糖尿病患者人工晶状体植入后后囊混浊及眼底改变

Clinical observations of posterior capsular opacification and of retinal changes in diabetes after intraocular lens implantation

目的 观察糖尿病患者白内障囊外摘除及人工晶状体植入术后后囊混浊及眼底改变。方法 对108例(117眼)糖尿病患者的白内障采用6-7mm角巩膜切口行ECCE及后房型IOL植入术,术后5月观察视力、晶状体后囊及眼底改变。结果108例糖尿病患者平均糖尿病病程7.9年,白内障平均病程2.5年。117眼白内障术后5月内观察:后囊混浊18眼(15.4％)。术后视力≥0.5者76眼(65.0％),36眼为0.05～0.4(30.8％),5眼<0.05(4.3％)。眼底检查发现108眼患糖尿病性视网膜病变,其中Ⅲ期58眼、Ⅳ-Ⅴ期24眼、Ⅵ期2眼,黄斑水肿10眼。结论 术后后囊混浊发生率为15.4％,糖尿病性视网膜病变发生率92.3％,而糖尿病病程5年以上者眼底病变发生率高达94.4％(102眼),其中Ⅲ期及以上者达78.7％(Ⅲ期53.7％、Ⅳ-Ⅴ期22.2％、Ⅵ期1.9％),黄斑水肿9.2％,后囊混浊及眼底改变均影响术后视力,但后者是最主要的原因。

Aim To observe fundal changes and posterior capsular opacification (PCO) in diabetes mellitus after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation. Methods On 117 eyes with diabetes, ECCE and posteror chamber IOL implantation were performed through a corneoscleral incision of 6-7mm. All the cases were followed up for 5 months, during which vision, posterior capsule and fundus were examined. Results For 108 cases of diabetes, the average course of diabetes and of cataract was respectively 7.9 and 2.5 years. During the followup, PCO occurred in 18 eyes (15.4%); postoperative vision was ≥0.5 in 76 eyes (65.0%), between 0.05 and 0.4 in 36 eyes (30.8%) and <0.05 in 5 eyes (4.3%); diabetic retinopathy was observed in 108 eyes, 58 being Stage III retinopathy, 24 being Stage IV-V, 2 being Stage VI and 10 being macular edema. Conclusion After ECCE and IOL implantation, incidence of PCO and diabetic retinopathy is 15.4% and 92.3% respectively. In diabetes with a course ≥ 5, the incidence of retinopathy is 94.4% (102 eyes), 78.7% of which being Stage III or more advanced and 9.2% of which being macular edema. Both PCO and fundal changes affect postoperative vision, the latter being the major one.