糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的分析  

Analysis of macular edema by OCT after phacoemulsification surgery in patients with diabetic retinopathy

作　　者：宋一帆[1] 蔡宏媛 王新[3] 赵琳[1] 陈晓勇[1] 

机构地区：[1]北京大学第三医院眼科中心,北京市100191 [2]北京市房山区良乡医院眼科,北京市102401 [3]北京大学第三医院延庆医院眼科,北京市102100

出　　处：《眼科新进展》2016年第7期658-661,666,共5页Recent Advances in Ophthalmology

基　　金：北京大学医学部交叉学科种子基金资助(编号:A78469-03);北京大学第三医院临床重点项目青年项目(编号:Y78469-04)~~

摘　　要：目的观察糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿情况并分析其部分原因。方法本研究为前瞻性研究,对在北京大学第三医院眼科中心行常规白内障超声乳化的糖尿病患者分别在术前及术后1个月、3个月时行相关检查并对结果进行统计学分析。结果共65例96眼纳入数据分析。术后1个月、3个月视力分别为(0.08±0.13)Log MAR和(0.07±0.11)Log MAR,均较术前的(0.59±0.18)Log MAR明显升高(均为P<0.001)。黄斑中心厚度术前为(253.6±29.2)μm,术后1个月时增加至(277.1±100.2)μm(P=0.008),术后3个月时增加至(275.0±94.1)μm(P=0.010),而黄斑内环区视网膜厚度则从术前的(321.3±25.0)μm分别增加至术后1个月的(342.1±65.6)μm(P<0.001)和术后3个月的(347.7±80.0)μm(P<0.001),黄斑外环区视网膜厚度则从术前的(278.8±19.9)μm增加至术后1个月的(288.6±50.1)μm(P=0.025)和术后3个月的(289.6±54.1)μm(均为P=0.025)。黄斑容积从术前的(10.11±0.73)mm^3增加至术后1个月的(10.65±2.31)mm^3(P=0.006)和术后3个月的(10.73±2.44)mm^3(P=0.003)。术前共22眼存在糖尿病性黄斑水肿(diabetic macular edema,DME),其中中心型DME 2眼,非中心型DME 14眼,弥漫型DME 6眼。不同DME分组术后1个月及3个月的黄斑中心厚度均值及改变量存在显著差异(均为P<0.05)。患眼术后的黄斑中心厚度与术前糖尿病视网膜病变的严重程度相关(1个月时r=0.331,P=0.001;3个月时r=0.318,P=0.002)。但糖尿病病程长短及术前是否行激光治疗与术后黄斑中心厚度无明显相关性。结论糖尿病患者行常规白内障超声乳化术后有出现黄斑水肿的可能性,患者术后的黄斑水肿程度与术前黄斑水肿的类型以及术前糖尿病视网膜病变严重程度均相关。Objective Todetermine the incidence and possible reasons of macular edema in diabetic patients whounderw ent uncom plicated cataract surgery. Methods The patients underwent phacoem ulsification in the Third Hospital of Peking U niversity were included in this prospective observational study. Before surgery and 1 month,3 months after surgery,all subjects were evaluated using optical coherence tom ography（ OCT） as well as the best corrected visual acuity（ BCVA）. Results Ninety-six eyes（ 65 patients） were included. BC-VA at postoperative 1 month and 3 months were（ 0. 08 ± 0. 13） Log MARand（ 0. 07 ± 0.11） Log MAR,which were better than preoperative BCVA（ 0. 59 ± 0. 18） Log MAR（ all P〈 0. 001）. The central macular thickness increased from（ 253. 6 ± 29. 2） μm pre-operatively to（ 277. 1 ± 100. 2） μm（ 1 month after surgery,P = 0. 008） and（ 275. 0 ± 94. 1） μm（ 3 months after surgery,P = 0. 010）. The inner subfield retinal thickness increased from（ 321. 3 ± 25. 0） μm pre-operatively to（ 342. 1 ± 65. 6） μm（ 1 month after surgery,P 〈 0.001） and（ 347. 7 ± 80. 0） μm（ 3 months after surgery,P 〈 0. 001）,respectively,the outer subfield retinal thickness was from（ 278. 8 ± 19. 9） μm to（ 288. 6 ± 50. 1） μm（ P = 0.025） and（ 289. 6 ± 54. 1） μm（ P = 0. 025）,respectively,and macular volum e increased from（ 10. 11 ± 0. 73） mm^3to（ 10. 65 ± 2. 31） mm^3（ 1 month after surgery,P = 0. 006）and（ 10. 73 ± 2. 44） mm^3（ 3 months after surgery,P = 0. 003）. Diabetic macular edema（ DME） existed in 22 eyes,among which,2 eyes had central DME,14 eyes had non-central DME and the other 6 eyes had both. The central macular thickness after surgery was related tothe presence and the category of macular edem a at baseline and diabetic retinopathy grade of the eye（ 1 month after surgery,r = 0. 331,P = 0. 001; 3 months after surgery,r = 0. 318,P = 0. 002）. The duration of diabetes or the photocoagulation before surg

关 键 词：黄斑水肿 糖尿病 光学相干断层扫描 白内障超声乳化手术 

分 类 号：R774.5[医药卫生—眼科]