糖尿病视网膜病变患者超声乳化术后视网膜神经纤维层的改变

The transforms of retinal nerve fiber layer in diabetic retinopathy after phacoemulsification

目的探讨超声乳化手术对糖尿病患者视神经的损伤程度。方法应用光学相干断层扫描仪（OCT）对超声乳化吸出联合人工晶状体植入术76例（83眼）视网膜神经纤维层厚度进行测量。单纯性年龄相关性白内障24例（27眼），眼底无糖尿病视网膜病变改变（NDR）的糖尿病者30例（31眼），非增生性糖尿病视网膜病变（NPDR）者22例（25眼）。以OCT观察比较术前、术后1d、1周、1个月、3个月及6个月视盘区视网膜神经纤维层（RNFL）厚度的改变及视力的改善。结果术前3组RNFL厚度分别为（94．23±10．67）μm、（94．02±11．09）μm、（90．34±9．97）μm，正常对照组及NDR组与NPDR组相比均有统计学意义（P=0．046）；术后1d厚度几乎无变化，分别为（94．19±10．11）μm、（94．16±9．80）μm、（90．09±10．04）μm；术后1周厚度开始增加，至3月达到最大分别为（101．03±8．68）μm、（100．89±9．98）μm、（96．53±9．97）μm，与术前相比较3组RNFL厚度的差异均有统计学意义（P〈0．05）；至术后6个月，视盘水肿逐渐减轻，RNFL厚度出现减小的趋势。结论超声乳化吸出术可能对视网膜神经纤维层有一定程度的损伤，而糖尿病是促进其发展的危险因素。

Objective To evaluate the injury on retinal nerve fiber from phacoemulsification sur- gery for diabetic retinopathy. Methods A retrospective analysis of phacoemulsification in 83 eyes of 76 pa- tients was done, in which group A （24 cases, 27 eyes） were senile cataract patients, group B （30 cases, 31 eyes） were metabolic cataract patients with out-diabetic retinopathy （NDR）, group C （22 cases, 25 eyes） were metabolic cataract patients without proliferative diabetic retinopathy （NPDR）. The changes of retinal nerve fiber layer （RNFL） thickness in the three groups were compared preoperatively and 1 d, 1 week, 1, 3, 6 months postoperatively. Results The retinal nerve fiber layer thicknesses were （94.23 ± 10.67） μm, （94.02 ± 11.09 ） μm, （90.34 ±9.97 ）μm respectively in three groups preoperatively. Compared with group C, there were statistical differences in group A and gourp B （P = 0.046） ; There were no changes of RNFL thickness in three groups postoperatively 1 day. The thicknesses values were （94.19 ± 10.11 ）μm, （94.16 ±9.80） μm,（90.09 ± 10.04） μm respectively. From the postoperative 1 week, the RNFL began thicken- ing, the values upped to maximum which were （ 101.03± 8.68 ） μm, （ 100.89 ±9.98） μm, （96.53 ± 9.97） μm in group A, group B and group C respectively. Compare with the preoperative values, there were statistical differences in the three groups （P 〈 0.05）. Until postoperative 6 month, the optic disc edema reduced grad- ually, the RNFL thickness became thinning. Conclusion Phacoemulsification may damage the retinal nerve fiber layer and diabetes meUitus is a dangerous factor.