Aiello L M, Wand M, Liang G
Ophthalmology. 1983 Jul;90(7):814-20. doi: 10.1016/s0161-6420(83)34498-5.
The potential complications of cataract surgery in the general population are well known. In addition, cataract extraction in the patient with diabetes mellitus is associated with other potential complications common to this disease: neovascular glaucoma and acceleration of proliferative diabetic retinopathy with or without vitreous hemorrhage. We analyzed the records of 154 patients with diabetes mellitus who had undergone standard intracapsular cataract extraction in one eye only with the other eye serving as the unoperated control eye. We were able to determine the status of the diabetic retinopathy before the operation and to note the development of vitreous hemorrhage and rubeosis iridis/neovascular glaucoma after the operation. If either event occurred within six weeks of the surgery, it was considered to be a complication of the cataract extraction. Intracapsular cataract extraction in this diabetic population, without regard of the preoperative status of the retinopathy, was associated with a statistically significant incidence of postoperative rubeosis iridis/neovascular glaucoma (7.8% vs 0%). In patients with preoperative active proliferative diabetic retinopathy, the risk of developing postoperative rubeosis iridis/neovascular glaucoma was even higher (40% vs 0%). There was also a statistically significant incidence of vitreous hemorrhage after surgery in eyes with no diabetic retinopathy or background diabetic retinopathy (6.5% vs 0%). In patients with active proliferative diabetic retinopathy, there was an increased incidence of vitreous hemorrhage after surgery (20% vs 6.5%), but this was not statistically significant due to the small number of patients studied. Possible explanations for these findings are explored and therapeutic and prophylactic measures recommended.
普通人群白内障手术的潜在并发症已广为人知。此外，糖尿病患者的白内障摘除术还伴有该疾病常见的其他潜在并发症：新生血管性青光眼以及增殖性糖尿病视网膜病变的加速进展，伴或不伴有玻璃体积血。我们分析了154例仅一只眼睛接受标准囊内白内障摘除术的糖尿病患者的记录，另一只眼睛作为未手术的对照眼。我们能够确定手术前糖尿病视网膜病变的状况，并记录手术后玻璃体积血和虹膜红变/新生血管性青光眼的发生情况。如果任何一种情况在手术后六周内发生，则被视为白内障摘除术的并发症。在这群糖尿病患者中，无论视网膜病变的术前状况如何，囊内白内障摘除术后虹膜红变/新生血管性青光眼的发生率在统计学上都有显著意义（7.8%对0%）。术前有活动性增殖性糖尿病视网膜病变的患者，术后发生虹膜红变/新生血管性青光眼的风险更高（40%对0%）。在无糖尿病视网膜病变或背景性糖尿病视网膜病变的眼中，手术后玻璃体积血的发生率在统计学上也有显著意义（6.5%对0%）。在有活动性增殖性糖尿病视网膜病变的患者中，手术后玻璃体积血的发生率有所增加（20%对6.5%），但由于研究的患者数量较少，这在统计学上并不显著。本文探讨了这些发现的可能解释，并推荐了治疗和预防措施。
