超聲乳化術對糖尿病白內障患者眼表的影響

朱天夫，張潤琦，劉 青，林玉婷，楊燕燕

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·臨床論著·

超聲乳化術對糖尿病白內障患者眼表的影響

朱天夫1，張潤琦2，劉 青1，林玉婷1，楊燕燕1

?METHODS: A total of 74 patients with cataract and diabetes (100 eyes) who underwent phacoemulsification of senile cataract combined with intraocular lens (IOL) implantation were selected in our hospital from Apr.2014 to Dec.2014, and they were divided into the group A and group B according to with/without a history of diabetes. A total of 34 patients (50 eyes) with a history of diabetes more than 3y were assigned to group A, and 40 patients (50 eyes) without history of diabetes were assigned to group B. The dry eye-related symptom score, corneal fluorescein (FL) score, tear film break-up time (BUT), Schirmer Ⅰ test (SⅠt) and corneal endothelial cells were examined and compared in pre-therapy and post-treatment, respectively.

?RESULTS: Before operation, there was no significant difference on the dry eye-related symptom score, FL score, BUT, SⅠt and corneal endothelial cells between the two groups (P>0.05). After operation, the dry eye-related symptom score in group A and B were both greatly higher than that before operation (P<0.05). The FL score and SⅠt in group A after operation were both higher but BUT was lower than that before operation (P<0.05). In group B, the FL score and SⅠt were both higher on first day, 1 week, and 2 weeks after operation than that before operation, However, the BUT was lower on 1d and 1wk after operation than that before operation (P<0.05). All the observation indexes were restored in 1mo after operation. After operation, endothelial cell area in the two groups were both larger than that before operation, and the significant difference were found from 2wk after operation in group A but only 1wk after operation in group B (P<0.05). The number of corneal endothelial cells in group A and B after operation were both less than that before operation (P<0.05). All the observation targets between group A and B had a significant difference in 1mo after operation (P<0.05).

?CONCLUSION: The cataract phacoemulsification has a significant influence in ocular surface of patients with cataract and diabetes than that without diabetes.

目的：觀察白內障超聲乳化手術前后糖尿病白內障患者眼表狀態的變化。

方法：納入2014-04/12于我院就診并行白內障超聲乳化吸除聯合人工晶狀體(IOL)植入術的老年性白內障住院患者74例100眼。按照患者是否有糖尿病史分為兩組，A組：有3a以上糖尿病史患者，34例50眼；B組：無糖尿病史患者40例50眼。分別于手術前和術后第1d，1、2wk，1mo，觀察比較患者的干眼癥狀評分、淚膜破裂時間(break-up time，BUT)、角膜熒光素染色評分(fluorescent，FL)、淚液分泌試驗(Schirmer’s Ⅰ test，SⅠt)及角膜內皮細胞等指標，對結果進行統計學分析。

結果：術前，兩組患者的干眼癥狀評分、FL評分、BUT值、SⅠt值、平均內皮細胞面積及內皮細胞數差異均無統計學意義(P>0.05)。兩組患者術后各觀察時間點的干眼癥狀均明顯重于術前(P<0.05)。A組術后各時間點FL評分和SⅠt值均明顯高于術前，BUT明顯短于術前(P<0.05)；B組術后1d，1、2wk時FL評分和SⅠt值均明顯高于術前，術后1d、1wk時BUT明顯短于術前(P<0.05)。兩組患者術后平均內皮細胞面積均大于術前，A組術后2wk開始變化差異有統計學意義，B組術后1wk開始變化差異有統計學意義(P<0.05)。兩組患者術后各時間點的角膜內皮細胞數均顯著少于術前，差異有統計學意義(P<0.05)。A組和B組間比較，術后1mo時各指標變化差異均有統計學意義(P<0.05)。

結論：白內障超聲乳化手術對糖尿病白內障患者眼表的影響大于單純白內障患者，臨床上需加以注意。

白內障；糖尿病；白內障超聲乳化；眼表；淚膜

引用：朱天夫，張潤琦，劉青，等.超聲乳化術對糖尿病白內障患者眼表的影響.國際眼科雜志2016;16(12):2209-2212

0引言

老年性白內障是引起老年眼疾患者視力下降甚至失明的主要原因，隨著年齡增加，患病率明顯增高[1]。超聲乳化手術是目前治療白內障的首選手術治療方法，具有手術切口最小化、患者恢復時間快、術后視力恢復效果好等優點，但該手術易造成部分患者，特別是糖尿病白內障患者角膜內皮細胞損傷、淚膜不穩定及眼表損害[2-3]。糖尿……