糖尿病病人白内障超声乳化术后黄斑区视网膜厚度及视力的变化分析

Analysis of the retinal thickness in macular area and visual acuity after cataract phacoemulsification in diabetic patients

目的:观察糖尿病(DM)病人白内障超声乳化摘除联合后房型人工晶状体植入术后中心黄斑区的视网膜厚度及视力的变化。方法:选取行白内障超声乳化联合人工晶体植入术的病人90例,其中DM合并白内障病人45例(45眼,观察组),年龄相关性白内障病人45例(45眼,对照组)。分别于术前、术后1 d、1周、1月及3月使用光学相干层析成像扫描(OCT)检查中心黄斑区的视网膜厚度(CMT)和最佳矫正视力(BCVA)。分析2组间及组内各时间点CMT及视力的变化,并探讨CMT与BCVA之间的关系。结果:观察组术后1个月及3个月的CMT较对照组均增厚(P<0.01和P<0.05);其中,观察组术后1个月的CMT增厚达最高值(P<0.01)。2组手术后各时间点的logMAR BCVA值与术前对比均呈现下降的趋势(P<0.01);观察组术后1个月和3个月的logMAR BCVA水平均高于对照组(P<0.01)。观察组的术后1个月、3个月logMAR BCVA与CMT呈正相关(r=0.47、0.36,P<0.05),对照组的术后各时间点logMAR BCVA与CMT无相关性(P>0.05)。结论:DM病人接受白内障超声乳化摘除联合人工晶状体植入手术后,CMT显著增加。2组病人术后BCVA虽均有改善,但部分DM病人在随访期间出现了显著BCVA的再次下降,可能与术后的CMT增加有关。

Objective:To measure the changes the retinal thickness in macular area and visual acuity after cataract phacoemulsification combined with posterior chamber intraocular lens implantation in diabetic patients.Methods:Ninety patients treated with phacoemulsification combined with posterior chamber intraocular lens implantation,which included 45 cases with diabetes mellitus complicated with cataract(45 eyes,observation group)and 45 cases with age-related cataract(45 eyes,control group),were investigated.The central macular thickness(CMT)and best corrected visual acuity(BCVA)in two groups were detected using the optical coherence tomography before operation,and after 1 day,1 week,1 month and 3 months of operation.The changes of the CMT and BCVA at each time-point were analyzed between two groups,and the relationship between CMT and BCVA was investigated.Results:The CMT in observation group after 1 and 3 months of operation thickened compared with the control group(P<0.01 and P<0.05),and the most thickness of CMT in observation group was after 1 month of cataract surgery(P<0.01).The post-operative logMAR BCVA value in two groups decreased compared with before operation(P<0.01),and the levels of logMAR BCVA in observation group were higher than that in control group after 1 and 3 months of phacoemulsification(P<0.01).The logMAR BCVA in observation group after 1 and 3 months of phacoemulsification were positively correlated with CMT(P<0.05),and there were not correlation between logMAR BCVA and CMT in control group at all postoperative time points(P>0.05).Conclusions:The CMT significantly increases in diabetic patients treated with phacoemulsification combined with posterior chamber intraocular lens implantation.The BCVA in two groups are improved,and the BCVA declines obviously in partial diabetic patients during the following-up,which may be related to the increasing of CMT after surgery.