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目的通过观察2型糖尿病患者行白内障超声乳化摘除及人工晶体植入术后视力及眼底的变化以评估糖尿病视网膜病变(DR)进展的相关危险因素。方法选取50例2型糖尿病伴非增殖型糖尿病视网膜病变(NPDR)且需单眼行白内障超声乳化及人工晶体植入术患者为研究对象,手术眼为手术组,非手术眼为非手术组。术后1、7 d及1、3个月,分别行最佳矫正视力(BCVA)及黄斑区光学相干断层扫描(OCT);术后3个月行FFA检查,分析DR进展的相关危险因素。结果手术组术后1 d~3个月视力明显改善(P<0.01),术后3个月BCVA呈下降趋势。手术组术后黄斑水肿发生率及DR进展率明显高于非手术组,差异有统计学意义(P<0.05或P<0.01)。Logistic回归分析结果显示,糖化血红蛋白(Hb A1c)(OR=21.423)、糖尿病病程(OR=9.061)、NPDR程度(OR=2.486)为DR进展的危险因素。结论 2型糖尿病NPDR患者行超声乳化及人工晶体植入术后BCVA明显改善,于术后3个月呈轻微下降趋势。糖尿病病程长、血糖控制差、术前DR加重是术后DR进展的危险因素。
Objective To evaluate the risk factors of diabetic retinopathy (DR) progression by observing the changes of visual acuity and fundus after phacoemulsification and intraocular lens implantation in type 2 diabetic patients. Methods Fifty patients with type 2 diabetes mellitus with nonproliferative diabetic retinopathy (NPDR) who underwent monocular cataract phacoemulsification and intraocular lens implantation were chosen as the study objects. The surgical eyes were operated as nonoperating eyes. The best corrected visual acuity (BCVA) and macular optical coherence tomography (OCT) were performed at 1, 7, and 1 and 3 months after surgery respectively. FFA was performed at 3 months after operation to analyze the risk factors related to the progression of DR. Results The visual acuity of the operation group was significantly improved from 1 d to 3 months after operation (P <0.01). The BCVA of the operation group decreased after 3 months. The incidence of postoperative macular edema and the rate of DR progression in the operation group were significantly higher than those in the non-operation group (P <0.05 or P <0.01). Logistic regression analysis showed that Hb A1c (OR = 21.423), duration of diabetes (OR = 9.061) and degree of NPDR (OR = 2.486) were risk factors for progression of DR. Conclusion The BCVA in patients with type 2 diabetic NPDR undergoing phacoemulsification and intraocular lens implantation was significantly improved and showed a slight decrease at 3 months after operation. Long duration of diabetes, poor glycemic control, preoperative DR increased DR risk factors for postoperative DR.