一项关于2型糖尿病患者单纯超声乳化白内障手术后糖尿病视网膜病变和黄斑病变自然病程的前瞻性病例对照研究。
A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes.
作者信息
Squirrell D, Bhola R, Bush J, Winder S, Talbot J F
机构信息
Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield S10 2RX, UK.
出版信息
Br J Ophthalmol. 2002 May;86(5):565-71. doi: 10.1136/bjo.86.5.565.
AIM
To determine if uncomplicated phacoemulsification cataract surgery is associated with an accelerated rate of progression of diabetic retinopathy or maculopathy postoperatively.
METHODS
A prospective trial of 50 type 2 diabetics undergoing monocular phacoemulsification cataract surgery by a single consultant surgeon. The grade of diabetic retinopathy and diabetic maculopathy in the operated and non-operated fellow eye was assessed preoperatively and for 12 months postoperatively.
RESULTS
Overall, retinopathy progression was observed in 11 patients. In seven the retinopathy progressed in both eyes, in three it progressed in the operated eye alone, and in one it progressed in the fellow eye alone. Macular oedema was observed in 13 eyes postoperatively. Four had transient pseudophakic cystoid macular oedema and nine true diabetic maculopathy. Where maculopathy progressed it did so symmetrically in five patients, it progressed in the operated eye alone in four patients, and the fellow eye alone in two patients. There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively. In both the operated (OE) and non-operated (NoE) eyes retinopathy progression was associated with a higher mean HbA(1)C (OE p=0.003; NoE p=0.001) and insulin treatment (OE p=0.008, NoE p=0.04).
CONCLUSION
Uncomplicated phacoemulsification cataract surgery does not cause acceleration of diabetic retinopathy postoperatively and any progression that is observed probably represents the natural history of the disease. Although macular oedema is common after cataract surgery it may follow a benign course and in many patients the development of clinically significant macular oedema postoperatively probably represents natural disease progression rather than being a direct effect of surgery.
目的
确定单纯性白内障超声乳化手术是否与术后糖尿病视网膜病变或黄斑病变的加速进展相关。
方法
一项前瞻性试验，纳入50例接受单眼白内障超声乳化手术的2型糖尿病患者，由同一位顾问外科医生进行手术。术前及术后12个月评估手术眼及对侧未手术眼的糖尿病视网膜病变和糖尿病黄斑病变分级。
结果
总体而言，11例患者出现视网膜病变进展。其中7例双眼视网膜病变进展，3例仅手术眼视网膜病变进展，1例仅对侧眼视网膜病变进展。术后13只眼出现黄斑水肿。4例有短暂的人工晶状体性囊样黄斑水肿，9例为真正的糖尿病性黄斑病变。黄斑病变进展的患者中，5例为双眼对称进展，4例仅手术眼进展，2例仅对侧眼进展。术后视网膜病变或黄斑病变进展的手术眼和对侧眼数量无显著差异。手术眼和未手术眼中，视网膜病变进展均与较高的平均糖化血红蛋白（手术眼p = 0.003；未手术眼p = 0.001）及胰岛素治疗相关（手术眼p = 0.008，未手术眼p = 0.04）。
结论
单纯性白内障超声乳化手术不会导致术后糖尿病视网膜病变加速进展，观察到的任何进展可能代表疾病的自然病程。尽管白内障手术后黄斑水肿很常见，但可能呈良性病程，在许多患者中，术后临床上显著的黄斑水肿发展可能代表疾病自然进展，而非手术的直接影响。
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