超声乳化术对伴有糖尿病的白内障患者角膜内皮的影响

Effect of phacoemulsification on the corneal endothelium of diabetic patients with cataract

摘要:

目的：观察伴有糖尿病的白内障患者与单纯白内障患者在超声乳化术后角膜内皮的变化情况。

方法：选取2016-10/2017-06在广西壮族自治区人民医院确诊的白内障(cataract)患者78例92眼，按照有无糖尿病分为糖尿病组与非糖尿病组，其中糖尿病组40例44眼，非糖尿病组38例48眼。所有患者均由同一经验丰富的眼科医师行白内障超声乳化术联合人工晶状体植入术，分别于术前，术后1、4、8wk采用非接触式角膜内皮计数仪检测角膜内皮细胞密度(corneal endothelial density，CED)、六角形细胞比例(hexagonal cell percentage，HCR)、变异系数(variation coefficients，CV)、中央角膜厚度(central corneal thickness，CCT)。利用共焦显微镜记录术前、术后4、8wk的角膜内皮细胞形态。分别观察两组术中虹膜松弛综合征的发生情况。

结果：糖尿病组与非糖尿病组术前比较，角膜内皮六角形细胞比例降低，变异系数增大，差异均有统计学意义(P<0.05)，角膜内皮细胞密度及中央角膜厚度差异均无统计学意义(P>0.05)； 糖尿病组与非糖尿病组术后不同时间点相比较，六边形细胞比例减低，变异系数增大，差异均有统计学意义(P<0.05)，角膜内皮细胞密度及中央角膜厚度差异均无统计学意义(P>0.05)； 两组术后1、4、8wk的角膜内皮细胞密度及六角形细胞比例相较于术前均明显降低，变异系数相较于术前明显增高，差异均有统计学意义(P<0.05)，术后1wk的中央角膜厚度相较于术前明显增厚，差异有统计学意义(P<0.05)，而术后4、8wk与术前相比无统计学意义(P>0.05)； 糖尿病组与非糖尿病组术前、术后4、8wk的角膜内皮细胞形态比较，术前糖尿病组角膜内皮细胞形态异型性较大，胞体大小不一，术后4wk糖尿病组的内皮细胞多形性增多，胞体大小各异，可见较大细胞核，术后8wk糖尿病组恢复较慢，仍可见不规则的内皮细胞及尚大的细胞核。糖尿病组术中虹膜松弛综合征的发生率为14%，非糖尿病组发生率为0。

结论：糖尿病及超声乳化术都会对角膜内皮细胞造成损害，同时超声乳化术对糖尿病患者的角膜内皮细胞形态影响较大且恢复较慢。糖尿病可能与虹膜松弛综合征的发生有关。

Abstract:

AIM:To evaluate the changes of corneal endothelium after phacoemulsification in diabetic patients with cataract and simple cataract.

METHODS: A total of 92 eyes of 78 patients with cataract were diagnosed from October 2016 to June 2017 in People's Hospital of Guangxi Zhuang Autonomous Region. Two groups were divided into diabetic group and non-diabetic group according to whether there was diabetes or not. The diabetes group had 40 patients(44 eyes)and non-diabetes group had 38 patients(48 eyes). All patients were performed phacoemulsification combined with intraocular lens implantation by an experienced ophthalmologist. And then, corneal endothelial density(CED), hexagonal cell percentage(HCR), coefficient of variation(CV)and central corneal thickness(CCT)were detected by non-contact corneal endothelium count instrument before surgery and 1, 4 and 8wk after surgery. Meanwhile, the morphology of corneal endothelium was detected by confocal microscope before surgery and 4 and 8wk after surgery. And the occurrence of intraoperative floppy iris syndrome in the two groups was observed respectively.

RESULTS: Compared with non-diabetes group, the preoperative percentage of hexagonal cell in diabetes group was decreased, the coefficient of variation was increased, the differences were statistically significant(P<0.05); but there were no significant difference in corneal endothelial density and central corneal thickness(P>0.05). Compared with non-diabetes group, the postoperative percentage of hexagonal cell in diabetes group at different time points was decreased, coefficient of variation was increased, the differences were statistically significant(P<0.05),the difference in corneal endothelial density and central corneal thickness were not statistically significant(P>0.05). Compared with pre-operation, the percentage of hexagonal cell and corneal endothelial density in diabetes group and non-diabetes group at postoperative 1,4 and 8wk were decreased obviously, coefficient of variation was further increased, there were statistical difference(P<0.05); the central corneal thickness at postoperative 1wk was obvious incrassation, there was statistical difference(P<0.05), but there was no significant difference in the central corneal thickness at postoperative 4 and 8wk(P>0.05); comparison of the morphology of corneal endothelium at pre-operation and the morphology of corneal endothelium at postoperative between two groups, the preoperative heteromorphism of morphology of corneal endothelium in diabetes group was obvious, size of a pleomorphic endothelial cell was different; at postoperative 4wk, the heteromorphism of morphology of corneal endothelium was further obviously and so was size of cell body, we could see the big nucleus; at postoperative 8wk, morphology of corneal endothelium in diabetes group recovered more slowly, we still saw many irregular endothelium and large nucleus. The incidence of intraoperative floppy iris syndrome in the diabetic group was 14%, and the non-diabetic group was 0.

CONCLUSION: Diabetes and phacoemulsification can damage corneal endothelium. Meanwhile, phacoemulsification has a great effect on morphology of corneal endothelium in diabetic group, and recovery of morphology of corneal endothelium is slower. Diabetes may be associated with the occurrence of intraoperative floppy iris syndrome.