Li Hai-yan, Luo Guo-chun, Guo Jiang, Liang Zhen
Department of Endocrinology, the Second People's Hospital of Shenzhen, Shenzhen, China.
Zhonghua Nei Ke Za Zhi. 2010 Oct;49(10):855-8.
To evaluate effects of glycemic control on refraction in diabetic patients.
Twenty newly diagnosed diabetic patients were included in this study. The random blood glucose, glycosylated hemoglobin A1c (HbA1c) levels, fasting C-peptide and postprandial 2 h C-peptide levels were measured before treatment. The patients with random blood glucose ≥ 12.0 mmol/L and HbA1c ≥ 10.0% were selected. Refraction, intraocular pressure, radius of the anterior corneal curvature, depth of the anterior chamber, lens thickness, vitreous length, and axial length were measured on admission and at the end of week 1, 2, 3 and 4 during glycaemic control.
A transient hyperopic change occurred in all the patients receiving glycemic control with a mean maximum hyperopic changes of 1.6 D (0.50 D ∼ 3.20 D). There was a positive correlation between the magnitude of the maximum hyperopic changes and the HbA1c levels on admission (r = 0.84, P < 0.05). There was a positive correlation between the magnitude of the maximum hyperopic changes and the daily rate of blood glucose reduction over the first 7 days of the treatment (r = 0.53, P < 0.05). There was no significant correlation between the magnitude of the maximum hyperopic changes and the levels of random blood glucose on admission. No significant correlation was observed between the maximum hyperopic changes and fasting C-peptide or postprandial 2 h C-peptide. There were no significant correlations between the magnitude of the maximum hyperopic changes and age, blood press, body mass index, triglyceride, total cholesterol, low-density lipoprotein or high-density lipoprotein. No significant changes were observed in the intraocular pressure, radius of the anterior corneal curvature, depth of the anterior chamber, lens thickness, vitreous length and axial length during glycemic control.
Transient hyperopic changes occur after glycemic control in diabetic patients with severe hyperglycaemia. The degrees of transient hyperopia are highly dependent on HbA1c levels before treatment and the rate of reduction of glucose level over the first 7 days of treatment. This is probably due to the decrease of refractive power by lens hydration, not morphological change of lens.
评估血糖控制对糖尿病患者屈光的影响。
本研究纳入20例新诊断的糖尿病患者。治疗前测量随机血糖、糖化血红蛋白A1c（HbA1c）水平、空腹C肽和餐后2小时C肽水平。选择随机血糖≥12.0 mmol/L且HbA1c≥10.0%的患者。在血糖控制期间，于入院时以及第1、2、3和4周结束时测量屈光、眼压、角膜前表面曲率半径、前房深度、晶状体厚度、玻璃体长度和眼轴长度。
所有接受血糖控制的患者均出现短暂性远视改变，平均最大远视改变为1.6 D（0.50 D～3.20 D）。最大远视改变幅度与入院时HbA1c水平呈正相关（r = 0.84，P < 0.05）。最大远视改变幅度与治疗前7天血糖每日降低率呈正相关（r = 0.53，P < 0.05）。最大远视改变幅度与入院时随机血糖水平无显著相关性。最大远视改变与空腹C肽或餐后2小时C肽无显著相关性。最大远视改变幅度与年龄、血压、体重指数、甘油三酯、总胆固醇、低密度脂蛋白或高密度脂蛋白无显著相关性。血糖控制期间，眼压、角膜前表面曲率半径、前房深度、晶状体厚度、玻璃体长度和眼轴长度未观察到显著变化。
严重高血糖的糖尿病患者血糖控制后会出现短暂性远视改变。短暂性远视的程度高度依赖于治疗前的HbA1c水平和治疗前7天血糖水平的降低率。这可能是由于晶状体水化导致屈光力下降，而非晶状体形态改变。
