白内障超声乳化吸除联合人工晶状体植入术对糖尿病患者黄斑部视网膜影响的OCT观察  

Macular changes after phacoemulsification and IOL implantation in diabetic patients observed by optical coherence tomography

作　　者：刘健[1] 徐洁慧[1] 楼继先[1] 汪怿[1] 曹永葆[1] LIU Jian XU Jiehui LOU Jixian et al(Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310013, China)

机构地区：[1]浙江医院眼科,杭州310013

出　　处：《浙江医学》2017年第10期801-804,共4页Zhejiang Medical Journal

摘　　要：目的观察糖尿患者白内障超声乳化吸除联合人工晶状体植入术前后黄斑部形态的变化,探讨影响术后最佳矫正视力(BCVA)的相关因素。方法选择行白内障超声乳化吸除联合人工晶体植入术患者58例(60眼),其中糖尿病组患者29例(31眼),非糖尿病组患者29例(29眼)。利用光学相干断层成像术(OCT)测量患者术前与术后不同时间点黄斑各亚区的视网膜厚度值,观察两组黄斑部视网膜厚度变化并探讨其影响因素;将患者术后1个月时log MAR BCVA与患者年龄、性别、糖尿病病程、黄斑部视网膜厚度及变化、高血压病史、Hb A1C、高脂血症史及吸烟史作相关性分析,探讨影响患者术后log MAR BCVA的相关因素。结果糖尿病组与非糖尿病组均在术后1个月时黄斑中心区厚度(CST)的改变量达到最大,之后逐渐缩小。两组术前及术后1个月时CST均与患者的糖尿病病程呈正相关(术前:r=0.53,P<0.01;术后1个月:r=0.69,P<0.05)。术后1个月时log MAR BCVA与糖尿病病程(r=0.47,P<0.01)、Hb A1C(r=0.38,P<0.01)、术前CST(r=0.61,P<0.01)及吸烟史(r=0.28,P<0.05)相关。通过多元线性回归,确定术前CST为术后log MAR BCVA的独立危险因素(P<0.05)。结论糖尿病患者白内障超声乳化术后1个月时CST改变量达到最大;术前CST与糖尿病病程相关,并影响术后BCVA。Objective To observe the macular morphology changes before and after phacoemulsification and IOL implantation in diabetic patients by spectral-domain optical coherence tomography （SD-OCT）. Methods Fifty eight patients （60 eyes） received phacoemulsification and IOL implantation for cataract, including 29 diabetics （31 eyes） and 29 non-diabetics（29 eyes）. Macular SD-OCT scans were performed on all patients before and 1 month after operation. The changes of macular and related influence factors, including age, sex, smoking history, hypertension, hyperlipidemia, HbAlc and diabetes were analyzed. Results The most obvious changes of macular thickness in two groups were observed at 1 month after the surgery. The central subfield thickness （CST） was positively correlated with diabetic duration （before surgery： r = 0.53, P〈0.01, 1 month after surgery： r=0.69, P=0.04）. The IogMAR best corrected visual acuity （BCVA） 1 month after surgery was positively correlated with diabetic duration（r=0.47, P〈0.01）, HbAIC（r=0. 38, P〈0.01）, CST before surgery （r=0.61, P〈0.01） and smoking history（r=0.28, P〈0.05）. Multiple regression analysis showed that CST before surgery was independent risk factor of BCVA（P〈0.05）. Conclusion CST of diabetes patients after phacoemulsification will reach a peak at 1 month after surgery. CST before surgery is correlated with the diabetic duration, which is the independent risk factors of BCVA after operation.

关 键 词：白内障超声乳化吸除联合人工晶状体植入术 糖尿病 黄斑水肿 光学相干断层成像术 

分 类 号：R587.2[医药卫生—内分泌] R779.6[医药卫生—内科学]