南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (04): 500-.doi: 10.12122/j.issn.1673-4254.2019.04.19

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超声乳化术中较低累计能量复合参数有助于2型糖尿病白内障患者的治疗

翟建伟，苏伟，唐作翼，陆兰芬，黄晓棠，韦柳丹   

  • 出版日期:2019-04-20 发布日期:2019-04-20

Phacoemulsification cataract surgery with different cumulative energy composite parameters in patients with type 2 diabetes mellitus: therapeutic effect and complications

  • Online:2019-04-20 Published:2019-04-20

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摘要： 目的探讨超声乳化术中不同累计能量复合参数对2型糖尿病白内障患者的临床意义。方法选取我院2017年1月~2018 年9月收治的2型糖尿病白内障患者252例（252眼），根据不同的累计能量复合参数，分为A、B两组，A组150例（150眼），累计能 量复合参数为8；B组102例（102眼），累计能量复合参数为10，同时将无2型糖尿病白内障患者90例（90眼）作为对照组，累计超 声能量参数为10。3组患者均接受白内障超声乳化术治疗，分析黄斑厚度及最佳矫正视力、视力、术后渗漏发生情况，包括术前、 术后1周、术后1月、术后3月等阶段。结果3组在进行超声乳化术前后的各指标差异有统计学意义（P<0.05），术后视力明显好 于术前。术后3月A组视力<0.1、≥1.0的比例、黄斑厚度、最佳矫正视力、渗透率与B组差异有统计学意义（P<0.05），而与对照组 差异无统计学意义（P>0.05）。术后1月、3月，A组与对照组的视力无差异，A组视力<0.1的比例小于B组（P<0.05），视力≥1.0的 比例大于B组（P<0.05）。术后1月，A组总渗漏率31.1%高于对照组21.1%，与B组无显著差异，但A组的弥漫性渗漏11.7%高于 对照组的2.2%（P<0.05）；术后3月,A组的总渗漏率10%小于B组的32.4%（P<0.05），主要是弥漫性渗漏与局部渗漏的差异。结 论超声乳化术可有效改善白内障患者的视力，并对非糖尿病白内障患者效果明显，同时较低的累计能量复合参数有助于2型糖 尿病白内障患者的治疗。黄斑厚度、局部性渗透和弥漫性渗透可作为超声乳化术后视力恢复、稳定的参考。

Abstract: Objective To evaluate the effect of different cumulative energy composite parameters on the outcomes of phacoemulsification cataract surgery in patients with type 2 diabetes mellitus. Methods A total of 252 patients with cataract (involving 252 eyes) and type 2 diabetes mellitus received phacoemulsification cataract surgery in our hospital between January, 2017 and June, 2019. The patients were divided into group A (150 cases) and group B (102 cases) for cataract phacoemulsification with cumulative energy composite parameters of 8 and 10, respectively, and 90 nondiabetic patients received cataract phacoemulsification with a cumulative energy composite parameters of 10 served as the control. The macular thickness, best corrected visual acuity, visual acuity, and postoperative leakage in the 3 groups were evaluated at 1 week, 1 month, and 3 months after the surgery. Results The visual acuity was significantly improved after phacoemulsification better in all the 3 groups. At 3 months after the surgery, the proportions of patients with visual acuity ratio <0.1 or >1.0, macular thickness, best corrected visual acuity and permeability differed significantly between groups A and B (P<0.05), but not between group A and the control group (P>0.05). At 1 month and 3 months after the surgery, the proportion of patients with visual acuity ratio <0.1 was significantly lower and the rate of visual acuity ratio >1.0 was higher in group A than in group B. At 1 month after the operation, the total leakage rate in group A (31.1%) was higher than that in the control group (21.1%) but comparable with that in group B; at 3 months, the total leakage rates were significantly lower in group A than in group B (10.0% vs 32.4%, P<0.05), and the leakage resulted mainly from local and diffuse permeation. Conclusion Phacoemulsification can effectively improve the visual acuity of cataract patients especially in non-diabetic patients. A lower cumulative energy composite parameter achieves better outcomes in type 2 diabetic patients with cataract. The macular thickness, local infiltration and diffuse leakage can be used as indicators for assessing visual recovery and stabilization after phacoemulsification.