个性化超声乳化在真性糖尿病性白内障的临床研究
개성화초성유화재진성당뇨병성백내장적림상연구
Clinical research of topography-guided phacoemulsmcation surgery for diabetic cataract patients
  • 万方数据
    中国实用眼科杂志 중국실용안과잡지
    CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
    2012年 8期 921-926 ,共6页

    邵毅%王乐%董雯佳%余瑶%张广斌%裴重刚%常以力%陈伟%李猛%毛益辉

    소의%왕악%동문가%여요%장엄빈%배중강%상이력%진위%리맹%모익휘

    角膜地形图%超声乳化白内障吸除术%散光%泪膜%真性糖尿病性白内障 角膜地形圖%超聲乳化白內障吸除術%散光%淚膜%真性糖尿病性白內障
    각막지형도%초성유화백내장흡제술%산광%루막%진성당뇨병성백내장
    Corneal topography%Phacoemulsification surgery%Astigmatism%Tear film%Diabetic cataract
    目的 探讨个性化超声乳化术对真性糖尿病白内障患者眼表症状、角膜厚度、散光及泪膜稳定性的影响.方法 术前存在角膜散光的真性糖尿病白内障患者60例(60眼,均为右眼),随机分为A、B组.A组采用常规上方透明角膜切口行超声乳化白内障吸除联合人工晶状体(IOL)植入术,B组在角膜地形图引导下作切口行超声乳化白内障吸除联合IOL植入术,术前、术后1周及3个月时测裸眼视力,眼表症状、OSDI、泪膜四项和屈光状态,术后1个月检查角膜厚度.结果 术前两组散光值、眼表症状、OSDI、泪膜四项差异无统计学意义(t散光=0.642,t眼表症状眼数=0.342,tOSDI =0.667,tBUT=0.437,t泪河高度=0.732,tST=0.151,tFL=-0.847,P均＞0.05),两组术前和术后1月角膜9个方位厚度比较经t检验差异均无统计学意义(P均＞0.05).两组术前角膜垂直散光J0和水平散光P相近(FJ0=0.46和FP=0.64,P均＞0.05),A组术前与术后1周相比,差异均有统计学意义(FJ0=18.372,FP=14.648,P均＜0.05),与术后3个月相比,差异均无统计学意义(FJ0=4.38,FP=5.45,P均＞0.05)；B组术前与术后1周和3个月相比,差异均无统计学意义(FJ0=5.78,FP=6.84; FJ0=6.34,FP=5.52；P均＜0.05).两组患者术后1周,眼表症状眼数、OSDI、BUT、ST、泪河高度及FL均出现异常(tA眼表症状眼数=17.823,tAOSI=12.326,tABUT=10.646,tA泪河高度=9.383,tAST=7.623,tAFL=-6.057；tB眼表症状眼数=10.662,tBOSDI=11.761,tBBUT=9.167,tB泪河高度=8.165,tBST=6.323,tBFL=-5.798；P均＜0.05),至术后第3月时患者的眼表症状眼数、OSDI、BUT、ST、泪河高度及FL已基本恢复至对照眼水平经t检验,P均＞0.05)；术后1周两组患者眼表症状眼数、OSDI、BUT及FL相比,差异均有统计学意义(t眼表症状眼数=16.605,tOSDI=13.581,tBUT=20.569,tFL=-8.632,P均＜0.05),ST、泪河高度相比,差异无统计学意义(t泪河高度=1.473,tST=1.684,P均＞0.05)；术后3月两组患者眼表症状眼数、OSDI、BUT、ST、泪河高度及FL相比,差异均无统计学意义(t眼表症状眼数=1.132,tOSDI =0.843,tBUT=0.367,t泪河高度=0.564,tST =1.143,tFL=-0.846,P均＞0.05).结论 对于合并真性糖尿病白内障,个性化切口行超声乳化联合IOL植入术可以部分矫正患者术前的角膜散光并可以较早稳定泪膜、减轻眼表症状,提高患者的视觉质量.
    목적 탐토개성화초성유화술대진성당뇨병백내장환자안표증상、각막후도、산광급루막은정성적영향.방법 술전존재각막산광적진성당뇨병백내장환자60례(60안,균위우안),수궤분위A、B조.A조채용상규상방투명각막절구행초성유화백내장흡제연합인공정상체(IOL)식입술,B조재각막지형도인도하작절구행초성유화백내장흡제연합IOL식입술,술전、술후1주급3개월시측라안시력,안표증상、OSDI、루막사항화굴광상태,술후1개월검사각막후도.결과 술전량조산광치、안표증상、OSDI、루막사항차이무통계학의의(t산광=0.642,t안표증상안수=0.342,tOSDI =0.667,tBUT=0.437,t루하고도=0.732,tST=0.151,tFL=-0.847,P균＞0.05),량조술전화술후1월각막9개방위후도비교경t검험차이균무통계학의의(P균＞0.05).량조술전각막수직산광J0화수평산광P상근(FJ0=0.46화FP=0.64,P균＞0.05),A조술전여술후1주상비,차이균유통계학의의(FJ0=18.372,FP=14.648,P균＜0.05),여술후3개월상비,차이균무통계학의의(FJ0=4.38,FP=5.45,P균＞0.05)；B조술전여술후1주화3개월상비,차이균무통계학의의(FJ0=5.78,FP=6.84; FJ0=6.34,FP=5.52；P균＜0.05).량조환자술후1주,안표증상안수、OSDI、BUT、ST、루하고도급FL균출현이상(tA안표증상안수=17.823,tAOSI=12.326,tABUT=10.646,tA루하고도=9.383,tAST=7.623,tAFL=-6.057；tB안표증상안수=10.662,tBOSDI=11.761,tBBUT=9.167,tB루하고도=8.165,tBST=6.323,tBFL=-5.798；P균＜0.05),지술후제3월시환자적안표증상안수、OSDI、BUT、ST、루하고도급FL이기본회복지대조안수평경t검험,P균＞0.05)；술후1주량조환자안표증상안수、OSDI、BUT급FL상비,차이균유통계학의의(t안표증상안수=16.605,tOSDI=13.581,tBUT=20.569,tFL=-8.632,P균＜0.05),ST、루하고도상비,차이무통계학의의(t루하고도=1.473,tST=1.684,P균＞0.05)；술후3월량조환자안표증상안수、OSDI、BUT、ST、루하고도급FL상비,차이균무통계학의의(t안표증상안수=1.132,tOSDI =0.843,tBUT=0.367,t루하고도=0.564,tST =1.143,tFL=-0.846,P균＞0.05).결론 대우합병진성당뇨병백내장,개성화절구행초성유화연합IOL식입술가이부분교정환자술전적각막산광병가이교조은정루막、감경안표증상,제고환자적시각질량.
