超声乳化联合地塞米松玻璃体腔植入物治疗合并糖尿病黄斑水肿白内障患者的疗效观察

Effect of phacoemulsification combined with intravitreal implant of dexamethasone on cataract patients with diabetic macular edema

目的比较合并糖尿病黄斑水肿(DME)的白内障患者,行超声乳化术(Phaco)联合地塞米松玻璃体腔植入物(Ozurdex;DEX-I)与单纯行超声乳化术后,其黄斑部形态与功能的变化。方法回顾性病例对照研究。纳入对象为我院就诊的合并DME的46例(46只眼)白内障患者,其中行伴有DEX-I的超声乳化术的23例(23只眼)患者为Phaco-Dex组,行单纯超声乳化术的23例(23只眼)患者为单纯Phaco组。比较其术前及术后不同阶段黄斑部形态与功能的变化。结果Phaco-Dex组,与术前相比,从术后第1个月开始BCVA(logMAR)均显著提高(P<0.05);黄斑中心凹视网膜厚度(CMT)和黄斑体积(MV)自第2个月起显著下降(P<0.05);与单纯Phaco组相比较,Phaco-Dex组在每个随访点CMT和MV均显著降低。随访期间单纯Phaco组眼压显著升高(P<0.05)。单纯Phaco-alone组,CMT和MV从第2个月开始增加(P<0.05)。结论对合并DME视力显著性下降的白内障患者,超声乳化吸除联合DEX-I治疗是有效、安全的,不管是黄斑部形态和功能的改善方面都要优于单纯白内障超声乳化手术。

Objective To compare functional and anatomical results of combined phacoemulsification and dexamethasone intravitreal implant(Ozurdex;DEX-I)with standard phacoemulsification in diabetic patients with cataract.Methods A retrospective cohort study.46 patients(46 eyes)with nonproliferative diabetic retinopathy,macular edema,and cataract who were treated routinely with phacoemulsifi cation associated with DEX-I(Phaco-Dex)or standard phacoemulsifification(Phaco-alone)were included in the analysis,and divided into Phaco-Dex group(23 eyes)and Phaco-alone group(23 eyes)according to the treatment method.The morphological and functional changes of macula were compared before and after the operation.Results Best-correct visual acuity began to increase significantly in the Phaco-Dex group at the first month after the operation(P<0.05);Central subfield thickness and macular volume began to decrease significantly in the Phaco-Dex group at 2 months after the operation(P<0.05);Central subfield thickness and macular volume were significantly lower in the Phaco-Dex group than in the Phaco-alone group at all follow-ups(P<0.05).Intraocular pressure increased significantly increased in the Phaco-Dex group as compared with the Phaco-alone group during follow-up(P<0.05).In the Phaco-alone group,central subfield thickness and macular volume began to increase at 2 months after the operation(P<0.05).Conclusions In diabetic patients with macular edema and visually significant cataract,combined treatment with phacoemulsification and DEX-I seemed to be effective,safe,and superior to standard phacoemulsification considering both functional and tomographic parameters.