白内障超声乳化吸除手术对老年白内障合并糖尿病患者眼底RNFL厚度的影响

Effect of phacoemulsification on retinal nerve fiber layer thickness of patients with senile cataract combined with diabetes mellitus

目的观察白内障超声乳化吸除手术(Phaco)对老年白内障合并糖尿病患者眼底盘周视网膜神经纤维层(RNFL)厚度的影响。方法选取老年白内障合并糖尿病患者30例(45只眼),均成功施行Phaco联合人工晶状体植入手术;利用光学相干断层扫描仪(OCT)定量测量术前及术后3 d、2周、1个月、3个月、6个月眼底盘周RNFL厚度,观察术后矫正视力、视乳头水肿发生情况。结果术前及术后3 d、2周、1个月、3个月、6个月盘周RNFL厚度分别为(93.24±8.46)、(91.71±8.19)、(95.49±8.53)、(102.00±8.10)、(105.91±7.15)、(102.02±7.10)μm;术后2周及1、3、6个月RNFL厚度较术前增加(P均<0.05);术后2周及1、3、6个月RNFL厚度较术后3 d增加(P均<0.05);术后1、3、6个月RNFL厚度较术后2周增加(P均<0.01);其余时间点各组两两比较差异无统计学意义。术前及术后3 d、2周、1个月、3个月、6个月矫正视力分别为0.16、0.44、0.54、0.51、0.56、0.67。术后3 d、2周、1个月、3个月、6个月视乳头水肿发生率分别为0、42%、55%、62%、31%。结论老年白内障合并糖尿病患者Phaco术后眼底盘周RNFL厚度增加,手术可能对眼底视神经造成了损伤。

Objective To observe the effect of phacoemulsification （Phaco） on retinal nerve fiber layer （RNFL） thickness of patients with senile cataract combined with diabetes mellitus. Methods In elderly patients, thirty diabetic pa- tients（45 eyes）of the senile cataract diagnosed were chosen randomly from May 2012 to October 2012 at the Xuanwu Hos- pital of Capital Medical University. The uncomplicated phacoemulsification combined with artificial lens implantation was performed. The RNFL thickness was measured by using optical coherence tomography （OCT） at different time points before and after Phaco surgery （ including preoperative and postoperative 3 d, 2 w, 1 month, 3 months and 6 months）. The RNFL thickness changes at different time points were compared as well as the occurrence of postoperative visual acuity and papill- edema. Results The average thickness of RNFL were （93.24 ＋ 8.46）, （91.71 ~ 8.19）, （95.49 ＋ 8.53 ）, （ 102 ＋ 8.10）, （ 105.91 ~7.15） and （ 102.02 ＋7.10） Ix m before and after surgery 3 d, 2 w, 1 month, 3 months and 6 months; RNFL thickness increased after surgery 2 w, 1 month, 3 months and 6 months as compared with the preoperative one （all P 〈 0.05） ; RNFL thickness increased after surgery 2 w, 1 month, 3 months and 6 months as compared with that of 3 d （ all P 〈 0.05） ; RNFL thickness increased after surgery 1 month, 3 months and 6 months as compared with that of 2 w （ all P 〈0.01 ） ; and the rest of the time points in each group had no statistical significance. The corrected vision beefore and af- ter the operation 3 d, 2 w, 1 month, 3 months and 6 months was 0.16, 0.44, 0.54, O. 51, 0.56 and 0.67. The inci- dences of papilledema after the operation 3 d, 2 w, 1 month, 3 months and 6 months were 0, 42%, 55%, 62% and 31%. Conclusion The RNFL thickness in patients with senile cataract combined with diabetes mellitus changes after phacoemulsification, which reflects that the surgery causes the damage of the optic nerve.