比较糖尿病病人白内障超声乳化术不同隧道长度切口对角膜生物力学的影响

To compare the effects of different tunnel length incisions on corneal biomechanics in diabetic cataract phacoemulsification

目的比较糖尿病合并白内障病人行白内障超声乳化手术采用不同隧道长度切口角膜生物力学的差异。方法收集2020年10月至2021年11月于贵州医科大学附属医院拟行白内障超声乳化手术的2型糖尿病病人67例67眼,行颞侧三平面透明角膜切口,按切口隧道长度分为两组:长隧道组(长度≥1.75 mm,<2.40 mm),共33例(33眼)。短隧道组(长度>1.20 mm,<1.75 mm),共34例(34眼)。应用可视化角膜生物力学分析仪测量两组病人术前、术后1 d、术后1周和术后1个月的角膜生物力学参数,透明角膜切口隧道长度通过眼前节光学相干断层扫描在病人术后1 d进行测量。结果术前及术后1 d、术后1周、术后1个月两组眼压、中央角膜厚度、最大形变幅度、第一压平时间、第二压平时间、峰距、矫正眼压、第一压平时角膜硬度参数(stiffness parameter at applanation 1,SP-A1)及角膜生物力学指数(corneal biomechanical index,CBI)的总体相比,差异有统计学意义(均P<0.05);其中术后1 d中央角膜厚度、CBI[(长隧道组(647.21±96.07)μm、0.58(0.10,0.82),短隧道组(674.34±115.59)μm、0.50(0.23,0.80)]较术前[长隧道组:(564.03±29.45)μm、0.06(0,0.24),短隧道组:(553.19±29.54)μm、0.13(0,0.43)]均显著增大(均P<0.05),术后1个月两组中央角膜厚度及CBI恢复至术前水平(均P>0.05)。l两组术后1 d第二压平时间及峰距较术前减少(均P<0.05)、在术后1周及术后1个月均比术后1 d增大(均P<0.05)。两组术后1个月及术后1周最大形变幅度较术后1 d增大(P<0.05),SP-A1在术后1个月及术后1周较术后1 d及术前明显减小(P<0.05)。长隧道组与短隧道组术后1 d眼压[1.83(0.08,4.17)mmHg比0.33(-0.50,1.83)mmHg]、第一压平时间[0.22(0.01,0.57)ms比0.04(-0.09,0.23)ms]、第二压平时间[-0.47(-0.68,-0.21)ms比-0.22(-0.48,0.01)ms]及矫正眼压[0.6(-0.99,1.72)mmHg比-1.53(-3.80,-0.36)mmHg]的变化量比较,差异有统计学意义(P<0.05),术后1周第二压平时间、峰距及矫正眼压的变化量比较,差异有统计学意义(P<0.05)。结论对于行白内障超声乳化术透明角膜三平面切口的糖尿病病人,长隧道切口组比短隧道切口组角膜生物力学在早期变化更明显、角膜生物力学改变更大,角膜修复愈合更慢。同正常白内障病人一样,对于糖尿病合并白内障病人而言,两组病人白内障超声乳化术后1个月角膜硬度也较术前降低。

Objective To compare the corneal biomechanics of different tunnel length incisions in patients with diabetes and cataract undergoing cataract phacoemulsification.Methods Sixty-seven patients(67 eyes)with type 2 diabetes who planned to undergo cataract phacoemulsification in the Affiliated Hospital of Guizhou Medical University from October 2020 to November 2021 were collected.Three plane transparent corneal incisions were performed on the side of the lobe.They were assigned into two groups according to the length of the incision tunnel:the long tunnel group(length≥1.75 mm,<2.40 mm),a total of 33 cases(33 eyes);the short tunnel group(length>1.20mm,<1.75 mm),a total of 34 cases(34 eyes).Corneal visualization scheimpflug technology was used to measure the corneal biomechanical parameters of the two groups of patients before surgery,1 day after surgery,1 week after surgery and 1 month after surgery.The tunnel length of clear corneal incision was measured by optical coherence tomography at the anterior segment 1 day after the operation.Results Before and 1 day after surgery,1 week after surgery,and 1 month after surgery,the intraocular pressure,central corneal thickness,and maximum deformation of the two groups were Amplitude,first applanation time,second applanation time,peak distance,corrected intraocular pressure,corneal stiffness parameter at applanation 1(SP-A1)and corneal biomechanical index(CBI),the differences were statistically significant(all P<0.05);among which,the central corneal thickness[long tunnel group:(647.21±96.07)μm,short tunnel group:(674.34±115.59)μm]and and CBI[long tunnel group:0.58(0.10,0.82),short tunnel group:0.50(0.23,0.80)]on the 1st day after operation were significantly increased than the preoperative central corneal thickness[long tunnel group:(564.03±29.45)μm,short tunnel group:(553.19±29.54)μm]and CBI[long tunnel group:0.06(0,0.24),short tunnel group:0.13(0,0.43)]before operation(all P<0.05),and the central corneal thickness and CBI of the two groups recovered 1 month after surgery(all P<0.05).The second applanation time and peak distance on the 1st postoperative day in the two groups were decreased than those before the operation(all P<0.05).The maximum deformation amplitude of both groups at 1 month after operation and 1 week after operation was larger than that at 1 day after operation(P<0.05).SP-A1 at 1 month after operation and 1 week after operation were significantly lower than that at 1 day after operation and before operation(P<0.05).The intraocular pressure[long tunnel group:1.83(0.08,4.17),short tunnel group:0.33(−0.50,1.83)]mmHg,the first flattening time[long tunnel group:0.22(0.01,0.57)ms,short tunnel group:0.04(−0.09,0.23)ms],the second applanation time[long tunnel group:−0.47(−0.68,−0.21)ms,short tunnel group:−0.22(−0.48,0.01)ms]and corrected intraocular pressure[long tunnel group:0.6(−0.99,1.72)mmHg,short tunnel group:−1.53(−3.80,−0.36)mmHg]of two groups at 1 day after operation were compared,the differences were statistically significant(P<0.05).The differences in the second flattening time,peak distance and corrected intraocular pressure at 1 week after surgery were statistically significant(P<0.05).Conclusions For diabetic patients undergoing cataract phacoemulsification with clear corneal tri-plane incision,compared with the shorter tunnel incision,the corneal biomechanics changed in the long tunnel incision group more obviously in the early stage,and the corneal biomechanical changes were larger,and in the long tunnel incision group mwas slower.As with normal cataract patients,corneal hardness in both groups was also lower than before surgery for diabetic patients with cataract 1 month after phacoemulsification.