手法小切口白内障手术对糖尿病白内障患者角膜变化的影响

Corneal changes in diabetic patients after manual small incision cataract surgery

摘要:

手法小切口白内障手术（MSICS）对糖尿病白内障患者角膜内皮细胞和角膜厚度变化的影响。方法60 例2 型糖尿病白内障患者60 只眼睛（糖尿病组）以及60 例年龄匹配的非糖尿病棕色白内障60 只眼睛（对照组）接受MSICS。术前、术后1、6 和12 周采用非接触角膜内皮显微镜检测所有患者角膜内皮细胞及角膜中央厚度。并且评估角膜内皮细胞形态学和六角形细胞百分比变化。结果对照组术前平均角膜内皮细胞计数高于糖尿病组（p <0.05）。两组术后角膜内皮细胞均减少（单因素方差分析p<0.05）。糖尿病组术后角膜内皮细胞数的减少（14.19%， p<0.05）高于非糖尿病组（8.05%）。糖尿病组角膜中央厚度增加大于对照组（p <0.05）。糖尿病组六角形细胞百分比的变化大于对照组（p <0.05）。组间变异系数的差异无统计学意义（p <0.05）。结论与非糖尿病患者相比，糖尿病患者MSICS 术后角膜内皮细胞损伤更多。建议糖尿病患者接受眼内手术前，对角膜内皮细胞进行评估。

Abstract:

To evaluate the changes in corneal endothelium and corneal thickness in patients with diabetes mellitus after manual small incision cataract surgery (MSICS). Methods Sixty eyes of 60 patients with type 2 diabetes mellitus (diabetic group) and 60 eyes of 60 age-matched patients of advanced cataract (control group) undergoing MSICS were evaluated. All the patients underwent specular microscopy for the corneal endothelial cell count of cornea and central corneal thickness before operation, and 1, 6 and 12 weeks after operation. The morphology, and variation in the endothelial size and shape and percentage of hexagonal cells were assessed. Results The mean pre-operative endothelial count in the control group was higher than that in the diabetic group (p < 0.05). The post-operative endothelial count significantly decreased in both groups (one-way ANOVA, p< 0.05). After operation the decrease in the endothelial cell number of the diabetic group (14.19%) was more obvious than that of the control group (8.05%, p< 0.05). The increase of central corneal thickness in the diabetic group was more significant as compared to the control group (p < 0.05). The change in the percentage of hexagon cells in the diabetic group was significantly bigger than that in the control group (p < 0.05). The coefficient of inter-group variation was not significantly differens (p > 0.05). Conclusions Compared to non-diabetic patients, diabetic patients have more damage of endothelial cells after MSICS. Corneal endothelial evaluation of diabetic patients is recommended before any intraocular surgery.