Misra Stuti L, Goh Yi Wei, Patel Dipika V, Riley Andrew F, McGhee Charles N J
Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Cornea. 2015 Feb;34(2):177-81. doi: 10.1097/ICO.0000000000000320.
The aim of this study was to analyze microstructural corneal changes following phacoemulsification of cataract with intraocular lens insertion in diabetes mellitus (DM).
Prospective study of consecutive patients undergoing phacoemulsification with intraocular lens insertion, over a period of 6 months. Age, gender, serum glycosylated hemoglobin A1c levels, and effective phacoemulsification time were recorded. Anterior segment optical coherence tomography and corneal in vivo confocal microscopy were performed preoperatively and 1-month postoperatively. Subbasal nerve plexus (SBN) density, basal epithelial cell density, and endothelial cell density (ECD) were quantitatively analyzed.
Twenty-eight patients with type 2 DM (71.2 ± 7.6 years) and 23 healthy controls (mean age, 74.4 ± 7.4 years) were recruited. Mean hemoglobin A1c level was 7.5% in patients with DM and 5.7% in the control group (P < 0.0001). A significant reduction in SBN density was noted postoperatively in both DM (P < 0.0001) and non-DM groups (P < 0.0001). Patients with DM had a lower mean SBN density compared with non-DM group, before (P < 0.0001) and after surgery (P < 0.0001). Longer effective phacoemulsification time correlated with a greater decrease in ECD postoperatively in the whole cohort (P < 0.0001), and in the control (P = 0.002) and DM (P = 0.039) groups independently. There was no significant difference in preoperative ECD between the DM group (2254 +/- 426 cells/mm(2)) and non-DM group (2384 +/- 438 cells/mm(2); P = 0.2). [corrected].
Subbasal nerve density is reduced after cataract surgery in patients with and without DM. However, lower initial SBN density in patients with DM may predispose them to develop diabetic keratopathy. DM does not predispose to greater endothelial loss following phacoemulsification.
本研究旨在分析糖尿病（DM）患者白内障超声乳化吸除联合人工晶状体植入术后角膜的微观结构变化。
对连续6个月内接受白内障超声乳化吸除联合人工晶状体植入术的患者进行前瞻性研究。记录患者的年龄、性别、血清糖化血红蛋白A1c水平及有效超声乳化时间。术前及术后1个月行眼前节光学相干断层扫描及角膜共聚焦显微镜检查。对基底神经丛（SBN）密度、基底上皮细胞密度及内皮细胞密度（ECD）进行定量分析。
招募了28例2型糖尿病患者（71.2±7.6岁）和23例健康对照者（平均年龄74.4±7.4岁）。糖尿病患者的平均糖化血红蛋白A1c水平为7.5%，对照组为5.7%（P<0.0001）。糖尿病组和非糖尿病组术后SBN密度均显著降低（糖尿病组P<0.0001，非糖尿病组P<0.0001）。糖尿病患者术前和术后的平均SBN密度均低于非糖尿病组（术前P<0.0001，术后P<0.0001）。在整个队列中，有效超声乳化时间越长，术后ECD下降越明显（P<0.0001），在对照组（P=0.002）和糖尿病组（P=0.039）中也是如此。糖尿病组术前ECD（2254±426个细胞/mm²）与非糖尿病组（2384±438个细胞/mm²；P=0.2）无显著差异。[已校正]
糖尿病患者和非糖尿病患者白内障手术后基底神经密度均降低。然而，糖尿病患者较低的初始SBN密度可能使他们易患糖尿病性角膜病变。糖尿病不会使超声乳化术后内皮细胞损失更多。