    Objective To observe the symptom of ocular surface,corneal thickness,tear film stability and astigmatism of diabetic cataract patients after phacoemulsification surgery guided by corneal topography and implantation IOL. Methods tn a prospective randomized sample controlled clinical study.Sixty diabetic cataract patients (60 right eyes) were randomly divided into two groups:(group A) traditional superior comeal incision phacoemulsification surgery and IOL implantation,(group B) corneal topography guiding incision phacoemulsification surgery and IOL implantation.The vision,the symptom of ocular surface,Ocular Surface Disease Index (OSDI),tear film function and topography tests were performed at 1 week,1 month and 3 months postoperatively. Results There were no significant difference for corneal astigmatism,the symptom of ocular surface,OSDI and tear film function were found between two groups preoperatively (tastigmatism=0.642,tsymptom=0.342,tOSDI=0.667,tBUT=0.437,theight of tear meniscus=0.732,tST=0.151,tFL=-0.847,P＞0.05),and no statistically significance of pachymetry (including the center and the eight midperipheral locations) at preoperative day 1 and postoperative month 1 in both groups (P＞0.05).Corneal topography indicated that no significant difference for corneal vertical J0 and horizon astigmatism P were found between two groups preoperatively (FJ0=0.46,FP=0.64,P ＞0.05).There were statistically significance for corneal vertical J0,horizon astigmatism P,symptom eyes,OSDI,break up time (BUT),Schirmer Ⅰ test (ST),the height of tear meniscus and fluorescein staining (FL) at preoperative compared the postoperative week 1 in group A (FAJ0=18.372, FAP=14.648, tAsymptom=17.823, tAOSDI =12.326, tABUT=10.646, tAheight of tear meniscus=9.383, tAST =7.623,tAFL=-6.057; FBJ0=5.78,FBP=6.84; tBsymptom=10.662,tBOSDI=11.761,tBBUT=9.167,tBheight of tear meniscus=8.165,tBST=6.323,tBFL =-5.798; P ＜0.05),whereas no statistically significance at preoperative compared the postoperative month 3 in both groups (FAJ0=4.38,FAP=5.45, tAsymptom=1.664,tAOSDI =0.834,tABUT=0.622, tAheight of tear meniscus=0.674, tAST=1.223, tAFL =-1.024; FBJ0=6.34,FBP=5.52, tBsymptom=1.459,tBOSDI=0.798,tBBUT=0.688,tBheight of tear meniscus=0.562,tBST=1.114,tBFL=-0.886; P ＞0.05).There were statistically significance for symptom eyes,OSDI,BUT and FL at postoperative week 1 in both groups (tsymptom=16.605,tOSDI=13.581,tBUT=20.569,tFL =-8.632,P ＜0.05),whereas no statistically significance at preoperative compared the postoperative month 3 in both groups (tsymptom=1.132,tOSDI=0.843,tBUT=0.367,theigh,of tear meniscus=0.564,tST=1.143,tFL =-0.846,P＞0.05). Conclusions Topography-guided phacoemulsification surgery and IOL implantation is a more favorable solution for diabetic cataract patients,which can correct the corneal astigmatism,stabilize the tear film,mitigate the symptom of ocular surface and therefore improve the visual quality.
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