合并糖尿病白内障患者术后黄斑厚度变化的临床研究

Clinical study of macular retinal thickness in patients with diabetes after cataract surgery

目的通过光学相干断层扫描仪测量黄斑区视网膜厚度,观察合并糖尿病的白内障患者术后黄斑区视网膜厚度的变化。方法选择2012年6-12月我科白内障手术患者59例96眼,其中无糖尿病的患者为A组(18例33眼),有糖尿病但无糖尿病视网膜病变的患者为B组(19例31眼),有糖尿病视网膜病变的患者为C组(22例32眼)。比较3组手术前后最佳矫正视力及术前,术后1 d、1周、1个月黄斑区视网膜厚度。结果术前3组最佳矫正视力无统计学差异,术后1个月A组患者31眼(94%)最佳矫正视力≥0.5;B组患者最佳矫正视力28眼(90%)≥0.5,2组比较差异无统计学意义(P>0.05);C组患者22眼(69%)最佳矫正视力≥0.5,与A、B两组相比,差异均有统计学意义(P<0.05)。中心凹区:A、B两组术后1 d、1周、1个月黄斑区视网膜厚度与术前比较,差异均无统计学意义(P>0.05);C组术后1 d、1周黄斑区视网膜厚度与术前比较,差异无统计学意义(P>0.05),C组术后1个月视网膜厚度较术前明显增加(P<0.05)。内环区和外环区:3组术后1 d、1周、1个月外环区视网膜厚度与术前比较,差异均无统计学意义(P>0.05)。结论糖尿病视网膜病变患者在术后,虽然经过一定的抗感染治疗,但视网膜厚度仍明显增加,并且黄斑中心凹区改变明显,提示糖尿病视网膜病变是引起白内障术后黄斑水肿的高危因素。

Objective To investigate the changes of macular retinal thickness in patients with diabetes after phacoemulsification and intraocular lens implantation by optical coherence tomography. Methods Fifty- nine patients （96 eyes） who underwent cataract surgery in our hospital from June to December in 2012 were re- cruited. The patients without diabetes were enrolled as group A （18 cases, 33 eyes）, the patients with diabetes but without diabetic retinopathy were enrolled as group B （19 cases, 31 eyes）, and the patients with diabetic retinopathy were enrolled as group C （22 cases, 32 eyes）. The corrected visual acuity was compared among the three groups before and after operation, and the retinal thickness in macular area was compared among the three groups before operation, and at 1 day, 1 week and 1 month after operation. Results The corrected visual acu- ity showed no significant difference among the three groups before operation. For patients with best corrected visual acuity≥0. 5 at 1 month after operation, there were 31 eyes （94%） in group A, 28 eyes （90%） in group B, and 22 eyes （69%） in group C. The difference between group A and group B was not statistically sig- nificant （P 〉 0. 05）, while group C showed significant difference as compared with group A and group B （P 〈 0.05 ）. Foveal region ： Compared with that before operation, there was no significant difference in retinal thick- ness in group A and group B at 1 day, 1 week and 1 month after operation （P 〉 0. 05 ）. Compared with that before operation, there was no significant difference in retinal thickness in group C at 1 day and 1 week after operation （P 〉 0. 05 ）, but there was significant difference in retinal thickness in group C at 1 month after oper- ation （ P 〈 0. 05 ）. Inner circle and outer circle ： Compared with that before operation, there was no significant difference in retinal thickness in the three groups at 1 day, 1 week and 1 month after operation （ P 〉 0. 05 ）. Conclusion Although the patients with diabetic retinopathy are given appropriate anti-inflammatory treatment after cataract surgery, the postoperative retinal thickness increases, and the thickness of macular foveal rezionchanges significantly, suggesting that diabetic retinopathy is the risk factor of mucular edema after catarat surgery.