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糖尿病与超声乳化白内障手术:困难、风险及潜在并发症

Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications.

作者信息

Grzybowski Andrzej, Kanclerz Piotr, Huerva Valentín, Ascaso Francisco J, Tuuminen Raimo

机构信息

Department of Ophthalmology, University of Warmia and Mazury, 10-082 Olsztyn, Poland.

Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-554 Poznan, Poland.

出版信息

J Clin Med. 2019 May 20;8(5):716. doi: 10.3390/jcm8050716.

Abstract

Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial-stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.

摘要

糖尿病是全球最常见的慢性病之一。糖尿病患者有患白内障的风险,且比非糖尿病患者更早接受手术。本研究的目的是回顾糖尿病患者白内障手术相关问题。糖尿病患者的角膜并发症包括伤口愈合延迟、由于上皮基底膜和上皮 - 基质相互作用受损而出现上皮缺损或复发性糜烂的风险。糖尿病患者的内皮细胞密度较低,其内皮更容易受到与白内障手术相关的创伤。小瞳孔在糖尿病患者中很常见,这使得白内障手术在技术上具有挑战性。最后,糖尿病患者发生术后人工晶状体性囊样黄斑水肿、后囊膜混浊或眼内炎的风险增加。对于患有增殖前期或增殖性糖尿病视网膜病变、糖尿病性黄斑水肿或虹膜新生血管的患者,玻璃体内注射抗血管内皮生长因子等辅助治疗可以抑制与白内障手术相关的病情加重。

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