糖尿病患者白内障术后角膜形态变化

Corneal morphological changes of diabetic patients after cataract surgery

目的探讨白内障超声乳化术对糖尿病患者角膜内皮细胞的影响及角膜厚度的变化。方法选取白内障超声乳化手术的患者107例(134只眼)分为3组:1单纯老年性白内障患者62例(65只眼)为对照组;2糖尿病患者21例(31只眼);3合并高血压的糖尿病患者24例(38只眼)。应用角膜内皮显微镜观察手术前及术后2天、1周、1个月的中央角膜内皮密度(CCD)、变异系数(CV)、六角形细胞百分比(6A%)及中央角膜厚度(CCT)的变化。结果术前2个糖尿病组与对照组比较:CCD、CV、6A%差异无显著性(P>0.05),CCT差异有显著性(P<0.05);术后2 d、1周、1个月CCD、6A%3组均较术前下降,CV增加,差异均有显著性(均为P<0.05);CCT在术后2 d、1周较术前增厚,合并高血压的糖尿病组较糖尿病组进一步增厚(均为P<0.05);术后各时间段2个糖尿病组CCD与相应对照组无明显统计学差异(P>0.05),CV、CCT均高于相应对照组,6A%下降,差异均有显著性(均为P<0.05)。结论超声乳化手术对角膜内皮及角膜厚度有影响,糖尿病患者内皮损害加重,合并高血压的糖尿病患者手术后角膜厚度增加更明显。

Objective To investigate the effect of phacoemulsification on corneal endothelium and corneal thickness of diabetic patients. Methods 107 patients（134 eyes） who underwent phacoemulsification were included. They were classified into 3 groups. 62 senile cataract patients（65 eyes） without diabetes mellitus and hypertension were taken as control group. There were 21 patients（31 eyes） in diabetes group. 24 patients（38 eyes） were in the diabetes combined with hypertension group. Assessments of central corneal endothelial density（ CCD）,coefficient of variation of cell area（ CV）,percentage of hexagonal cells（6A%） and central corneal thickness（CCT） were done by specular microscopy on preoperation and postoperative 2 days,1 week and 1 month. Results There was no significant difference in preoperative CCD,CV,6A% when two diabetic groups compared with control group（ P〉 0. 05）,while the difference of CCT was significant（ P 0. 05）. CCD and 6A% dropped significantly and CV increased significantly in three groups on postoperative 2 days,1week（average P〈 0. 05）. Change of CCT was significant higher on postoperative 2 days and 1 week in three groups. CCT in diabetes combined with hypertension group was significant higher than that in diabetes group on post- operative 2 days,1 week（both P〈 0. 05）. There were no significant differences in postoperative CCD when two diabetes compared with control group（ P 〉0. 05）,while CV and CCT were significant higher and 6A% was significant lower（both P〈 0. 05）. Conclusions Phacoemulsification have impact on corneal endothelium and corneal thickness. The damage to endothelium in patients with diabetes mellitus was more severe. The change of corneal thickness after cataract surgery was much thicker in patients with diabetes combined with hypertension.