超声乳化术中较低累计能量复合参数有助于2型糖尿病白内障患者的治疗

Phacoemulsification cataract surgery with different cumulative energy composite parameters in patients with type 2 diabetes mellitus: therapeutic effect and complications

目的探讨超声乳化术中不同累计能量复合参数对2型糖尿病白内障患者的临床意义。方法选取我院2017年1月～2018年9月收治的2型糖尿病白内障患者252例(252眼),根据不同的累计能量复合参数,分为A、B两组,A组150例(150眼),累计能量复合参数为8;B组102例(102眼),累计能量复合参数为10,同时将无2型糖尿病白内障患者90例(90眼)作为对照组,累计超声能量参数为10。3组患者均接受白内障超声乳化术治疗,分析黄斑厚度及最佳矫正视力、视力、术后渗漏发生情况,包括术前、术后1周、术后1月、术后3月等阶段。结果 3组在进行超声乳化术前后的各指标差异有统计学意义(P<0.05),术后视力明显好于术前。术后3月A组视力<0.1、≥1.0的比例、黄斑厚度、最佳矫正视力、渗透率与B组差异有统计学意义(P<0.05),而与对照组差异无统计学意义(P>0.05)。术后1月、3月,A组与对照组的视力无差异,A组视力<0.1的比例小于B组(P<0.05),视力≥1.0的比例大于B组(P<0.05)。术后1月,A组总渗漏率31.1%高于对照组21.1%,与B组无显著差异,但A组的弥漫性渗漏11.7%高于对照组的2.2%(P<0.05);术后3月,A组的总渗漏率10%小于B组的32.4%(P<0.05),主要是弥漫性渗漏与局部渗漏的差异。结论超声乳化术可有效改善白内障患者的视力,并对非糖尿病白内障患者效果明显,同时较低的累计能量复合参数有助于2型糖尿病白内障患者的治疗。黄斑厚度、局部性渗透和弥漫性渗透可作为超声乳化术后视力恢复、稳定的参考。

Objective To evaluate the effect of different cumulative energy composite parameters on the outcomes of phacoemulsification cataract surgery in patients with type 2 diabetes mellitus. Methods A total of 252 patients with cataract(involving 252 eyes) and type 2 diabetes mellitus received phacoemulsification cataract surgery in our hospital between January, 2017 and June, 2019. The patients were divided into group A(150 cases) and group B(102 cases) for cataract phacoemulsification with cumulative energy composite parameters of 8 and 10, respectively, and 90 nondiabetic patients received cataract phacoemulsification with a cumulative energy composite parameters of 10 served as the control. The macular thickness, best corrected visual acuity, visual acuity, and postoperative leakage in the 3 groups were evaluated at 1 week, 1 month, and 3 months after the surgery. Results The visual acuity was significantly improved after phacoemulsification better in all the 3 groups. At 3 months after the surgery, the proportions of patients with visual acuity ratio <0.1 or >1.0, macular thickness, best corrected visual acuity and permeability differed significantly between groups A and B(P<0.05), but not between group A and the control group(P>0.05). At 1 month and 3 months after the surgery, the proportion of patients with visual acuity ratio <0.1 was significantly lower and the rate of visual acuity ratio >1.0 was higher in group A than in group B.At 1 month after the operation, the total leakage rate in group A(31.1%) was higher than that in the control group(21.1%) but comparable with that in group B;at 3 months, the total leakage rates were significantly lower in group A than in group B(10.0% vs 32.4%, P<0.05), and the leakage resulted mainly from local and diffuse permeation. Conclusion Phacoemulsification can effectively improve the visual acuity of cataract patients especially in non-diabetic patients. A lower cumulative energy composite parameter achieves better outcomes in type 2 diabetic patients with cataract. The macular thickness, local infiltration and diffuse leakage can be used as indicators for assessing visual recovery and stabilization after phacoemulsification.