Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Ophthalmology, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Acta Ophthalmol. 2021 Mar;99(2):e202-e208. doi: 10.1111/aos.14565. Epub 2020 Aug 4.
To evaluate changes in the tear film lipid layer thickness (LLT) in cataract patients with diabetes mellitus (DM) after cataract surgery.
We recruited consecutive cataract patients and recorded data regarding DM condition. Lipid layer thickness (LLT) and partial blinks rates measured with the LipiView interferometer, tear break-up time (TBUT) and Schirmer's tests, and dry eye symptoms evaluated with the Ocular Surface Disease Index (OSDI) questionnaire were conducted before and one month after cataract surgery.
Finally, 38 age-related cataract (ARC) and 31 diabetic cataract (DC) patients were available for analysis. No significant difference in preoperative LLT and partial blink rates was found between ARC and DC group. However, preoperative TBUT and Schirmer's test results were significantly lower in DC group compared to ARC group (both p < 0.001). DC group showed higher preoperative OSDI score with no significant difference than ARC group (p = 0.279). In DC group, LLT was significantly thinner in cases with longer duration of DM (over 10 years) than in those with shorter duration (p < 0.001). One month after surgery, LLT of DC group was significantly thinner than at baseline (pre: 65.7 ± 23.3, post: 51.3 ± 17.1, p = 0.002). While in ARC group, LLT had no significant difference before and after cataract surgery (pre: 67.1 ± 23.4, post: 60.2 ± 21.1, p = 0.078). Compared to baseline data, there was no statistically significant difference between two groups in the partial blink rates, TBUT and Schirmer's test results after cataract surgery (p > 0.05). Ocular Surface Disease Index (OSDI) scores were significantly higher after surgery than at baseline in both ARC (pre: 8.9 ± 8.4, post: 12.4 ± 8.5, p = 0.003) and DC group (pre: 11.4 ± 10.3, post: 18.5 ± 8.5, p = 0.001). Multivariate linear regression analysis showed OSDI scores were associated with LLT either before or after cataract surgery (β = -0.862, p < 0.001 and β = -0.592, p < 0.001, respectively).
The tear film LLT is correlated with duration of DM and becomes significantly thinner one month after cataract surgery, leading to the aggravation of dry eye symptoms.
评估糖尿病（DM）白内障患者白内障手术后泪膜脂质层厚度（LLT）的变化。
我们招募了连续的白内障患者，并记录了 DM 情况的数据。使用 LipiView 干涉仪测量脂质层厚度（LLT）和部分眨眼率，使用泪膜破裂时间（TBUT）和 Schirmer 测试测量泪液，使用眼表疾病指数（OSDI）问卷评估干眼症状。所有患者均在白内障手术前和术后 1 个月进行了上述检查。
最终，38 例年龄相关性白内障（ARC）和 31 例糖尿病性白内障（DC）患者纳入分析。ARC 组和 DC 组术前 LLT 和部分眨眼率无显著差异。然而，DC 组的术前 TBUT 和 Schirmer 测试结果明显低于 ARC 组（均 P < 0.001）。DC 组的术前 OSDI 评分高于 ARC 组，但无统计学差异（P = 0.279）。在 DC 组中，LLT 在 DM 病程较长（超过 10 年）的患者中明显变薄，而在病程较短的患者中无明显变化（P < 0.001）。白内障手术后 1 个月，DC 组的 LLT 明显变薄，与基线相比（术前：65.7 ± 23.3，术后：51.3 ± 17.1，P = 0.002）。而在 ARC 组中，白内障手术后 LLT 与术前相比无显著差异（术前：67.1 ± 23.4，术后：60.2 ± 21.1，P = 0.078）。与基线数据相比，白内障手术后两组间的部分眨眼率、TBUT 和 Schirmer 测试结果均无统计学差异（P > 0.05）。白内障手术后，ARC 组（术前：8.9 ± 8.4，术后：12.4 ± 8.5，P = 0.003）和 DC 组（术前：11.4 ± 10.3，术后：18.5 ± 8.5，P = 0.001）的 OSDI 评分均明显高于基线。多变量线性回归分析显示，白内障手术前后的 OSDI 评分与 LLT 均相关（β = -0.862，P < 0.001 和 β = -0.592，P < 0.001）。
泪膜 LLT 与 DM 病程有关，白内障手术后 1 个月明显变薄，导致干眼症状加重。
