两种绷带镜在糖尿病患者玻璃体视网膜手术中应用后对角膜的影响  

Vitreoretinal surgery for proliferative diabetic retinopathy with two types of bandage contact lenses:clinical results and protection of corneal epithelium

作　　者：陈佳佳[1] 王文战 

机构地区：[1]郑州大学第一附属医院,河南省眼科医院眼一科,中国河南省郑州市450000

出　　处：《国际眼科杂志》2017年第12期2299-2303,共5页International Eye Science

摘　　要：目的:观察不同类型的角膜绷带镜在玻璃体视网膜手术中应用后对糖尿病患者角膜的影响。方法:前瞻性非随机对照研究。将符合增殖性糖尿病视网膜病变、拟行玻璃体视网膜手术的患者69例69眼按照患者意愿分为两组。A组36例36眼,术中使用直径为13.8mm角膜绷带镜覆盖于角膜表面,非接触广角镜下实施玻璃体切割联合眼内填充术,手术结束后去除绷带镜;B组33例33眼,同法使用直径为14.0mm角膜绷带镜,以相同方式实施手术。术前和术后1、2、3、7d进行裂隙灯显微镜、角膜荧光素钠染色检查。术前和术后7d行角膜内皮细胞计数、角膜厚度测量。结果:术前两组患者角膜荧光素钠染色阳性检出率分别为42%和42%(χ~2=0.004,P=0.949)。术后第1、2、3、7d两组患者角膜染色阳性率分别为47%和45%(χ~2=0.022,P=0.883),44%和45%(χ~2=0.007,P=0.933),44%和42%(χ~2=0.029,P=0.886),42%和39%(χ~2=0.037,P=0.848);两组患者间各时间点角膜上皮阳性检出率比较,差异无统计学意义(P>0.05)。术前和术后7d时,A组角膜内皮细胞计数分别为2779.25±329.55、2777.14±331.17个/mm^2,差异无统计学意义(t=0.551,P=0.585);B组角膜内皮细胞计数分别为2678.61±335.64、2672.45±336.25个/mm^2,差异无统计学意义(t=1.774,P=0.086)。术前和术后7d时A组角膜厚度分别为519.25±23.42、542.03±25.94μm,差异有统计学意义(t=-6.854,P<0.001);B组为525.64±20.97、551.33±27.87μm,差异有统计学意义(t=-7.204,P<0.001)。结论:糖尿病患者玻璃体视网膜手术中使用不同类型角膜绷带镜,手术前后角膜上皮完整性无差异。不同类型的绷带镜均可有效保护角膜上皮,术中可保持良好的角膜透明性。AIM： To observe the effect of two kinds of bandage contact lenses on epithelial erosions and corneal thickness after vitreoretinal surgery for proliferative diabetic retinopathy（PDR）. METHODS： In this prospective, nonrandomized, comparative clinical study, 69 eyes of 69 patients with PDR were divided into two groups. They underwent vitreoretinal surgery. Group A, 36 eyes of 36 cases, the bandage contact lens with diameter of 13.8mm were covered on corneal surface during surgery under noncontact wide-angle viewing systems. Group B, 33 eyes of 33 cases, the bandage contact lens with diameter of 14.0mm were covered on corneal surface during the same surgery. Visual acuity, intraocular pressure, slit-lamp examination, corneal fluorescein sodium staining, count of corneal endothelium cells, measure of corneal thickness before and after operation were assessed.RESULTS： Pre-operation, corneal fluorescein sodium staining positive rate was 42% in Group A and 42% in Group B（χ2=0.004, P=0.949）. At 1d after surgery, the positive rate of was 47% in Group A and 45% in Group B（χ2=0.022, P=0.883）. At 2d after surgery, the positive rate of was 44% in Group A and 45% in Group B（χ2=0.007, P=0.933）. At 3d after surgery, the positive rate of was 44% in Group A and 42% in Group B（χ2=0.029, P=0.886）. At 7d after surgery, the positive rate of was 42% in Group A and 39% in Group B（χ2=0.037, P=0.848）. Count of corneal endothelium cells showed no significant difference between Group A and Group B（P〉0.05）. Count of corneal endothelium cells of Group A before surgery and at 7d after surgery were 2779.25±329.55 /mm2, 2777.14±331.17 /mm2, without significant difference（t=0.551, P=0.585）; those of Group B were 2678.61±335.64/mm2, 2672.45±336.25 /mm2, without significant difference（t=1.774, P=0.086）. Measure of corneal thickness was 519.25±23.42μm before surgery and 542.03±25.94μm after surgery in Group A（t=-6.854, P〈0.001）. Measure of corneal thickness was 525.64±20.97μm before su

关 键 词：玻璃体视网膜手术 增殖性糖尿病视网膜病变 糖尿病性角膜病变 绷带镜 角膜 

分 类 号：R587.2[医药卫生—内分泌]