2型糖尿病合并白内障患者超声乳化围手术期血糖水平对角膜内皮及干眼症状的影响

Effect of Perioperative Phacoemulsification Blood Glucose Level on Corneal Endothelium and Dry Eye Symptoms in Type 2 Diabetes Mellitus Patients with Cataract

目的:探讨2型糖尿病(T2DM)合并白内障患者超声乳化围手术期血糖水平对角膜内皮及干眼症状的影响.方法:选取2018年5月-2019年8月本院收治的150例T2DM合并白内障患者.采用随机数字表法将其分为对照组和观察组,每组75例.均行超声乳化吸除联合人工晶状体植入术,在围手术期间,对照组进行常规服药,观察组在对照组基础上进行血糖控制.比较两组术前和术后第1、3、7天三餐前和三餐后2 h的血糖水平及餐后血糖波动幅度情况.术后跟踪随访12周,记录患者术前和术后第12周的裸眼视力和术后并发症的发生情况.结果:术后第1天,观察组早餐前和三餐后2 h的血糖值均显著低于对照组,差异均有统计学意义(P<0.05).术后第3、7天,观察组三餐前和三餐后2 h的血糖值均显著低于对照组,差异均有统计学意义(P<0.05).术后第3、7天,对照组餐后血糖波动幅度均高于观察组,差异均有统计学意义(P<0.05).对照组和观察组术后第1天的餐后血糖波动幅度分别高于同组内术前(P<0.05).随访至术后第12周,两组裸眼视力均高于术前,且观察组高于对照组,差异均有统计学意义(P<0.05).在术后12周内,两组角膜水肿、角膜内褶皱和干眼症发生率比较,差异均无统计学意义(P>0.05).结论:有效控制T2DM合并白内障患者超声乳化围手术期的血糖水平,可提高患者的术后裸眼视力,但不会显著降低术后角膜水肿、角膜内褶皱和干眼症的发生率.

Objective:To investigate the effect of perioperative phacoemulsification blood glucose level on corneal endothelium and dry eye symptoms in type 2 diabetes mellitus(T2DM)with cataract.Method:A total of 150 patients with T2DM complicated with cataract admitted to our hospital from May 2018 to August 2019 were selected.Using the random number table method,they were divided into the control group and the observation group,75 cases in each group.All underwent phacoemulsification and intraocular lens implantation.During the perioperative period,the control group received routine medication,and the observation group received blood glucose control on the basis of the control group.The blood glucose levels of the two groups before and 2 hours after three meals on the preoperative and 1st,3rd and 7th day and the fluctuation of postprandial blood glucose were compared.The patients were followed up for 12 weeks after the operation,the incidence of visual acuity and postoperative complications were recorded before and at 12 weeks after surgery.Result:On the first day after the operation,the blood glucose values of the observation group before breakfast and 2 h after three meals were significantly lower than those of the control group,with statistically significant differences(P<0.05).On the 3rd and 7th day after the operation,the blood glucose value before and 2 h after three meals in the observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).On the 3rd and 7th day after the operation,the fluctuation range of postprandial blood glucose in the control group were higher than those in the observation group,and the differences were statistically significant(P<0.05).The fluctuation range of postprandial blood glucose in the control group and the observation group on the first day after the operation was higher than that before the operation in the same group(P<0.05).After 12 weeks follow-up,the visual acuity of both groups were higher than those before operation,and the observation group was higher than the control group,the differences were statistically significant(P<0.05).Within 12 weeks after surgery,the incidence of corneal edema,corneal fold and dry eye were compared between the two groups,the differences were not statistically significant(P>0.05).Conclusion:The effective control of blood glucose level during the perioperative period of phacoemulsification in patients with T2DM combined with cataract can improve the postoperative naked eye vision of the patients,but does not significantly reduce the incidence of postoperative corneal edema,corneal fold and dry eye syndrome.