糖尿病患者行白内障超声乳化术后黄斑水肿的发生率及危险因素

Incidence and Risk Factorsof Macular Edema after Cataract Surgery in Diabetic Patients

摘要: 目的：探讨2型糖尿病患者行白内障超声乳化术后黄斑水肿(DME)的发生率及影响术后黄斑水肿发生的危险因素。方法：选择2018年6月至2019年6月期间于我院施行单眼白内障超声乳化手术的糖尿病患者77例(77眼)，详细询问患者糖尿病病史及胰岛素使用情况；高血压分级及控制情况；有无冠心病、脑梗死及其他全身疾病。术前测量患者空腹血糖、糖化血红蛋白、血压、血脂、蛋白尿，肌酐等等，并对眼底糖尿病视网膜病变进行分级。于术前、术后1天、1周、1月、三月分别行双眼光学相干断层扫描血流成像技术(OCTA)检查，测量患者的黄斑中心凹视网膜厚度，以术后中心凹视网膜厚度大于术前基线的30%判定为黄斑水肿的发生。根据结果将77眼分为黄斑水肿组与非黄斑水肿组，比较两组之间影响因素的差异。结果：77名糖尿病患者中，77只手术眼中23只眼发生黄斑水肿，发生率为29.9% (23/77)，对侧眼(0/77)无明显黄斑水肿的发生。水肿组与非水肿组之间，糖尿病视网膜病变(P < 0.001)，血清肌酐(P = 0.046)及糖化血红蛋白水平(P = 0.021)的差异具有统计学意义。结论：糖尿病患者行白内障超声乳化术后黄斑水肿的发生率高，伴有糖尿病视网膜病变、高血清肌酐及糖化红蛋白水平是白内障术后DME发生的独立危险因素。

Abstract: Objective: To study the macular edema (DME) after cataract surgery in patients with type-2 dia-betes and the related risk factors. Methods: Select 77 diabetic patients after cataract surgery in our hospital from June 2018 to June 2019, ask about their diabetes history and insulin usage; hy-pertension classification and control; whether there have coronary heart disease, cerebral infarc-tion and other systemic diseases; measure the fasting blood-glucose, glycosylated hemoglobin blood pressure, blood lipid, proteinuria, creatinine and so on before surgery and grade the funds of diabetic retinopathy. The optical coherence tomography angiography (OCTA) was used to check the thickness of the foveal retinal at pre-operation, postoperative 1 day, 1 week, 1 month and 3 months. Retinaover 30% of the baseline was judged to be the occurrence of macular edema. According to the test results, it divides the 77 eyes into macular edema group and non-macular edema group and compares the results of the two groups. Results: Among the 77 patients, postoperative macular edema occurred in 23 of the surgical eyes, with a incidence of 29.9% (23/77), no macular edema occurred in the fellow eyes (0/77). The diabetic retinopathy (P < 0.001), serum creatinine (P = 0.046) and HbA1c levels (P = 0.021) were with statistical differences in the two groups. Conclusion: The occurrence of DME in diabetics after cataract surgery is high. This study found that diabetic retinopathy, high serum creatinine, and HbA1c levels were independent risk factors for DME after cataract surgery.