白内障合并青光眼患者手术前后眼压、血脂比、胰岛素敏感性、角膜内皮细胞、最佳矫正视力变化及其相关性分析

Changes in Preoperative and Postoperative Intraocular Pressure, Blood Lipid Ratio, Insulin Sensitivity, Corneal Endothelial Cell and Optimal Corrected Visual Acuity and Their Correlation in Patients with Cataract Combined with Glaucoma

目的探讨白内障合并青光眼患者手术前后眼压、血脂比、胰岛素敏感性、角膜内皮细胞、最佳矫正视力变化及其相关性。方法选取行超声乳化晶状体植入联合小梁切除术治疗的白内障合并青光眼51例(51眼),观察患者术前及术后3 d、1个月、3个月眼压、胰岛素敏感指数、血脂比[甘油三酯(TG)/高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)/HDL-C、总胆固醇(TC)/HDL-C]、角膜内皮细胞丢失率和密度以及最佳矫正视力情况,并分析手术前后各观察指标间相关性。结果手术前后,白内障合并青光眼患者眼压、胰岛素敏感指数、血脂比、角膜内皮细胞密度及最佳矫正视力总体比较差异均有统计学意义(P<0.01)。与术前比较,术后3 d、1个月、3个月白内障合并青光眼患者眼压降低;术后1和3个月白内障合并青光眼患者胰岛素敏感指数和最佳矫正视力升高,TG/HDL-C、LDL-C/HDL-C、TC/HDL-C和角膜内皮细胞密度降低,差异有统计学意义(P<0.01)。与术后3 d比较,术后1和3个月白内障合并青光眼患者眼压、TG/HDL-C、LDL-C/HDL-C、TC/HDL-C和角膜内皮细胞密度降低,胰岛素敏感指数和最佳矫正视力升高,差异有统计学意义(P<0.05或P<0.01)。Pearson线性相关分析结果显示,手术前后白内障合并青光眼患者TG/HDL-C、LDL-C/HDL-C、TC/HDL-C与眼压、角膜内皮细胞密度呈正相关,与最佳矫正视力呈负相关;胰岛素敏感指数与眼压、角膜内皮细胞密度呈负相关,与最佳矫正视力呈正相关。结论白内障合并青光眼患者采用超声乳化晶状体植入联合小梁切除术治疗可降低眼压,改善角膜内皮细胞完整性,促进视力恢复,且患者手术前后血脂比、胰岛素敏感指数与眼压、角膜内皮细胞密度、最佳矫正视力有紧密关系,可用于评估患者疗效。

Objective To investigate the changes in preoperative and postoperative intraocular pressure(IOP), blood lipid ratio, insulin sensitivity, corneal endothelial cell and optimal corrected visual acuity, and their correlation in patients with cataract combined with glaucoma. Methods Fifty-one patients(51 eyes) with cataract combined with glaucoma that were treated with implantation of lens phacoemulsification combined with trabeculectomy were enrolled in this study. The change in IOP, insulin sensitivity and blood lipid ratios [triglyceride(TG)/high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C)/HDL-C, and total cholesterol(TC)/HDL-C], loss rate and density of corneal endothelial cells and the optimal corrected visual acuity of patients were compared before surgery, and at 3 days, 1 month and 3 months after surgery. The correlation between indexes before and after surgery was analyzed. Results Before and after surgery, there were significant differences in the IOP, insulin sensitivity index, blood lipid ratio, density of corneal endothelial cell, and the optimal corrected visual acuity of patients with cataract and glaucoma(P<0.01). Compared with that before surgery, the IOP of patients with cataract combined with glaucoma was decreased at 3 days, 1 month and 3 months after surgery. The insulin sensitivity index and the optimal corrected visual acuity of patients were significantly increased at 1 month and 3 months after surgery, while the TG/HDL-C, LDL-C/HDL-C, TC/HDL-C, and density of corneal endothelial cells at 1 month and 3 months after surgery were significantly declined(P<0.01). Compared with those at 3 days after surgery, the IOP, TG/HDL-C, LDL-C/HDL-C, TC/HDL-C, and density of corneal endothelial cell were significantly decreased in patients with cataract and glaucoma at 1 month and 3 months after surgery, while the insulin sensitivity index and optimal corrected visual acuity were significantly increased(P<0.05 or P<0.01). Pearson linear correlation analysis showed that TG/HDL-C, LDL-C/HDL-C, TC/HDL-C were positively correlated with IOP and density of endothelial cells, and were negatively correlated with the optimal corrected visual acuity. Insulin sensitivity index of patients was negatively correlated with IOP and density of endothelial cells, and positively correlated with optimal corrected visual acuity in patients with cataract and glaucoma. Conclusion Trabeculectomy combined with lens implantation of phacoemulsification can effectively reduce the IOP of patients with cataract and glaucoma, improve the integrity of corneal endothelial cells, and promote visual recovery of patients. Preoperative and postoperative blood lipid ratio and insulin sensitivity are closely related to IOP, corneal endothelial cell density, and the optimal corrected visual acuity, which can be used to evaluate the efficacy of patients.