飞秒激光辅助的超声乳化白内障吸除术对糖尿病合并不同核硬度白内障患者角膜内皮及预后的影响  

Effect of femtosecond laser-assisted phacoemulsification on corneal endothelium and prognosis of diabetic patients with cataract with different nuclear hardness

作　　者：杨晓玮 高祎 姜雅琴 周玉娟 Yang Xiaowei;Gao Yi;Jiang Yaqin;Zhou Yujuan(Weifang Eye Hospital,National Key Clinical Specialty,Zhengda Guangming Eye Group,Weifang Eye Institute,Weifang 261000,China)

机构地区：[1]潍坊眼科医院、国家临床重点专科、正大光明眼科集团、潍坊市眼科研究所,潍坊261000

出　　处：《中华眼科杂志》2024年第6期511-517,共7页Chinese Journal of Ophthalmology

摘　　要：目的:探讨飞秒激光辅助的超声乳化白内障吸除术对2型糖尿病合并不同核硬度年龄相关性白内障患者角膜内皮特性及预后的影响。方法:非随机对照试验。收集2020年3月至2022年12月期间在潍坊眼科医院行白内障摘除手术的2型糖尿病患者161例(161只眼),其中男性73例,女性88例,年龄(65.9±5.23)岁。根据患者意愿,将选择常规超声乳化白内障吸除及人工晶状体植入术的101例患者作为A组,选择飞秒激光辅助的超声乳化白内障吸除及人工晶状体植入术的60例作为B组。并根据晶状体Emery-Little分级,将两组中Ⅰ、Ⅱ级核的患者分别纳入A1和B1组,Ⅲ级核分别纳入A2和B2组,Ⅳ级核分别纳入A3和B3组。比较两组患者有效超声乳化时间(EPT)和超声乳化累积释放能量(CDE)。术前及术后1 d、1周、1个月、3个月采用角膜内皮显微镜获取患者的中央角膜厚度(CCT)、内皮细胞密度(ECD)、变异系数(CV)、六边形细胞比例(HEX),并比较各组之间的差异。结果:A组和B组患者术中EPT分别为(6.52±4.93)和(5.63±4.31)s,CDE分别为11.57%±5.21%和10.68%±6.02%,差异均无统计学意义(均P>0.05)。两组中不同白内障核硬度的患者术中EPT及CDE比较,A1和B1组的差异均无统计学意义(均P>0.05),A2和B2、A3和B3组的差异均有统计学意义(均P<0.05)。两组患者术后CCT均较术前增加。A1和B1组术后不同时间CCT的差异无统计学意义(均P>0.05),A2和B2、A3和B3组术后1 d、术后1周CCT的差异均有统计学意义(均P<0.05),B组明显低于A组。而术后1个月、术后3个月的差异均无统计学意义(均P>0.05)。两组患者术后ECD均较术前减少。A1和B1组术后不同时间ECD的差异无统计学意义(均P>0.05),A2和B2、A3和B3组组术后1 d、术后1周、术后1个月、术后3个月的ECD均有统计学意义(均P<0.05),B组明显优于A组。两组患者术后不同时间的变异系数、HEX的差异无统计学意义(P>0.05)。结论:飞秒�Objective To assess the impact of femtosecond laser-assisted phacoemulsification on corneal endothelial characteristics and prognosis among patients with type 2 diabetes and age-related cataracts,considering varying nuclear hardness.Methods This non-randomized controlled trial involved 161 patients(161 eyes)with type 2 diabetes undergoing cataract extraction at Weifang Eye Hospital between March 2020 and December 2022.The cohort comprised 73 males and 88 females,with an average age of(65.9±5.23)years.Based on patient preference,101 individuals underwent conventional phacoemulsification(group A),while 60 chose femtosecond laser-assisted phacoemulsification(group B).Patients were further stratified based on Emery-Little grade of lens nuclei into A1/B1(gradeⅠandⅡ),A2/B2(gradeⅢ),and A3/B3(gradeⅣ)subgroups.The study compared effective phacoemulsification time(EPT),cumulative energy release of phacoemulsification(CDE),central corneal thickness(CCT),endothelial cell density(ECD),coefficient of variation(CV),and hexagon cell ratio(HEX)before and after surgery at 1 day,1 week,1 month,and 3 months.Results The intraoperative EPT of patients in groups A and B were(6.52±4.93)and(5.63±4.31)s,respectively,and the CDE were 11.57%±5.21%and 10.68%±6.02%,respectively.The differences between them were not statistically significant(all P>0.05).There were no significant differences in EPT and CDE between groups A1 and B1(all P>0.05),and there were statistically significant differences between groups A2 and B2,A3 and B3(all P<0.05).The postoperative CCT was increased in both groups.There were no statistically significant differences in CCT between A1 and B1 groups at different time after surgery(all P>0.05),and there were statistically significant differences in CCT between A2 and B2,A3 and B3 groups at 1 day and 1 week after surgery(all P<0.05),and group B was significantly lower than group A.There was no significant difference between 1 month and 3 months after surgery(P>0.05).ECD was reduced in both groups.There was no

关 键 词：激光 飞秒 超声乳化白内障吸除术 白内障 糖尿病 2型 糖尿病并发症 内皮 角膜 内皮细胞 预后 

分 类 号：R779.6[医药卫生—眼科] R587.2[医药卫生—临床医学]