加味密蒙花方对糖尿病患者白内障超声乳化术后黄斑厚度的影响

Effect of modified Mimenghua decoction on the retinal thickness in macular area after cataract surgery in diabetic patients

目的观察和评价加味密蒙花方对糖尿病合并白内障的患者,白内障术后黄斑区视网膜厚度的影响。方法选择2016年10月—2018年12月糖尿病合并白内障患者60例(60只眼),随机分为对照组及中药组,各30例(30只眼),常规行白内障超声乳化手术。术后对照组常规给予复方妥布霉素地塞米松滴眼液点眼1个月,中药组在对照组治疗基础上加用加味密蒙花方颗粒剂连续口服2周。观察比较两组在术前、术后1周、1个月、2个月4个时间点最佳矫正视力(BCVA)、黄斑区视网膜中央厚度(CRT)及黄斑囊样水肿(CME)发生率。结果(1)BCVA:手术后1周、1个月和2个月后,两组视力均比治疗前升高,均有统计学意义(P<0.05),术后视力,同组不同时间点之间,及两组间比较,均无统计学意义(P>0.05)。(2)CRT比较:对照组术后CRT较术前增加,术后1个月达最高,与术前相比,t1个月=2.725,P=0.008,t2个月=2.455,P=0.017。术后1个月与术后1周比较,t=2.215,P=0.031,均有统计学意义(P<0.05)。中药组各时间点CRT相互比较,均无统计学意义(P>0.05)。术后1个月、2个月时对照组较中药组CRT增厚,差异有统计学意义(P<0.05)。(3)黄斑囊样水肿(CME)发生率:术后2个月时,对照组共发生4例黄斑囊样水肿,中药组未发生,2组比较无统计学意义。结论糖尿病患者白内障术后黄斑区视网膜中央厚度增加,加味密蒙花方可有效防治糖尿病患者白内障术后的黄斑厚度的增加。

OBJECTIVE To measure the retinal thickness in macular area by optical coherence tomography(OCT)and observe the effect of Mimenghua decoction on the retinal thickness in macular area after cataract surgery in diabetic patients.METHODS 60 cases of cataract surgery in our department with diabetes mellitus from October 2016 to December 2018 were randomly divided into the control group(CG)and the Traditional Chinese Medicine group(TCMG),30 cases each.The control group was routinely treated with tobramycin-dexamethasone(TobraDex)eye drops for one month after surgery,and the Traditional Chinese Medicine group was given mimenghuafang granule orally for 2 weeks on the basis of TobraDex treatment.Best corrected visual acuity(BCVA),central retinal thickness(CRT)and the incidence of cystoids macular edema(CME)were observed and compared between two groups at preoperative,postoperative,1 week,1 month and 2 months.RESULTS(1)BCVA:At one week,one month and months after operation,visual acuity of both gorups improved significantly,with statistical significance(all P>0.05).There was no significant difference in postoperative visual acuity between different time points in the same group and between the two groups(P>0.05).(2)CRT comparison:In the control group,the postoperative CRT was increased compared with that before operation,and reached the highest at 1 month after operation,compared with preoperative,t1 month=2.725,P=0.008,t2 month=2.455,P=0.017.Compared with 1 week after operation,t=2.215,P=0.031,there were statistical significance(P<0.05).Changes of CRT in TCM group:there was no significant difference in CRT at each time point in TCM group(P>0.05).At 1 month and 2 months after operation,the CRT in the control group was thicker than that in the Traditional Chinese Medicine group,and the difference was statistically significant(P<0.05).(3)The incidence of cystoid macular edema(CME):at 2 months after operation,there were 4 cases of cystoid macular edema in the control group,but not in the Traditional Chinese Medicine group.There was no statistical significance between the two groups(P=0.112).CONCLUSIONS After cataract surgery in diabetic patients,the macular fovea thickness increases.Mimenghua decoction can effectively reduce the increase of macular thickness after cataract surgery in diabetic patients.