糖尿病与非糖尿病患者白内障术后黄斑水肿分析

Evaluation of macular edema after cataract surgery in diabetic and non-diabetic patients

目的 通过比较糖尿病患者与非糖尿病患者白内障术后发生黄斑水肿（ME）的差异,探讨差异产生的原因.方法 前瞻性研究.选取2011年4月至2013年5月于北京大学眼科中心行白内障超声乳化＋人工晶状体植入术患者112例175只眼,其中糖尿病患者72只眼,非糖尿病患者103只眼.主要检测指标是两组术前、术后1月及术后3月的最佳矫正视力（BCVA）及黄斑中心亚区域平均厚度（CSMT）.结果 非糖尿病组术前、术后1月及术后3月BCVA均明显好于糖尿病组,差异有统计学意义（t =-2.237,P=0.027;t=-2.504,P=0.013;t=-2.233,P=0.027）.非糖尿病组术前、术后1月及术后3月CSMT均明显低于糖尿病组,差异有统计学意义（t=-2.200,P=0.029;t =-3.906,P=0.000;t=-3.399,P=0.001）.术后1月非糖尿病组发生黄斑水肿为1只眼（0.97％1/103）,糖尿病组黄斑水肿为9只眼（12.5％ 9/72）,差异有统计学意义（χ^2=10.455,P=0.001）;术后3月非糖尿病组发生黄斑水肿为1只眼（0.97％1/103）,糖尿病组黄斑水肿为6只眼（8.33％ 6/72）,差异有统计学意义（χ^2=5.982,P=0.014）.黄斑水肿与糖尿病视网膜病变严重程度相关（P =0.015）.结论糖尿病患者行白内障超声乳化术后黄斑水肿的发生率高,糖尿病视网膜病变的严重程度是主要影响因素.

Objective To analyze the reasons for different incidence of macular edema （ME） after cataract surgery in diabetic and non-diabetic patients using optical coherence tomography （OCT）.Methods In a prospective clinical study,175 eyes of 112 cataract patients were enrolled in the study.The study included 72 eyes from diabetic patients and 103 eyes from non-diabetic subjects.All patients underwent uncomplicated cataract surgery with phacoemulsification.Main outcome measures included best-corrected visual acuity （BCVA） and central subfield mean thickness （CSMT）.CSMT was examined using OCT within 4 weeks preoperatively and 1 month and 3 months postoperatively.Macular edema was defined as an increase of CSMT （Δ CSMT） on OCT 〉30% from baseline.Results There were significantly differences in BCVA and CSMT between diabetic and non-diabetic subjects preoperatively,1 month and 3 months after cataract surgery.One month after surgery,incidence of ME of diabetic subjects （12.50%）（9/72） was significantly more （χ^2=10.455,P =0.001） than of non-diabetic subjects （0.97%）（1/103）.Three months after surgery,incidence of ME of diabetic subjects （8.33%）（6/72） was significantly more （χ^2=5.982,P =0.014） than of non-diabetic subjects （0.97%）（1/103）.The degree of diabetic retinopathy might be correlated to macular edema after surgery.Conclusions There is a higher incidence of ME in diabetic patients.The degree of diabetic retinopathy might be correlated to macular edema after surgery.