增生型糖尿病视网膜病变患者玻璃体切除术后角膜上皮功能障碍的临床分析  

Clinical analysis of corneal epithelial dysfunction after vitrectomy for proliferative diabetic retinopathy

作　　者：张莹[1] 苟丽[1] 王金硕[1] 闫磐石[1] Zhang Ying;Gou Li;Wang Jinshuo;Yan Panshi(Department of Ophthalmology,the First Afiliated Hospital of Zhengzhou University,Henan Provincical Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2024年第4期264-269,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析增生型糖尿病视网膜病变(PDR)患者玻璃体切除术后角膜上皮功能障碍(CED)的发生情况及相关因素。方法回顾性病例对照研究。收集郑州大学第一附属医院2021年2月至2022年1月接受玻璃体切除术的PDR患者82例(82只眼)的临床资料。术后4周参照角膜上皮功能评估标准记录CED发生情况,按是否发生CED将患者分为两组:CED组17例和无CED组65例。比较两组PDR患者的基线资料,分析CED发生的影响因素。结果本研究术后4周共17例(20.73%,17/82)发生CED;CED组和无CED组患者年龄≥60岁者分别有10例、9例,两组差异有统计学意义(χ^(2)=15.31,P<0.001)。两组患者术中硅油填充、术后泪膜异常分布、术前空腹血糖水平相比差异均有统计学意义(χ^(2)=14.97、21.40,t=6.28;均P<0.001)。多因素Logistic分析结果显示,年龄≥60岁(OR=8.83,95%CI:1.447~53.940,P=0.018)、术中硅油填充(OR=8.16,95%CI:1.641~40.572,P=0.010)、泪膜异常(OR=22.08,95%CI:3.817~127.776,P=0.001)、术前空腹血糖高水平(OR=41.81,95%CI:3.898~448.410,P=0.002)均是PDR患者玻璃体切除术后CED发生的影响因素。结论PDR患者玻璃体切除术后有较高的CED发生风险,CED与患者年龄、术中硅油填充、泪膜异常及术前空腹血糖高水平有关。ObjectiveTo analyze the occurrence and factors associated with corneal epithelial dysfunction(CED)after vitrectomy in patients with proliferative diabetic retinopathy(PDR).MethodsThis was a retrospective case control study.The clinical data of 82 cases(82 eyes)of PDR treated with vitrectomy in the First Affiliated Hospital of Zhengzhou University from Feb.2021 to Jan.2022 were collected,and the occurrence of CED was recorded at 4 weeks postoperatively with reference to corneal epithelial function assessment criteria.Patients were divided into two groups based on whether CED occurred after vitrectomy:the CED group with 17 cases and the non CED group with 65 cases.And the baseline data of PDR patients in the two groups of patients who developed and did not develop CED were compared to analyze the factors influencing the development of CED.ResultsIn this study,CED occurred in 17 cases(20.73%,17/82)at 4 weeks after vitrectomy.There were 10 cases and 9 cases with age≥60 years old in the CED group and the non CED group,respectively,and the difference was statistically significant(χ^(2)=15.31,P<0.001).Comparison of baseline data between the CED group and the non CED group revealed statistically significant differences in intraoperative silicone oil filling or not,tear film abnormality or not,and preoperative fasting blood glucose profile(χ^(2)=14.97,P<0.001;χ^(2)=21.40,P<0.001;t=6.28,P<0.001).The multifactorial logistic results showed that≥60 years(OR=8.83,95%CI:1.447-53.940,P=0.018)of age,intraoperative silicone oil filling(OR=8.16,95%CI:1.641-40.572,P=0.010),tear film abnormality(OR=22.08,95%CI:3.817-127.776,P=0.001),and high level of preoperative fasting glucose(OR=41.81,95%CI:3.898-448.410,P=0.002)were all factors influencing the occurrence of CED after vitrectomy in patients with PDR.ConclusionPatients with PDR have a higher risk of developing CED after vitrectomy,which may be related to patients′age,intraoperative silicone oil filling,tear film abnormalities,and high preoperative fasting glucose levels.

关 键 词：糖尿病视网膜病变 增生型 玻璃体切除术 上皮 角膜 功能障碍 填充 硅油 泪膜 

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