白内障术后黄斑中心凹与不同象限视网膜神经纤维层厚度的观察

Observation of macular fovea and retinal nerve fiber layer thickness at different quadrants after cataract surgery

目的:测量单纯白内障与合并糖尿病白内障患者超声乳化术后黄斑区中心凹与不同象限视网膜神经纤维层厚度变化的特点。方法:回顾性非随机临床对比研究。选择行超声乳化白内障手术的患者90例110眼,单纯白内障组32例40眼为A组,合并糖尿病无视网膜病变的28例35眼为B组,有非增生性糖尿病视网膜病变的30例35眼为C组。通过光学相干断层扫描仪测量比较术前及术后1,14,28d黄斑区视网膜神经纤维层厚度。采用卡方检验、重复测量方差分析、SNK-q检验对数据进行检验。结果:中心凹区:三组的中心凹均有增长(F=18.92,P<0.05),C组与A组、C组与B组间差异有统计学意义(P均<0.05)。各象限:三组上方、鼻侧、下方、颞侧象限随着时间均有增长(F=13.33,14.37,19.02,16.93,P均<0.05),三组间比较鼻侧象限的增长无统计学意义,而上方、下方、颞侧比较C组与A组、C组与B组间差异有统计学意义(P均<0.05)。结论:合并糖尿病视网膜病变的白内障患者行超声乳化术后黄斑中心凹区及各象限视网膜神经纤维层厚度在术后4wk内明显增加,黄斑水肿发生率高,开始时间早,持续时间长,患者术后视力恢复严重受损。

AIM：To measure the changes of macular retinal nerve fiber layer thickness at different quadrants and macular fovea in diabetic and nondiabetic patients after phacoemulsification. METHODS： This was a retrospective nonrandom clinical comparison study, 90 patients （110 eyes） who underwent phacoemulsification were recruited, nondiabetic patients （32 cases, 40 eyes） were in group A, in diabetic without diabetic retinopathy （28 cases, 35 eyes） were as group B, with non-proliferation diabetic retinopathy （30 cases, 35 eyes） were group C. Macular retinal nerve fiber layer thicknesses were collected by optical coherence tomography on the preoperative day and on postoperative 1at, 14th, 28th d. Statistical analysis of count data measurement data were done separately by the Chisquare test, variance analysis and SNK-q test. RESULTS： The foveal： There was significant increase could be detected among A, B, C （F= 18.92, P〈0.05）, while group C showed significant difference as compared with groups A and B （P〈0.05）. The quadrant： There was significant increase could be detected among A, B, C （F= 13.33, 14. 37, 19. 02, 16. 93, P〈0. 05）. This was not statistically significant of nasal among A, B, C groups （P〉 0.05）. However group C showed significant difference in the superior, the inferior, the temporal as compared with groups A and B （P〈0.05）. CONCLUSION： Macular retinal nerve fiber layer thicknessand macular fovea of patients with diabetic retinopathy were significant increased after phacoemulsification in 4wk, the incidence of macular edema is higher, the time earlier, the duration longer, the poorer visual recovery.