白内障超声乳化手术中联合玻璃体腔注射曲安奈德治疗糖尿病黄斑水肿合并重度白内障的疗效观察

Phacoemulsification with intravitreal triamcinolone injection to treat diabetic macular edema with severe cataract

目的 观察白内障超声乳化手术中联合玻璃体腔注射曲安奈德（IVTA）治疗糖尿病黄斑水肿（DME）合并重度白内障的临床效果。方法 临床检查确诊为DME伴重度白内障患者21例25只眼纳入研究。其中，15只眼行标准白内障超声乳化联合人工晶状体植入手术及IVTA治疗（IVTA组），10只眼仅行标准白内障超声乳化联合人工晶状体植入手术（非IVTA组）。所有患眼均行最佳矫正视力（BCVA）、裂隙灯显微镜、间接检眼镜及光相干断层扫描（OCT）检查。采用重复测量方差分析，对比IVTA组、非IVTA组手术后1、3、6个月的平均最小分辨角对数（logMAR）BCVA及黄斑中心凹厚度（CMT）变化情况。对手术前后logMAR BCVA与CMT行Pearson相关性分析。采用多元线性回归分析法分析影响手术后6个月视力恢复的相关因素。结果 重复测量方差分析结果显示，IVTA组与非IVTA组手术后平均logMAR BCVA均较手术前提高。IVTA组与非IVTA组手术前后平均logMAR BCVA比较，差异有统计学意义（F=4.855、6.235，P=0.037、0.020）。手术后1、3、6个月，IVTA组与非IVTA组平均logMAR BCVA改善程度比较，差异均无统计学意义（F=0.007、0.006、0.023，P=0.973、0.938、0.882）。手术后1、3个月，IVTA组CMT降低程度优于非IVTA组；两组CMT降低程度比较，差异有统计学意义（F=10.449、7.374，P=0.012、0.026）。手术后6个月，IVTA组与非IVTA组CMT降低程度比较，差异无统计学意义（F=2.173，P=0.114）。相关性分析结果显示，手术前及手术后6个月平均logMAR BCVA与平均CMT之间均无相关性（r=0.279、0.172，P=0.295、0.574）。多元线性回归分析结果显示，影响手术后6个月视力恢复的因素有外界膜状态和糖尿病病程（β=0.577、-0.411，P=0.025、0.030）。结论 白内障超声乳化手术中联合IVTA治疗DME合并重度白内障可在短期内减轻黄斑水肿，改善患者视力。

Objective To observe the efficacy of phacoemulsification with intravitreal triamcinolone injection （IVTA） in diabetic patients with severe cataract and diabetic macular edema （DME）. Methods Twenty-one patients （25 eyes） with severe cataract and DME were enrolled in this retrospective study. Fifteen eyes underwent standard phacoemulsification and intraocular lens implantation with 4 mg IVTA at completion of surgery. Ten eyes underwent standard phacoemulsification and intraocular lens implantation. All the patients were followed up for best corrected visual acuity （BCVA）, optical coherence tomography（OCT） and ophthalmological examination.Changes in logarithm of he minimal angel of resolution （logMAR） BCVA and central macular thickness （CMT） were evaluated preoperatively and 1 month, 3 months and 6 months postoperatively by repeated measures ANOVA. Correlations between logMAR BCVA and CMT preoperatively and postoperatively were analyzed by Pearson correlation analysis. Postoperative 6 months logMAR BCVA and affecting factors were evaluated by multivariate linear regression analysis. Results Both groups showed significant improvements of logMAR BCVA after surgery （F=4.855, 6.235;P=0.037, 0.020）. There were no statistical differences of logMAR BCVA improvement at different time points postoperatively （F=0.007, 0.006, 0.023;P=0.973, 0.938, 0.882）. The CMT reductions in IVTA group at month 1 and month 3 postoperatively were statistically significant than the reductions in group without IVTA（F=10.449, 7.374;P=0.012, 0.026）, and there was no statistical difference of CMT reduction at month 6 postoperatively between two groups（F=2.173;P=0.114）. Correlation Coefficients between CMT and BCVA were not statistically significant preoperatively and 6 months postoperatively（r=0.279, 0.172;P=0.295, 0.574）. Analysis of multiple linear regression showed that external limiting membrane status and duration of diabetes are factors affecting the visual recovery （β=0.577,-0.411;P=0.025, 0.030）. Conclusions Phacoemulsification with concurrent IVTA for treatment of patients with severe cataract and DME is effective in reducing edema. But IVTA does not further improve logMAR BCVA postoperatively.