摘要
目的探讨糖尿病合并白内障患者行微切口超声乳化白内障吸除术的治疗效果及术后视功能恢复情况,并分析影响术后视功能恢复情况的相关因素。方法回顾性选取2019年1月到2022年12月榆林市第二医院收治的150例糖尿病合并白内障患者作为研究对象,依照患者选择的手术方式分为观察组(n=100)与对照组(n=50)。对照组采取常规超声乳化吸除术,观察组采取微小切口超声乳化白内障吸除术,对比两组患者术后视力恢复情况,内皮细胞数目与眼压水平。并将观察组的100例患者依照术后视力恢复情况进行分组,分为<0.05组(n=17),0.05~0.2组(n=56),>0.2组(n=27),分析微切口超声乳化白内障吸除术后视功能恢复情况的单因素,并采用Logistic回归分析分析微切口超声乳化白内障吸除术后视功能恢复情况的多因素。结果手术后,两组视力<0.05患者比例均较手术前减少,视力>0.20患者比例均较手术前增加,且观察组视力<0.05患者比例为17.00%,低于对照组(34.00%),视力>0.20患者比例为54.00%,高于对照组(10.00%),差异均有统计学意义(P<0.05)。手术后7 d、1、3个月,两组患者的内皮细胞数目均较手术前降低,观察组手术后7 d内皮细胞数明显低于观察组,差异均有统计学意义(P<0.05),手术前、手术后1、3个月内皮细胞数目比较,差异均无统计学意义(P>0.05)。两组患者手术后7 d、手术后1、3个月眼压水平均较手术前降低,差异均有统计学意义(P<0.05),但观察组与对照组比较,差异均无统计学意义(P>0.05)。不同视力恢复情况的3组患者术后并发症、糖尿病视网膜病变分期、糖尿病病程、术前糖化血红蛋白水平比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果表明,糖尿病视网膜病变分期、术前糖化血红蛋白水平为影响微切口超声乳化白内障吸除术后视功能恢复情况的独立危险因素(P<0.05)。结论与常规超声乳化吸除术相比,对糖尿病合并白内障患者采取微小切口超声乳化白内障吸除术能够进一步促进患者术后视力功能恢复,但对患者术后内皮细胞数目与眼压水平无明显不良影响。另外,糖尿病视网膜病变分期与术前糖化血红蛋白水平是糖尿病合并白内障患者术后视力功能恢复影响的独立因素。
Objective To investigate the therapeutic effect of micro incision phacoemulsification cataract aspiration for diabetes patients with cataract and the postoperative visual function recovery,and analyze the related factors affecting the postoperative visual recovery.Methods One hundred and fifty patients with diabetes with cataract who were admitted to Yulin Second Hospital from January 2019 to December 2022 were retrospectively selected as the study subjects,and were divided into the observation group(n=100)and the control group(n=50)according to the operation mode selected by the patients.Patients in the control group who were treated with conventional phacoemulsification,and patients in the observation group who were treated with micro incision phacoemulsification.Postoperative visual recovery,endothelial cell count,and intraocular pressure levels of two groups were compared.Patients in the observation group who had undergone micro incision phacoemulsification were divided into groups according to the postoperative visual acuity recovery,and were divided into<0.05 group(n=17),0.05-0.20 group(n=56),and>0.20 group(n=27).The single factor of visual function recovery after micro incision phacoemulsification was analyzed,and the multiple factors of visual function recovery after micro incision phacoemulsification were analyzed by Logistic regression analysis.Results After operation,the proportion of patients with visual acuity<0.05 in both groups decreased compared to before surgery,while the proportion of patients with visual acuity>0.20 increased compared to before surgery,the proportion of patients with visual acuity<0.05 in the observation group was 17.00%,which was lower than the control group(34.00%),and the proportion of patients with visual acuity>0.20 was 54.00%,which was higher than the control group(10.00%),the differences were statistically significant(P<0.05).The number of endothelial cells in both groups decreased 7 days,1 month,3 months after operation,the number of endothelial cells in the observation group was significantly lower than that in the observation group 7 days after operation,the differences were statistically significant(P<0.05).The intraocular pressure of the two groups decreased significantly 7 days,1 month and 3 months after operation,the differences were statistically significant(P<0.05),but there was no significant difference between the observation group and the control group(P>0.05).Postoperative complications,stages of diabetes retinopathy,course of diabetes,and preoperative glycosylated hemoglobin levels in the three groups of patients with different levels of visual recovery were significantly different(P<0.05).Logistic regression analysis showed that the stage of diabetes retinopathy and preoperative glycosylated hemoglobin level were independent risk factors for visual function recovery after micro incision phacoemulsification(P<0.05).Conclusion Compared with conventional phacoemulsification,micro incision phacoemulsification for diabetes patients with cataract can further promote the recovery of postoperative visual function,but has no significant adverse effect on the number of endothelial cells and intraocular pressure.In addition,the stage of diabetes retinopathy and preoperative glycosylated hemoglobin level are independent factors affecting the recovery of visual function in diabetes patients with cataract after surgery.
作者
朱嘉丽
付金京
刘钊
ZHU Jia-li;FU Jin-jing;LIU Zhao(Department of Ophthalmology,Yulin Second Hospital,Yulin Shaanxi 719000,China;Department of Ophthalmology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China)
出处
《临床和实验医学杂志》
2023年第11期1186-1190,共5页
Journal of Clinical and Experimental Medicine
基金
陕西省科学技术厅软科学研究计划一般项目(编号:2018KRM174)。
