糖尿病视网膜病变不同分期角膜及角膜上皮厚度变化

Analysis of the Cornea and Corneal Epithelial Thickness in Different Stages of Diabetic Patients

目的:对比分析糖尿病视网膜病变(DR)不同分期患眼和正常眼的角膜及角膜上皮厚度的变化情况。方法:系列病例研究。选择2018年1月1日至2020年1月31日于山西省眼科医院就诊并确诊为DR的患者100例(103眼),其中非增殖期组(NPDR)50例(53眼),增殖期组(PDR)50例(50眼)。另随机选取正常志愿者46例(48眼),利用频域前节光学相干断层扫描技术(AS-OCT)对非增殖期组、增殖期组及正常组均进行中心2、5、7、9 mm共4个同心圆区域扫描范围的角膜及角膜上皮厚度检查分析。采用单因素方差分析比较3组DR患者的角膜及角膜上皮各区域平均厚度。结果:3组间中央前、后角膜曲率及中央角膜厚度差异均无统计学意义(F=1.84,P=0.16;F=1.88,P=0.16;F=1.96,P=0.15),正常组中央角膜上皮厚度均高于其余2组(P<0.05)。正常组与NPDR组角膜上皮厚度多区域差异均有统计学意义(P<0.05);正常组与PDR组角膜上皮厚度多区域差异均有统计学意义(P<0.05);NPDR组与PDR组角膜上皮厚度只有S5 mm、SN5 mm、ST5 mm、T7 mm共4个区域差异有统计学意义(P<0.05),其余区域差异无统计学意义。结论:DR发展的不同阶段会对角膜上皮组织厚度产生潜在影响,这种变化可能可以作为DR筛查的指标之一。

Objective:To analyze the cornea and corneal epithelial thickness in different stages of diabetic patients.Methods:This was a serial case study.A total of 146 patients(151 eyes)were enrolled in the study groups.There were 48 eyes healthy eyes in the normal group,53 eyes with non-proliferative diabetic retinopathy were in the NPDR group,and 50 eyes with proliferative diabetic retinopathy were in the PDR group.All patients were recruited from Shanxi Eye Hospital from January 1,2018 to January 31,2020.Using anterior segment optical coherence tomography(AS-OCT)to observe the thickness changes in a 9 mm area of the cornea and corneal epithelium in the 3 groups of patients:the NPDR,PDR,and normal groups.An independent one-way analysis of variance were used to compare the data for the three groups.Results:There were no differences in the anterior keratometer and posterior keratometer of central cornea and central corneal thickness between the three groups(F=1.84,P=0.16;F=1.88,P=0.16;F=1.96,P=0.15).The central corneal epithelial thickness in the healthy eyes group was higher than for the other two groups(P<0.05).No difference was found between the NPDR group and the PDR group for corneal epithelial thickness,but the corneal epithelial thickness in the healthy eyes group was different from the other two groups.There were significant differences in corneal epithelial thickness between the normal group and NPDR group(P<0.05)and between the normal group and PDR group(P<0.05).There were significant differences in corneal epithelial thickness between the NPDR group and PDR group in the S5 mm,SN5 mm,ST5 mm,and T7 mm areas(P<0.05),but no differences in the other areas.Conclusions:The thickness of the corneal epithelium in patients can be one of the screening methods for different stages of diabetic patients.