白内障超声乳化联合内眼全视网膜光凝术治疗糖尿病性视网膜病变的疗效及安全性分析

Clinical Study on Efficacy and Safety of Phacoemulsification Combined with Intraocular Panretinal Photocoagulation in Diabetic Retinopathy

摘要: 目的：评估白内障超声乳化联合内眼全视网膜激光光凝术(PRP)治疗糖尿病性视网膜病变(DR)的安全性及有效性。方法：回顾性纳入2024年1月至2024年10月确诊为重度非增殖期(NPDR)或增殖期糖尿病性视网膜病变(PDR)且合并白内障的15例患者(15眼)。所有患者行白内障超声乳化联合25G内眼PRP治疗，术后随访1个月，记录最佳矫正视力(BCVA)、眼压、脉络膜厚度及并发症。BCVA采用LogMAR量表评估，统计学分析采用配对t检验及单因素方差分析。结果：15例15只眼中，男性7例7只眼，女性8例8只眼；年龄45~68 (59.27 ± 6.71)岁。患眼手术前及术后1天、术后1个月，logMAR BCVA分别为0.91 ± 0.34、0.78 ± 0.29、0.63 ± 0.26；眼压分别为(14.2 ± 3.1)、(16.8 ± 2.9)、(14.5 ± 2.7) mmHg；脉络膜厚度分别为(233.93 ± 72.47)、(295.67 ± 78.92)、(260.00 ± 73.69) μm。与手术前比较，BCVA：手术后1天、手术后1个月时差异有统计学意义(F = 5.617, P < 0.001)；脉络膜厚度：手术后1天显著升高，手术后1个月较手术后1天回落，仍高于基线数值(P < 0.001)；眼压：术前眼压以12~18 mmHg范围为主(53.3%, 8/15)，术后1天眼压 > 18 mmHg的比例显著升高至46.7% (7/15)，与术前相比差异具有统计学意义(P = 0.013)。术后1月眼压恢复至术前水平(>18 mmHg占比13.3%)，与术前无显著差异(P = 0.862)。所有患眼手术中及手术后均未发生黄斑裂孔、感染性眼内炎、视网膜脱离等并发症。结论：白内障手术联合内眼PRP可一次性解决DR患者屈光间质混浊及视网膜缺血问题，显著改善视力且安全性良好。

Abstract: Objective: To evaluate the safety and efficacy of phacoemulsification combined with internal eye panretinal photocoagulation (PRP) for the treatment of diabetic retinopathy (DR). Methods: A retrospective study was conducted on 15 patients (15 eyes) diagnosed with severe non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) with concurrent cataracts from January to October 2024. All patients underwent phacoemulsification combined with 25G internal eye PRP treatment. Follow-up was conducted for 1 month postoperatively to record best-corrected visual acuity (BCVA), intraocular pressure (IOP), choroidal thickness, and complications. BCVA was assessed using the LogMAR scale, and statistical analysis was performed using paired t-tests and one-way analysis of variance. Results: Among the 15 eyes of 15 patients, there were 7 male eyes (7 patients) and 8 female eyes (8 patients), with an average age of 59.27 ± 6.71 years (range, 45~68 years). The logMAR BCVA before surgery and at 1 day and 1 month postoperatively were 0.91 ± 0.34, 0.78 ± 0.29, and 0.63 ± 0.26, respectively. The IOP values were 14.2 ± 3.1 mmHg preoperatively, 16.8 ± 2.9 mmHg at 1 day postoperatively, and 14.5 ± 2.7 mmHg at 1 month postoperatively. The choroidal thickness values were 233.93 ± 72.47 µm preoperatively, 295.67 ± 78.92 µm at 1 day postoperatively, and 260.00 ± 73.69 µm at 1 month postoperatively. Compared with preoperative values, BCVA showed statistically significant differences at 1 day and 1 month postoperatively (F = 5.617, P < 0.001). Choroidal thickness increased significantly 1 day postoperatively and decreased at 1 month postoperatively but remained higher than baseline values (P < 0.001). Intraocular pressure primarily ranged from 12 to 18 mmHg preoperatively (53.3%, 8/15), with a significant increase in eyes with pressure > 18 mmHg one day post-surgery (46.7%, 7/15) showing a significant difference compared to preoperative values (P= 0.013). At 1 month postoperatively, IOP returned to preoperative levels (P = 0.862). No complications such as macular hole, endophthalmitis, or retinal detachment occurred during or after surgery in any of the eyes. Conclusion: Phacoemulsification combined with internal eye PRP can effectively address both the opacification of the refractive media and retinal ischemia in DR patients in a single procedure, significantly improving visual acuity with good safety.