目的：观察终末期糖尿病肾病(end-stage diabetic nephropathy，ESDN)患者围血液透析期眼压(intraocular pressure，IOP)、眼灌注压(ocular perfusion pressure，OPP)、中央前房深度(central anterior chamber depth，CACD)和黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness，SFCT)变化的特点，评估血液透析(hemodialysis，HD)对ESDN患者眼部血供的可能影响。

方法：病例前后对照研究。观察我院肾病科HD治疗的ESDN患者42例84眼，在HD开始前30min、开始后2h、结束后30min内，分别测量收缩压和舒张压，手持式回弹式眼压计测量眼压，经换算得出OPP(OPP=4/9舒张压+2/9收缩压-眼压)。HD开始前30min和结束后30min内，分别采用光学相干生物测量仪测量CACD，光学相干断层扫描(optical coherence tomography，OCT)测量SFCT。对HD前后各测量参数采用方差齐性检验、ANOVA分析、LSD-t组间比较和配对样本t检验进行统计学分析。

结果：ESDN患者84眼中，HD开始前30min、开始后2h与结束后30min相比，收缩压差异无统计学意义(F=0.254，P=0.783)； 舒张压差异无统计学意义(F=0.114，P=0.896)； IOP差异有统计学意义(F=7.527，P=0.001)； OPP差异有统计学意义(F=4.692，P=0.027)。HD开始前30min与开始后2h相比，IOP差异有统计学意义(t=-3.646，P=0.001)，IOP较HD前升高； OPP差异有统计学意义(t=2.321，P=0.022)，OPP较HD前降低。HD开始前30min与结束后30min相比，IOP差异有统计学意义(t=-2.977，P=0.003)，IOP较HD前升高； OPP差异无统计学意义(t=0.219，P=0.872)； CACD差异有统计学意义(t=6.291，P<0.05)，CACD较HD前变浅； SFCT差异有统计学意义(t=5.736，P<0.05)，SFCT较HD前变薄。

结论：HD后可致ESDN患者IOP不同程度升高，OPP一过性降低，前房变浅，脉络膜血供减少。HD前应评估ESDN患者的眼部状况，采取有效的监测和预防措施，降低HD引起眼部血供状态变化对视功能的可能影响。

AIM: To observe the changes of intraocular pressure(IOP), ocular perfusion pressure(OPP), central anterior chamber depth(CACD)and subfoveal choroidal thickness(SFCT)in peri-hemodialysis in patients with end-stage diabetic nephropathy(ESDN), for evaluating the influences of hemodialysis(HD)on ocular blood supply of the ESDN patients.

METHODS: Totally 42 cases(84 eyes)of ESDN patients treated with HD in the Department of Nephrology were observed. Systolic and diastolic blood pressure, IOP with the hand-held rebound tonometer were measured at 30min before HD, 2h after HD duration and 30min after HD completion. OPP was calculated(OPP= 4/9 diastolic pressure + 2/9 systolic pressure - IOP). CACD measured by optical coherence measuring instrument(IOL-Master)and SFCT measured by optical coherence tomography(OCT)were observed at 30min before HD and 30min after HD completion. The outcomes were assessed by analysis of homogeneity test of variance, one-way ANOVA, LSD-t test and t-test, to look for differences of the parameters in various time of HD.

RESULTS: Totally 84 eyes of ESDN patients: in 30min before HD, 2h after HD duration and 30min after HD completion, systolic blood pressure was no statistically significant(F=0.254, P=0.783), and diastolic blood pressure was no statistically significant(F=0.114, P=0.896), and IOP was statistically significant(F=7.527, P=0.001), and OPP was statistically significant(F=4.692, P=0.027). In 2h after HD duration and 30min after HD completion, IOP was statistically significant(t=-3.646, P=0.001), and OPP was statistically significant(t=2.321, P=0.022). In 30min before HD and 30min after HD completion, increase of IOP was statistically significant(t=-2.977, P=0.003), and OPP was no statistically significant(t=0.219, P=0.872), and decrease of CACD was statistically significant(t=6.291, P<0.05), and decrease of SFCT was statistically significant(t=5.736, P<0.05).

CONCLUSION: IOP increasing, OPP transiently decreasing, CACD shallow and SFCT thin were presented in peri-hemodialysis. It is important to evaluate eye conditions of ESDN patients before HD, and to take effective preventive measures to reduce the possible risk factors in peri-hemodialysis.