糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的危险因素及对其视力恢复、心理压力的影响

Risk factors of macular edema in patients with diabetic retinopathy after cataract phacoemulsification and the influence on visual recovery and mental pressure

目的:研究糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的危险因素及对其视力恢复、心理压力的影响。方法:选取我院2014年4月至2017年4月200例(367只患眼)糖尿病视网膜病变患者为研究对象,所有患者均接受白内障超声乳化术治疗。收集患者年龄、性别、糖尿病病程、糖化血红蛋白、胰岛素治疗、吸烟史、饮酒史、基础疾病等临床资料。术后对患者进行为期6个月随访,诊断黄斑水肿发生情况,评估患者视力水平及心理压力。结果:200例患者共发生黄斑水肿35例,发生率为17.5%。黄斑水肿组年龄≥60岁、糖尿病病程>10年、糖化血红蛋白>7%、胰岛素治疗、合并高血压、合并高脂血症患者比例分别为62.9%、65.7%、68.6%、57.1%、45.7%、40.0%,显著高于无黄斑水肿组的44.2%、41.8%、42.4%、37.0%、23.0%、18.2%(χ~2=4.012,6.638,7.925,4.876,7.538,8.010;P<0.05)。黄斑水肿组术后6个月最佳矫正视力为(0.69±0.14),显著低于无黄斑水肿组的(0.74±0.16)(t=2.288,P<0.05),心理压力总分为(72.28±13.10)分,显著高于无黄斑水肿组的(67.41±12.19)分(t=2.119,P<0.05)。结论:年龄、糖尿病病程、糖化血红蛋白、胰岛素治疗、合并高血压、合并高脂血症等6个因素对糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿发生有显著影响。黄斑水肿不利于患者术后视力恢复,患者可能承受较大心理压力。

Objective:To study the risk factors of macular edema in patients with diabetic retinopathy(DR)after cataract phacoemulsification and the influence on visual recovery and mental pressure.Methods:A total of 200patients(367affected eyes)with DR treated in our hospital during the period from April 2014 to April 2017 were selected as the subjects,and all of them were treated with phacoemulsification.The clinical data such as age,gender,duration of diabetes,glycosylated hemoglobin(HbA1c),insulin therapy,smoking history,drinking history and basic diseases were collected.The patients were followed up for 6 months after surgery.The situation of macular edema was diagnosed and the visual acuity and mental pressure were evaluated.Results:Macular edema occurred in 35 of 200patients,with an incidence of 17.5%.The proportions of patients who were or older than 60 years old,whose duration of diabetes was longer than 10 years,whose HbA1 cwas higher than 7%,who underwent insulin therapy,who had hypertension and who had hyperlipidemia in the macular edema group were significantly higher than those in the non-macular edema group(χ~2=4.012,6.638,7.925,4.876,7.538,8.010;P<0.05).The best corrected visual acuity of macular edema group at 6months after surgery was significantly lower than that of non-macular edema group(t=2.288,P<0.05),while the total mental pressure score was significantly higher than that of non-macular edema group(t=2.119,P<0.05).Conclusion:Age,duration of diabetes,HbA1 c,insulin therapy,hypertension and hyperlipidemia are influencing factors of macular edema in patients with DR after phacoemulsification.Macular edema is not conducive to the recovery of visual acuity after surgery,and patients may suffer great mental pressure.