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白内障手术与糖尿病性黄斑水肿复发或进展的风险

Cataract surgery and the risk of developing recurrence or progression of diabetic macular edema.

作者信息

Kim Mirinae, Park Young-Gun, Park Young-Hoon

机构信息

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

PLoS One. 2025 Aug 18;20(8):e0328874. doi: 10.1371/journal.pone.0328874. eCollection 2025.

Abstract

PURPOSE

To determine whether uneventful cataract surgery in patients with diabetic macular edema (DME) affects the course of the disease, and its relationship with postoperative clinical outcomes in real-world settings.

MATERIALS AND METHODS

This retrospective cohort study included patients of center-involving DME and a prior history of periocular injection in the operative eye before cataract surgery with a follow-up of at least 6 months. Patients were assigned to active and inactive DME group according to preoperative status. Patients' clinical outcome measurements before and after cataract surgery were compared between the groups. Cox-proportional hazards model was performed to identify risk factors of DME recurrence or progression after cataract surgery.

RESULTS

The study included 153 eyes in 153 patients. No significant differences were observed in the trend of the groups' clinical outcomes, including best-corrected visual acuity, central macular thickness and central choroidal thickness (P = .763,.872, and.127, respectively). Patients with higher HbA1c were more likely to develop recurrence or progression of DME after cataract surgery (hazard ratio = 1.407, P = .039).

CONCLUSION

The clinical outcomes following cataract surgery in patients with inactive or actively treated DME did not show significant differences at any postoperative period. Recurrence or progression of DME after cataract surgery was found to be associated with high HbA1c. Clinicians do not have to delay the cataract surgery in patients with DME who have good glycemic control and are undergoing treatment as needed.

摘要

目的

确定糖尿病性黄斑水肿(DME)患者进行顺利的白内障手术是否会影响疾病进程,以及在现实环境中其与术后临床结局的关系。

材料与方法

这项回顾性队列研究纳入了患有中心性DME且在白内障手术前患眼有眼周注射史且随访至少6个月的患者。根据术前状态将患者分为活动性DME组和非活动性DME组。比较两组患者白内障手术前后的临床结局测量值。采用Cox比例风险模型确定白内障手术后DME复发或进展的危险因素。

结果

该研究纳入了153例患者的153只眼。在两组的临床结局趋势方面未观察到显著差异,包括最佳矫正视力、中心黄斑厚度和中心脉络膜厚度(分别为P = 0.763、0.872和0.127)。糖化血红蛋白(HbA1c)水平较高的患者在白内障手术后更有可能发生DME复发或进展(风险比 = 1.407,P = 0.039)。

结论

非活动性或接受积极治疗的DME患者白内障手术后的临床结局在任何术后时期均未显示出显著差异。发现白内障手术后DME的复发或进展与高HbA1c有关。对于血糖控制良好且正在按需接受治疗的DME患者,临床医生不必推迟白内障手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a6b/12360533/cbd3768ee484/pone.0328874.g001.jpg

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