目的 对比分析有无视网膜病变的糖尿病患者白内障手术后黄斑水肿发生率及其相关因素。 方法 回顾性研究。行白内障超声乳化联合人工晶状体植入手术的135例患者135只眼纳入研究。其中，无糖尿病（对照组）、无视网膜病变的糖尿病（糖尿病组）以及有糖尿病视网膜病变（DR）的糖尿病患者（DR组）各45例45只眼。手术前及手术后1、3个月，所有患眼均行最佳矫正视力（BCVA）检查；行光相干断层扫描（OCT）检查，测量黄斑中心直径1 mm区域视网膜内界膜到视网膜色素上皮层的距离，并以此作为黄斑中心亚区域厚度（CSMT）。3组患眼手术前平均BCVA、CSMT比较，差异均无统计学意义（F=1.300、1.329，P=0.280、0.273）。对比观察3组患眼手术后BCVA、CSMT的变化。将OCT检查发现的CSMT较手术前增加30%以上定义为黄斑水肿。对比观察3组患眼手术后黄斑水肿的发生率。采用Logistic回归分析法分析手术后BCVA与CSMT的相关性以及糖尿病、DR与手术后黄斑水肿的相关性。 结果 手术后1、3个月，与对照组、糖尿病组比较，DR组患眼BCVA明显降低，CSMT明显增加，差异有统计学意义（P＜0.05）；对照组与糖尿病组患眼BCVA、CSMT比较，差异无统计学意义（P＞0.05）。对照组、糖尿病组、DR组手术后1个月黄斑水肿发生率分别为2.2%、4.4%、15.6%，手术后3个月黄斑水肿发生率分别为2.2%、2.2%、13.3%。DR组黄斑水肿发生率明显高于对照组、糖尿病组，差异有统计学意义（χ²=6.696、6.644，P=0.035、0.036）。Logistic回归分析结果显示，手术后BCVA与CSMT有相关性（r=0.444，P=0.000）；糖尿病与手术后黄斑水肿无相关性（r=7.231，P=0.999）；DR与手术后黄斑水肿有相关性（r=0.378，P=0.008）。 结论 与无视网膜病变的糖尿病患者比较，DR患者白内障手术后黄斑水肿发生率更高。糖尿病与手术后黄斑水肿无相关性，DR与手术后黄斑水肿有相关性。

Objective To observe and analyze the incidence of macular edema and its related factors after cataract surgery in diabetics with and without diabetic retinopathy. Methods A retrospective study. The data of 90 diabetics including 45 cases with diabetic retinopathy (DR group) and 45 cases without DR (diabetics group) and an equal number of non-diabetic matched controls (control group) who underwent phacoemulcification and intraocular lens implantation were collected. Patients with macular edema before the surgery were excluded. Main outcome measurements included best-corrected visual acuity (BCVA) and central subfield mean thickness (CSMT). Optical coherence tomography (OCT) was used to measure the distance from the inner limiting membrane to the pigment epithelium of the central macular with diameter of 1 mm, which was used as the CSMT. There were no significant differences in BCVA and CSMT among three groups preoperatively (F=1.300, 1.329; P=0.280, 0.273). The BCVA and CSMT before and after the surgery in all three groups were compared. macular edema was defined as an increase of CSMT on OCT ＞30% from preoperative baseline. The incidence of macular edema of three groups after the surgery were compared and analyzed. The correlation between postoperative BCVA and CSMT, and the correlation between diabetes mellitus, DR and macular edema after surgery were analyzed by Logistic regression analysis. Results After the surgery, compared with control and diabetics group, the BCVA in DR group decreased and the CSMT increased significantly and the differences were statistically significant (P＜0.05). However, between control and diabetics group, the differences in BCVA and CSMT after the surgery were not statistically significant (P＞0.05). The incidences of macular edema in DR group (15.6% and 13.3%) 1 month and 3 months postoperatively were significantly more than that in control group (2.2% and 2.2%) and non-DR diabetics group (4.4% and 2.2%), and the differences were statistically significant (χ²=6.696, 6.644; P=0.035, 0.036). Logistic regression analysis showed that the postoperative BCVA was correlated with CSMT (r=0.444, P=0.000), diabetics was not correlated with postoperative macular edema (r=7.231, P=0.999) and DR was correlated with macular edema after surgery (r=0.378, P=0.008). The diabetic retinopathy might correlated to macular edema after surgery. Conclusions The incidence of macular edema after cataract surgery in patients with DR was significantly higher than that in patients without DR. There is no correlation between diabetics and postoperative macular edema, and DR is correlated with macular edema after surgery.

关键词: 黄斑水肿/病因学; 糖尿病视网膜病变; 超声乳化白内障吸除术

Key words: Macular edema/etiology; Diabetic retinopathy; Phacoemulsification

引用本文： 高莎莎, 秦廷玉, 赵琳. 有无视网膜病变的糖尿病患者白内障手术后黄斑水肿发生率比较及相关因素分析. 中华眼底病杂志, 2017, 33(6): 593-596. doi: 10.3760/cma.j.issn.1005-1015.2017.06.009 复制