糖尿病人白内障后房型人工晶体植入术疗效观察

Observe the Effect of Diabetic Cataract With Inplanted Posterior Chamber Lens

目的 :研究如何才能使糖尿病人白内障的视力提高 ,视力损害降低到最低点 ,恢复最佳视力。方法 :1994年 10月～ 2 0 0 1年 12月糖尿病人白内障摘除并植入后房型人工晶体 10 8例 ,12 2眼 ;男性 4 0例 ,女性 68例 ;年龄 5 0～ 72岁。糖尿病史 3～ 5年 30眼 ,大于 10年 65眼 ,大于 15年 15眼 ,大于 2 0年 12眼。术前测定空腹及 3餐后 2h后血糖 ,经控制饮食、口服药物、皮下注射胰岛素 ,血糖控制在 7mmol L ,尿糖阴性。手术方法是超声乳化白内障人工晶体植入术或现代白内障囊外摘除术及人工晶体植入术 ,术后抗炎治疗 ,观察血糖变化 ,血糖仍控制在小于 8mmol L。结果 :视力大于或等于 0 8者 4 1眼 ,占 33 61% ;0 5～ 0 7者 64眼 ,占 5 2 4 6% ;0 4以下 17眼 ,占 13 93%。术后中晚期并发症 :晶体前膜、晶体后囊混浊、糖尿病眼底、黄斑变性、虹膜红变等。眼底检查 :糖尿病性视网膜病变单纯型Ⅰ期 110眼 ,Ⅱ期 12眼。结论 :糖尿病人一般应将血糖控制在 6 0～ 7 0mmol L ,手术是比较安全的 ;对轻型糖尿病人给予控制饮食及口服降糖药物 ;口服药物不能控制者 ,给予长效及短效胰岛素联合用药 ,并饮食控制定量用餐 ,对于术后并发症 ,则做相应适当的治疗 ,如晶体前膜给予少量激素或 5—Fu局部注射 ,散瞳 。

Objective:To research how to improve visual acuity of diabetic cataract's patients and to reduce their complication.Methods:From 1994,10 to 2001,12,phacoemulsication or ECCE and lens implantation were preformed in 108 cases,122 eyes.male:40 cases.fcemale 68 cases.ages:50～70 years old,diabetic was diagnosed,about 3～5years history in 30 eyes,and over ten years in 65 eyes,over fifteen years in 5 eyes,over twenty years in 12 eyes.Before opreation,blood glucose would be assayed,including before breakfast and after three dinners,by controlling diets,oral antihypoglycemie or injecting with issulin ih.Blood glucose was maintained no more than 7mmol/L,qualitative test for glucose in urine was negative.The cases were preformed by PHACO,ECCE and lens implantation,after opreation give the patient an injection of antibiotic and insulin,maintain blood glucose no more than 8mmol/L,in order to preventing incision infeftion.Results:Postoperatire visual accity in 122 eyes had improved,inwhich 41 eyes got to 0.8,64 eyes,had 0.5～0.7,17 eyes,had no more than 0.4.In the third month after operation,the complication include occlusion of pupil,subcapsular cataract,diabetic retinopathy,macular degeneration and rubeosis iridis etc.Checking ocular fundus:back-ground diabetic retinopathy I:were 110 eyes,Ⅱ:were 12 eyes.Conclusion:If the blood glucose were controlled in 6.0～7.0mmol/L,then the opreation is secure,Incipient diabetic patient control their glucose in bolld through limiting their diets of oral a cine.If diet and antihypoglycemic couldn't control blood glucose.Give the patient an injection of insulin iH which controls blood glucose,besides limiting diets.As for the complication theraphy:local injection with Dexamethasoni or 5-Fu,dilating pupils,observing blood glucose,If the patients got subcapsular cataract,during operation,subcap cular shouldbe cut or make it clearer.If the blood glucose of the patientis over 8mmol/L,We should carefully observe blood glucose and give them oral antihypoglycemic to prevent their complication.