年龄相关性白内障合并2型糖尿病患者超声乳化术后黄斑区脉络膜毛细血管血流密度变化及相关性研究  

Choriocapillary flow changes after phacoemulsification surgery in patients with type 2 diabetes and its related factors

作　　者：王造文 王尔茜 陈有信 WANG Zaowen;WANG Erxi;CHEN Youxin(The Key Laboratory of Ocular Fundus Diseases,Chinese Academy of Medical Sciences,Department of Ophthalmology,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院眼底病重点实验室,北京协和医院眼科,北京市100730

出　　处：《眼科新进展》2020年第10期963-966,共4页Recent Advances in Ophthalmology

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项资金项目(编号:2018PT32029)。

摘　　要：目的探讨合并2型糖尿病的年龄相关性白内障患者超声乳化术后黄斑区脉络膜毛细血管血流密度(choriocapillary flow density,CFD)的改变及其与黄斑区视网膜厚度的相关性。方法前瞻性研究。纳入行白内障超声乳化术的2型糖尿病及非糖尿病年龄相关性白内障患者各21例21眼,分为糖尿病组及非糖尿病组。检测糖尿病组患者糖化血红蛋白水平及是否存在糖尿病视网膜病变。分别在术后1 d、10 d、30 d、90 d使用光学相干断层扫描血管成像术(OCTA)对两组进行黄斑部3 mm×3 mm的扫描,测量两组患者的黄斑区脉络膜CFD及视网膜厚度。结果糖尿病组术后1 d、10 d、30 d、90 d的黄斑区脉络膜CFD分别为(62.89±4.83)%、(61.95±3.96)%、(60.96±4.29)%、(60.78±4.67)%,随时间的延长呈下降趋势(F=9.203,P<0.001);术后1-90 d的黄斑区脉络膜CFD变化值为(-2.11±1.42)%,与非糖尿病组黄斑区脉络膜CFD变化值(-1.15±1.31)%相比,差异有统计学意义(P=0.038)。糖尿病组中,术后1-90 d的黄斑区脉络膜CFD降低幅度与黄斑区视网膜厚度变化呈显著负相关(中心凹区域:r=-0.48,P=0.028;旁中心凹区域:r=-0.54,P=0.012)。糖尿病组术后1-30 d的黄斑区脉络膜CFD降低幅度与糖化血红蛋白水平呈显著负相关(r=-0.45,P=0.040),术后1-90 d的黄斑区脉络膜CFD降低幅度与基线存在糖尿病视网膜病变呈显著负相关(r=-0.46,P=0.036)。结论超声乳化手术可引起2型糖尿病患者黄斑区脉络膜CFD下降,其降低幅度与黄斑区视网膜厚度变化呈显著负相关,并且与糖化血红蛋白水平、基线是否存在糖尿病视网膜病变有密切的关系。Objective To investigate choriocapillary flow density(CFD)changes following phacoemulsification surgery in patients with type 2 diabetes and its correlation with and its correlation with macular retinal thickness.Methods This study prospectively enrolled 21 eyes of 21 patients with type 2 diabetes(diabetic group)and 21 eyes of 21 non-diabetic controls(non-diabetic group)who underwent uncomplicated phacoemulsification surgery.The level of glycosylated hemoglobin and pre-existing diabetic retinopathy were detected in diabetic group.All subjects were operated by 3 mm×3 mm macular scans on an optical coherence tomography angiography(OCTA)device at postoperative day 1,10,30,and 90.Quantitative measurements of macular CFD and macular retinal thickness were obtained.Results The macular CFD in diabetic group was(62.89±4.83)%at postoperative day 1,and declined to(61.95±3.96)%,(60.96±4.29)%,and(60.78±4.67)%at postoperative day 10,30,and 90,prospectively(F=9.203,P<0.001),consecutive decline as time went by.The change in CFD from postoperative day 1 to 90 was(-2.11±1.42)%in diabetic patients,significantly more larger than that in non-diabetic patients[(-1.15±1.31)%,P=0.038].In diabetic patients,the CFD changes from postoperative day 1 to 90 was negatively significantly correlated with macular retinal thickness(r=-0.48,P=0.028 for foveal area;r=-0.54,P=0.012 for parafoveal area).The CFD decline from postoperative day 1 to 30 was negatively significantly correlated with glycosylated hemoglobin level(r=-0.45,P=0.040).The amount of CFD reduction from postoperative day 1 to 90 was negatively significantly associated with pre-existing diabetic retinopathy(r=-0.46,P=0.036).Conclusion Phacoemulsification surgery in diabetic patients reduced macular CFD,which is correlated with postoperative macular thickening,baseline glycemic control level,and pre-existing diabetic retinopathy.

关 键 词：超声乳化术 光学相干断层扫描血管成像术 脉络膜毛细血管 血流密度 糖尿病 

分 类 号：R774[医药卫生—眼科]