目的：探讨糖尿病性白内障患者术后角膜内皮细胞和泪膜的变化。

方法：回顾性分析本院2016-06/2017-06收治的88例88眼糖尿病性白内障患者(研究组)，另选取本院100例100眼单纯年龄相关性白内障患者(对照组)，两组患者均在本院行超声乳化吸出术联合折叠式人工晶状体植入术。术后随访3mo，采用Topcon SP-3000p型非接触角膜内皮检查仪检查两组患者手术前后角膜内皮细胞密度、内皮细胞变异系数、六角形细胞比例，观察两组患者泪膜破裂时间(break-up time，BUT)、基础泪液分泌试验(Schirmer Ⅰ t，SⅠt)、角膜荧光素染色(fluorescein staining，FL)的变化。

结果：治疗前和治疗后7d两组患者间角膜内皮细胞密度比较，差异无统计学意义(P>0.05)； 治疗后3mo研究组角膜内皮细胞密度显著低于对照组，差异有统计学意义(P<0.05)； 治疗后两组各时间段的角膜内皮细胞密度变化较治疗前明显下降，差异有统计学意义(P<0.05)。治疗后7d，3mo两组患者角膜内皮细胞变异系数比较，差异有统计学意义(P<0.05)； 治疗后两组患者角膜内皮细胞变异系数水平高于治疗前，差异有统计学意义(P<0.05)。治疗后两组患者六角形细胞比例低于治疗前，差异有统计学意义(P<0.05)； 治疗7d，3mo后研究组六角形细胞比例明显低于对照组，差异有统计学意义(P<0.05)。治疗前两组患者BUT、SⅠt、FL比较，差异无统计学意义(P>0.05)； 治疗7d后两组患者BUT、FL比较，差异无统计学意义(P>0.05)，研究组患者SⅠt低于对照组，差异有统计学意义(P<0.05)； 治疗后3mo研究组BUT、SⅠt均显著低于对照组，差异有统计学意义(P<0.05)，但FL与对照组比较，差异无统计学意义(P>0.05)； 治疗后两组患者BUT、SⅠt、FL与治疗前比较，差异有统计学意义(P<0.05)。

结论：白内障超声乳化吸出术对角膜内皮细胞有一定损害，破坏泪膜的稳定性，尤其是糖尿病性白内障患者角膜内皮细胞受损更严重，且术后恢复较慢。

METHODS: Totally 88 patients(88 eyes)with diabetic cataract(study group)treated in our hospital from June 2016 to June 2017 were retrospectively analyzed, and 100 patients(100 eyes)with senile cataract(control group)were selected. Patients of two groups underwent phacoemulsification and foldable intraocular lens implantation and followed up for 3mo. The corneal endothelial cell density, endothelial cell coefficient of variation and hexagonal cell proportion were measured by TOPCON SP - 3000P non-contact corneal endothelial tester before and after operation in two groups. The tear break-up time(BUT), basal tear secretion test(SⅠt)and corneal fluorescein test(FL)in two groups were observed.

RESULTS: There was no difference in corneal endothelial cell density between the two groups before treatment and 7d after treatment(P>0.05). The corneal endothelial cell density in the study group was significantly lower than that in the control group(3mo after treatment)(P<0.05). The density of corneal endothelial cells decreased significantly in two groups at each time points after treatment(P<0.05). The variation coefficient of corneal endothelial cells showed significant difference between groups at 7d and 3mo after treatment(P<0.05). The variation coefficient levels of corneal endothelial cells in both groups increased after treatment(P<0.05). The ratio of hexagonal cells decreased after treatment(P<0.05), and the ratio of hexagonal cells at 7d and 3mo after treatment in study group was significantly lower than that of the control group(P<0.05). Before treatment, there was no difference in BUT, SⅠt and FL between the two groups(P>0.05). BUT and FL between the two groups at 7d after treatment had no significant difference(P>0.05), while the SⅠt of the study group was significantly lower than that of the control group(P<0.05). BUT and SⅠt of the study group were significantly lower than those of the control group at 3mo after treatment(P<0.05), with no difference in FL between the two groups(P>0.05). After treatment, BUT, SⅠt and FL were improved in the two groups(P<0.05).

CONCLUSION: Phacoemulsification has some damage to corneal endothelial cells and destroys the stability of tear film, corneal endothelial cells are damaged more severely and recover slowly after operation especially in diabetic cataract patients.