Sadiq S A, Chatterjee A, Vernon S A
Queen's Medical Centre, Nottingham, UK.
Eye (Lond). 1995;9 ( Pt 6):728-38. doi: 10.1038/eye.1995.185.
There has been recent interest in the progression of diabetic retinopathy following extracapsular cataract extraction (ECCE) especially with vitreous loss. It is well known that diabetic retinopathy progresses after intracapsular cataract extraction (ICCE) but was thought to be less common after ECCE. We present 7 patients with symmetrical non-proliferative diabetic retinopathy who underwent ECCE with intraocular lens (IOL) implantation. These patients ranged in age from 56 to 69 years; 2 were insulin-dependent diabetics (IDDM) and 5 non-IDDMs. Rubeosis iridis developed quickly between post-operative outpatient visits despite good diabetic control and a static retinal picture in the fellow eye. Visual loss following the onset of rubeosis was severe, with 3 patients needing cyclocryotherapy and eventually having no perception of light. The rapid onset of rubeosis between post-operative outpatient visits leads us to suggest much shorter periods between reviews than is current practice and the consideration of routine panretinal photocoagulation in the immediate post-operative period in diabetics with worsening retinopathy after ECCE and IOL. Possible causes of the increase in neovascularisation and rubeosis are discussed. The most important message highlighted by these case histories is that the surgery and follow-up of diabetic patients undergoing surgery should be undertaken by an ophthalmologist with an interest in diabetes. Where there is no recognised diabetic retinal specialist in a unit, then early referral to such an ophthalmologist is recommended when complications arise.
近期，人们对囊外白内障摘除术（ECCE）尤其是伴有玻璃体丢失的情况下糖尿病视网膜病变的进展产生了兴趣。众所周知，糖尿病视网膜病变在囊内白内障摘除术（ICCE）后会进展，但曾被认为在ECCE后较少见。我们报告了7例患有对称性非增殖性糖尿病视网膜病变的患者，他们接受了ECCE并植入了人工晶状体（IOL）。这些患者年龄在56至69岁之间；2例为胰岛素依赖型糖尿病患者（IDDM），5例为非IDDM患者。尽管糖尿病控制良好且对侧眼视网膜情况稳定，但虹膜新生血管在术后门诊随访期间迅速发展。虹膜新生血管出现后视力丧失严重，3例患者需要进行睫状体冷凝术，最终失明。术后门诊随访期间虹膜新生血管的快速出现促使我们建议复查间隔时间应比目前的做法短得多，并考虑对ECCE和IOL术后视网膜病变恶化的糖尿病患者在术后即刻进行常规全视网膜光凝治疗。文中讨论了新生血管形成和虹膜新生血管增加的可能原因。这些病例史所强调的最重要信息是，糖尿病患者手术的手术操作和随访应由对糖尿病感兴趣的眼科医生进行。如果一个科室没有公认的糖尿病视网膜专科医生，那么当出现并发症时，建议尽早转诊给这样的眼科医生。
