviated and visual acuity improved more or less, with no other serious complications. The course of patients with DR was significantly long. Eleven patients＇ VA were better steadily than 0.5 one year after surgery in follow - up survey, accounting for 73%. CONCLUSION： Acute inflammation in anterior chamber in diabetes after cataract surgery is related to their special heterogeneity. Good preoperative preparations is necessary for such patients, and with control and sta-bilization of blood sugar level, use of high biocompati-bility IOLs such as heparin-surface-modified poly （methyl methacrylate） intraocular lenses or little-hurt IOLs such as foldable lens. Active treatment may produce favourable surgery effect.