白内障超声乳化术对糖尿病患者角膜内皮细胞和中央角膜厚度影响
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摘要
目的:评估糖尿病患者和非糖尿病患者在行白内障超声乳化手术后,角膜内皮细胞和中央角膜厚度变化。方法:观察于我院行白内障超声乳化吸出联合人工晶状体植入术的年龄相关性白内障患者各100例(100眼),于术前1天、术后1周、1个月、3个月、6个月和1年随访记录其角膜内皮细胞密度(endothelial cell density, ECD)、六角形细胞百分比(percentage of hexagonal cells,PHC)、变异系数(coefficient of variation, CV)和中央角膜厚度(central corneal thickness, CCT)等指标,并对结果进行统计学分析。结果:非糖尿病组在术前各指标无明显差异(P>0.05),术后1年ECD, PHC在两组均下降,CV升高(P<0.05),CCT出现明显波动,糖尿病组在术后一周达到峰值。ECD,CV和PHC在术后各时间点出现明显的组间差异(P<0.05)。结论:白内障超声乳化术后远期内,糖尿病组的角膜内细胞和中央角膜厚度较非糖尿病组发生显著变化。
Objective: Here we intended to investigate the changes in corneal endothelial cells and central corneal thickness after phacoemulsification surgery on the eyes of diabetic and non-diabetic cataract patients. Methods: A total of 200 cataract patients who were scheduled for phacoemulsification surgery and intraocular lens implantation were recruited and divided into 2 categories(100 hundred eyes each group). Changes in endothelial cell density(ECD), coefficient of variation(CV), percentage of hexagonal cells(PHC), central corneal thickness(CCT) were all recorded at preoperative day 1 and postoperative 1 week, 1 month, 3 months, 6 months and 1 year. Results:None of the recorded variables showed any difference between the nondiabetic and diabetic groups before surgery(P>0.05). During the postoperative 1 year, ECD and PHC decreased in both groups(all P<0.05) while CV increased, whereas CCT and fluctuated in both groups significantly(both P<0.05), with the peaks at postoperative 1 week in the diabetic group. The groups differed significantly in ECD, CV and PHC at each time point postoperatively(all P<0.05). Conclusions: The diabetic group had more changes in a long time in corneal endothelial cells and central corneal thickness than the nondiabetic group postoperatively.
Objective: Here we intended to investigate the changes in corneal endothelial cells and central corneal thickness after phacoemulsification surgery on the eyes of diabetic and non-diabetic cataract patients. Methods: A total of 200 cataract patients who were scheduled for phacoemulsification surgery and intraocular lens implantation were recruited and divided into 2 categories(100 hundred eyes each group). Changes in endothelial cell density(ECD), coefficient of variation(CV), percentage of hexagonal cells(PHC), central corneal thickness(CCT) were all recorded at preoperative day 1 and postoperative 1 week, 1 month, 3 months, 6 months and 1 year. Results:None of the recorded variables showed any difference between the nondiabetic and diabetic groups before surgery(P>0.05). During the postoperative 1 year, ECD and PHC decreased in both groups(all P<0.05) while CV increased, whereas CCT and fluctuated in both groups significantly(both P<0.05), with the peaks at postoperative 1 week in the diabetic group. The groups differed significantly in ECD, CV and PHC at each time point postoperatively(all P<0.05). Conclusions: The diabetic group had more changes in a long time in corneal endothelial cells and central corneal thickness than the nondiabetic group postoperatively.
