糖尿病患者与非糖尿病患者玻璃体切除手术后角膜内皮差异

Differences in Corneal Endothelium Cell after Pars Plana Vitrectomy: Diabetes Mellitus versus Non-Diabetes Mellitus Patients

摘要: 目的：本研究目的是用体内角膜共聚焦显微镜(Corneal Confocal Microscopy, CCM)分析糖尿病患者和非糖尿病患者玻璃体切除手术后角膜内皮差异。方法：对实施玻璃体切除手术患者进行前瞻性研究，纳入接受玻璃体切除术的糖尿病患者23人和非糖尿病患者23人，手术方式不合并白内障超声乳化吸除联合人工晶体植入术，为期10个月，记录年龄、性别、具体手术方式、手术时间和糖化血红蛋白。在术前和术后2周进行CCM测量角膜内皮细胞密度，所有统计分析均使用SPSS统计软件进行。结果：玻璃体切除术后两组患者角膜内皮细胞密度均降低。术后角膜内皮损失率糖尿病组显著高于非糖尿病组(t = −2.579, P = 0.013)。在糖化血红蛋白 ≥ 6.5%时，角膜内皮损失率与糖化血红蛋白负相关(b = 0.036, P = 0.036)，糖化血红蛋白每升高1%，角膜内皮损失率升高3.6%。此外，短手术时间组和长手术时间组中糖尿病组角膜内皮的损失率与非糖尿病组无统计学意义(P > 0.05)；结论：糖尿病患者玻璃体切除术后角膜内皮损伤更显著，提示高血糖环境可能加剧角膜修复障碍，HbA1c ≥ 6.5%的糖尿病患者术后内皮损伤风险显著增加。

Abstract: Objective: To analyze the differences in corneal endothelial cells between diabetes mellitus and non-diabetes mellitus following Pars Plana Vitrectomy (PPV) using in vivo confocal microscopy. Methods: A prospective study was conducted on patients following PPV. A total of 23 diabetic patients and 23 non-diabetic patients who underwent PPV without combined phacoemulsification and intraocular lens implantation were enrolled over a 10-month period. Data recorded included age, sex, specific surgical procedure, operative time, and glycated hemoglobin (HbA1c) levels. Corneal Confocal Microscopy (CCM) was performed preoperatively and at 2 weeks postoperatively to measure corneal endothelial cell density. All statistical analyses were performed using SPSS software. Results: Corneal endothelial cell density decreased in both groups after PPV. The postoperative corneal endothelial cell loss rate was significantly higher in the diabetic group compared to the non-diabetic group (t = −2.579, P = 0.013). In patients with HbA1c ≥ 6.5%, the endothelial cell loss rate was positively correlated with HbA1c levels (b = 0.036, P = 0.036), indicating that for every 1% increase in HbA1c, the endothelial cell loss rate increased by 3.6%. Furthermore, no statistically significant difference in endothelial cell loss rate was observed between diabetes mellitus and non-diabetes mellitus when comparing short and long operative time subgroups (P > 0.05). Conclusion: Corneal endothelial damage following PPV is more pronounced in diabetes mellitus, suggesting that a hyperglycemic environment may exacerbate impaired corneal repair. Diabetic patients with HbA1c ≥ 6.5% are at significantly increased risk of postoperative endothelial injury.