糖尿病患者超声乳化术后视网膜微循环变化及影响因素的研究

Influencing factors of retinal microcirculation changes in diabetic patients after phacoemulsification

目的分析超声乳化白内障吸除术对糖尿病患者视网膜微循环的变化及其影响因素。方法前瞻性非随机对照研究。纳入抚顺市眼病医院2022年3月至2023年3月糖尿病患者行超声乳化白内障吸除术后眼底检查确诊并发非增生型糖尿病视网膜病变(NPDR)患者20例(20眼)为NPDR组,无糖尿病视网膜病变(NDR)患者20例(20眼)为NDR组。同期收集单纯白内障无糖尿病患者20例(20眼)为对照组。分别为三组患者进行手术前后光学相干断层扫描血流成像(OCTA)与视力检查,记录术前,术后1 d、1周、1个月和3个月的最佳矫正视力(BCVA,logMAR)、视网膜浅层血管丛密度(SCP)、视网膜深层血管丛密度(DCP)、中心凹旁300μm血流密度(FD300)、视盘旁放射状毛细血管密度(RPC)、黄斑厚度(MT)、黄斑中心凹无血管区(FAZ)面积和周长。术中记录超乳参数累积释放能量(CDE)和术中超声乳化时间。采用Pearson相关性分析,分析视力与血流参数,术中超乳参数与手术前后血流变化量之间的相关性。结果术前三组间SCP与DCP差异均有统计学意义(F=4.99、7.59,P=0.010、P<0.001),NPDR组的SCP和DCP较对照组低(P<0.001、P=0.040),NDR组的DCP较对照组低(P=0.019)。手术前后比较结果:BCVA(F时间=20.21,P<0.001;F组间=0.71,P=0.494;F交互=3.35,P=0.042),术后各个时间点较术前均提高(均P<0.001)。SCP(F时间=78.31,P<0.001;F组间=4.99,P=0.010;F交互=11.60,P<0.001),术后各个时间点的视网膜SCP较术前均增加(均P<0.001)。DCP(F时间=1.92,P=1.120;F组间=7.59,P<0.001;F交互=4.58,P=0.037),术前术后不同时间点比较,差异无统计学意义(P>0.05)。手术前后SCP的变化量(ΔSCP)(F时间=13.83,P<0.001;F组间=5.07,P=0.028;F交互=7.59,P<0.001),NPDR组患者ΔSCP,较NDR组及对照组患者更大(均P<0.001)。手术前后DCP的变化量(ΔDCP)(F时间=2.11,P=0.152;F组间=2.28,P=0.112;F交互=0.68,P=0.510),三组间ΔDCP差异无统计学意义(P>0.05)。FD300、MT、FAZ周长、FAZ面积、视盘周围血流密度、视盘内血流管密度,总体差异均无统计学意义(均P>0.05)。Pearson相关分析显示,NPDR组、NDR组及对照组ΔDCP与CDE均呈明显的正相关(r=0.54、0.58、0.81,P=0.015、0.007、P<0.001);对照组ΔDCP与超声乳化时间呈明显正相关(r=0.56,P=0.010)。NDR组中FAZ面积与BCVA在术后1周和3个月时呈明显的正相关(r=0.45,P=0.047),NPDR组FAZ周长与BCVA在术后1 d和1周时呈明显正相关(r=0.52、0.46,P=0.018、0.044)。结论超声乳化白内障吸除术影响糖尿病患者眼底微循环,术后SCP增加,糖尿病合并糖尿病视网膜病变患者中增加更为明显;ΔDCP与手术参数呈正相关。

ObjectiveTo study the effect of phacoemulsification on fundus microcirculation in diabetic patients.MethodsThis was a prospective non-randomized controlled study.From Mar.2022 to Mar.2023 in Fushun Ophthalmopathy Hospital,20 diabetic patients(20 eyes)with non-proliferative diabetic retinopathy(NPDR)diagnosed by fundus examination after phacoemulsification were collected as an NPDR group,and 20 patients(20 eyes)without diabetic retinopathy(NDR)as an NDR group.At the same time,20 cases(20 eyes)with simple cataract and non-diabetes were collected as a control group.Preoperative and postoperative visual acuity and optical coherence tomography angiography(OCTA)were examined for these three groups of patients respectively.Best corrected visual acuity(BCVA,logMAR),retinal superficial vascular plexus density(SCP),deep retinal vascular plexus density(DCP),300μm foveal density(FD300),radial parapapillary capillaries(RPC)near the optic disc,macular thickness(MT),and the area and perimeter of fovea avascular zone(FAZ)were recorded for all patients before operation,as well as at 1 week,1 month and 3 months after operation.Cumulative dissipated energy(CDE)and intraoperative phacoemulsification time were also recorded during operation.Pearson correlation analysis was performed to investigate the relationships between visual acuity and blood flow parameters,as well as between intraoperative phacoemulsification parameters and the changes in blood flow before and after surgery.ResultsPreoperatively,both SCP and DCP showed statistically significant differences among the three groups(F=4.99,7.59;P=0.010,P<0.001).The NPDR group had lower SCP and DCP values compared to the control group(P<0.001,P=0.040),while the DCP in the NDR group was also significantly lower than that of the control group(P=0.019).Postoperative analysis revealed significant changes in BCVA(F time=20.21,P<0.001;F group=0.71,P=0.494;F interaction=3.35,P=0.042).All postoperative time points demonstrated significant improvements in visual acuity compared to preoperative levels(all P<0.001).For SCP,significant results were obtained as well(F time=78.31,P<0.001;F group=4.99,P=0.010;F interaction=11.60,P<0.001).The density of the superficial retinal vascular plexus at all postoperative time points increased significantly compared to preoperative values,indicating an overall enhancement in blood flow density(all P<0.001).DCP analysis revealed significant differences among the three groups(F time=1.92,P=1.120;F group=7.59,P<0.001;F interaction=4.58,P=0.037).No significant differences were observed when comparing preoperative and postoperative time points(P>0.05).The changes in the density of the retinal superficial capillary plexus(ΔSCP)were:F time=13.83,P<0.001;F group=5.07,P=0.028;F interaction=7.59,P<0.001.Among the three groups,theΔSCP in the NPDR group were greater than those of the NDR group and the control group(all P<0.001).The changes in the density of the retinal deep capillary plexus(ΔDCP)were:F time=2.11,P=0.152;F group=2.28,P=0.112;F interaction=0.68,P=0.510.There was no significant difference inΔDCP among the three groups(P>0.05).Additionally,no significant differences were found in the overall measurements of FD300,MT,FAZ perimeter,FAZ area,peripapillary blood flow density,or intradiscal blood flow density(all P>0.05).Pearson correlation analysis demonstrated significant positive correlations betweenΔDCP and CDE in the NPDR,NDR,and control groups(r=0.54,0.58,0.81;P=0.015,0.007,P<0.001).Additionally,in the control group,ΔDCP showed a significant positive correlation with phacoemulsification time(r=0.56,P=0.010).In the NDR group,the area of FAZ was significantly positively correlated with BCVA at one week and three months postoperatively(r=0.45,P=0.047).In the NPDR group,the perimeter of FAZ exhibited a significant positive correlation with BCVA at one day and one week postoperatively(r=0.52,0.46;P=0.018,0.044).ConclusionPhacoemulsification surgery impacts the fundus microcirculation in diabetic patients,leading to a postoperative increase in the SCP.This increase is especially notable in patients with diabetes accompanied diabetic retinopathy.Additionally,ΔDCP show a positive correlation with surgical parameters.