糖尿病患者超声乳化术后视网膜微循环变化及影响因素的研究  

Influencing factors of retinal microcirculation changes in diabetic patients after phacoemulsification

作　　者：崔世超 王禹 张轶峰 于珍 贾超 卢童娟 王新宇 Cui Shichao;Wang Yu;Zhang Yifeng;Yu Zhen;Jia Chao;Lu Tongjuan;Wang Xinyu(Jinzhou Medical University,Jinzhou 121001,China;Fushun Ophthalmopathy Hospital,Fushun 113008,China)

机构地区：[1]锦州医科大学,锦州121001 [2]抚顺市眼病医院,抚顺113008

出　　处：《中华眼外伤职业眼病杂志》2024年第9期688-700,共13页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析超声乳化白内障吸除术对糖尿病患者视网膜微循环的变化及其影响因素。方法前瞻性非随机对照研究。纳入抚顺市眼病医院2022年3月至2023年3月糖尿病患者行超声乳化白内障吸除术后眼底检查确诊并发非增生型糖尿病视网膜病变(NPDR)患者20例(20眼)为NPDR组,无糖尿病视网膜病变(NDR)患者20例(20眼)为NDR组。同期收集单纯白内障无糖尿病患者20例(20眼)为对照组。分别为三组患者进行手术前后光学相干断层扫描血流成像(OCTA)与视力检查,记录术前,术后1 d、1周、1个月和3个月的最佳矫正视力(BCVA,logMAR)、视网膜浅层血管丛密度(SCP)、视网膜深层血管丛密度(DCP)、中心凹旁300μm血流密度(FD300)、视盘旁放射状毛细血管密度(RPC)、黄斑厚度(MT)、黄斑中心凹无血管区(FAZ)面积和周长。术中记录超乳参数累积释放能量(CDE)和术中超声乳化时间。采用Pearson相关性分析,分析视力与血流参数,术中超乳参数与手术前后血流变化量之间的相关性。结果术前三组间SCP与DCP差异均有统计学意义(F=4.99、7.59,P=0.010、P<0.001),NPDR组的SCP和DCP较对照组低(P<0.001、P=0.040),NDR组的DCP较对照组低(P=0.019)。手术前后比较结果:BCVA(F时间=20.21,P<0.001;F组间=0.71,P=0.494;F交互=3.35,P=0.042),术后各个时间点较术前均提高(均P<0.001)。SCP(F时间=78.31,P<0.001;F组间=4.99,P=0.010;F交互=11.60,P<0.001),术后各个时间点的视网膜SCP较术前均增加(均P<0.001)。DCP(F时间=1.92,P=1.120;F组间=7.59,P<0.001;F交互=4.58,P=0.037),术前术后不同时间点比较,差异无统计学意义(P>0.05)。手术前后SCP的变化量(ΔSCP)(F时间=13.83,P<0.001;F组间=5.07,P=0.028;F交互=7.59,P<0.001),NPDR组患者ΔSCP,较NDR组及对照组患者更大(均P<0.001)。手术前后DCP的变化量(ΔDCP)(F时间=2.11,P=0.152;F组间=2.28,P=0.112;F交互=0.68,P=0.510),三组间ΔDCP差异无统计学意义(P>0.05)。FD300、MT、FAZ周长、FAZ�ObjectiveTo study the effect of phacoemulsification on fundus microcirculation in diabetic patients.MethodsThis was a prospective non-randomized controlled study.From Mar.2022 to Mar.2023 in Fushun Ophthalmopathy Hospital,20 diabetic patients(20 eyes)with non-proliferative diabetic retinopathy(NPDR)diagnosed by fundus examination after phacoemulsification were collected as an NPDR group,and 20 patients(20 eyes)without diabetic retinopathy(NDR)as an NDR group.At the same time,20 cases(20 eyes)with simple cataract and non-diabetes were collected as a control group.Preoperative and postoperative visual acuity and optical coherence tomography angiography(OCTA)were examined for these three groups of patients respectively.Best corrected visual acuity(BCVA,logMAR),retinal superficial vascular plexus density(SCP),deep retinal vascular plexus density(DCP),300μm foveal density(FD300),radial parapapillary capillaries(RPC)near the optic disc,macular thickness(MT),and the area and perimeter of fovea avascular zone(FAZ)were recorded for all patients before operation,as well as at 1 week,1 month and 3 months after operation.Cumulative dissipated energy(CDE)and intraoperative phacoemulsification time were also recorded during operation.Pearson correlation analysis was performed to investigate the relationships between visual acuity and blood flow parameters,as well as between intraoperative phacoemulsification parameters and the changes in blood flow before and after surgery.ResultsPreoperatively,both SCP and DCP showed statistically significant differences among the three groups(F=4.99,7.59;P=0.010,P<0.001).The NPDR group had lower SCP and DCP values compared to the control group(P<0.001,P=0.040),while the DCP in the NDR group was also significantly lower than that of the control group(P=0.019).Postoperative analysis revealed significant changes in BCVA(F time=20.21,P<0.001;F group=0.71,P=0.494;F interaction=3.35,P=0.042).All postoperative time points demonstrated significant improvements in visual acuity compared to preoperat

关 键 词：糖尿病 超声乳化白内障吸除术 微循环 视网膜 光学相干断层扫描血管成像 

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