引文
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[18]Pineles SL,Chang MY,Oltra EL,et al.Anterior segment ischemia:etiology,assessment,and management[J].Eye,2018,32(2):173-178.134
[19]Al-Mohtaseb Z,He X,Yesilirmak N,et al.Comparison of corneal endothelial cell loss between two femtosecond laser platforms and standard phacoemulsification[J].J Refrac Surg,2017,33(10):708-712
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[22]Calvo-Maroto AM,Cervino A,Perez-Cambrodi RJ,et al.Quantitative corneal anatomy:evaluation of the effect of diabetes duration on the endothelial cell density and corneal thickness[J].Ophthalmic Physiol Opt,2015,35(3):293-298
[2]Goktas A,Gumus K,Mirza GE.Corneal endothelial characteristics and central corneal thickness in a population of Turkish cataract patients[J].Eye Contact Lens,2012,38:142-145
[3]Society Cd.China guideline for type 2 diabetes(2013 Edition)[J].Chin J Diabetes,2014,22:2-42
[4]Dhasmana R,Singh I,Nagpal RC,et al.Corneal changes in diabetic patients after manual small incision cataract surgery[J].J Clin Diagn Res,2014,8:VC03-6
[5]Bucht C,Sderberg P,Manneberg G,et al.Simulation of specular microscopy images of corneal endothelium,a tool for control of measurement errors[J].Acta Ophthal,2011,89:e242-250
[6]Chou ML,Burnouf T,Wang TJ,et al.Ex vivo expansion of bovine corneal endothelial cells in xeno-free medium supplemented with platelet releasate[J].PloS One,2014,9:e99145
[7]Sudhir RR,Raman R,Sharma T,et al.Changes in the corneal endothelial cell density and morphology in patients with type 2 diabetes mellitus:a population-based study,Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study(SN-DREAMS,Report23)[J].Cornea,2012,31:1119-1122
[8]Goktas A,Gumus K,Mirza GE,et al.Corneal endothelial characteristics and central corneal thickness in a population of Turkish cataract patients[J].Eye Contact Lens,2012,38:142-145
[9]Joyce NC.Proliferative capacity of the corneal endothelium[J].Prog Retin Eye Res,2003,22:359-389
[10]Kim DH,Wee WR,Hyon JY.The pattern of early corneal endothelial cell recovery following cataract surgery:cellular migration or enlargement?[J].Graef Arch Clin Exp,2015,253:2211-2216
[11]Orski M,Synder A,Pa覥enga-Pydyn D,et al.The effect of the selected factors on corneal endothelial cell loss following phacoemulsification[J].Klin Oczna,2013,116:94-99
[12]Conrad-Hengerer I,Al Juburi M,Schultz T,et al.Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery:three-month follow-up[J].JCataract Refract Surg,2013,39(9):1307-1313
[13]Yagi-Yaguchi Y,Yamaguchi T,Higa K,et al.Preoperative aqueous cytokine levels are associated with a rapid reduction in endothelial cells after penetrating Keratoplasty[J].Am J Ophthalmol,2017,181:166-173
[14]Yazu H,Yamaguchi T,Aketa N,et al.Preoperative aqueous cytokine levels are associated with endothelial cell loss after Descemet's stripping automated endothelial Keratoplasty[J].Invest Ophthalmol Vis Sci,2018,59(2):612-620
[15]Yamaguchi T,Higa K,Suzuki T,et al.Elevated cytokine levels in the aqueous humor of eyes with bullous keratopathy and low endothelial cell density[J].Invest Ophthalmol Vis Sci,2016,57(14):5954-5962
[16]Patel DK,Prasad SK,Kutnar R,et al.Cataract:a major secondary complication of diabetes,its epidemiology and an overview on major medicinal plants screened for anticataract activity[J].Asian Pacifie JTropical Dis,2011,1:323-329
[17]Shenoy R,Khandekar R,Bialasiewicz A,et al.Corneal endothelium in patients with diabetes mellitus:a historical cohort study[J].European journal of ophthalmology,2008,19:369-375
[18]Pineles SL,Chang MY,Oltra EL,et al.Anterior segment ischemia:etiology,assessment,and management[J].Eye,2018,32(2):173-178.134
[19]Al-Mohtaseb Z,He X,Yesilirmak N,et al.Comparison of corneal endothelial cell loss between two femtosecond laser platforms and standard phacoemulsification[J].J Refrac Surg,2017,33(10):708-712
[20]Herse PR.Corneal hydration control in normal and allox-an-induced diabetic rabbits[J].Invest Ophthalmol Vis Sci,1990,31:2205-2213
[21]Tsaousis KT,Panagiotou DZ,Kostopoulou E,et al.Corneal oedema after phacoemulsification in the early postoperative period:a qualitative comparative case-control study between diabetics and non-diabetics[J].Ann Med Surg,2016,5:67-71
[22]Calvo-Maroto AM,Cervino A,Perez-Cambrodi RJ,et al.Quantitative corneal anatomy:evaluation of the effect of diabetes duration on the endothelial cell density and corneal thickness[J].Ophthalmic Physiol Opt,2015,35(3):293-298