目的:观察糖尿病性白内障患者行超声乳化术后不同时间中央区和手术切口区角膜内皮细胞形态学的变化,探索糖尿病患者白内障术后角膜内皮细胞的变化规律及影响因素。方法:随机选取28例32眼非胰岛素依赖型糖尿病合并老年性白内障患者(糖尿病组)和31例32眼老年性白内障患者(对照组),行白内障超声乳化吸除术联合折叠式人工晶状体植入术。术前、术后1wk;1,3mo分别观察角膜中央区和手术切口区内皮细胞密度、六角形细胞比例和变异系数。结果:术后角膜内皮细胞密度和六角形细胞比例均呈现逐渐下降趋势,变异系数渐增加。糖尿病组与对照组相比,术前内皮细胞密度无显著性差异,六角形细胞比例和变异系数有显著性差异(P<0.01);术后3mo时两组间3项指标均有显著性差异(P<0.01),其中各指标在术前与术后3mo时的增减值以糖尿病组为著。糖尿病组术后各时间段的切口区内皮细胞密度低于中央区,有显著性差异(术后1wk;1mo时P<0.05,3mo时P<0.01),六角形细胞比例低于中央区(术后1wk;1mo时P<0.01,3mo时P<0.05),变异系数高于中央区(术后各时间P<0.01)。结论:糖尿病患者对手术损伤的耐受性低,且创伤愈合的速率和效率两方面均差于正常人。在该手术中,其角膜内皮受到超声因素和机械因素的双重损伤。对于白内障患者合并糖尿病者,在超声损伤的基础上,应注意机械因素的作用;并且这种创伤对角膜内皮的影响可能更大。

AIM:To observe the corneal endothelial cells morphology at the central and incision cornea of diabetes patient after phacoemulsification,and find out the regularity of corneal endothelial cells morphologic change and some related affected factors.METHODS:Twenty-eight cases 32 eyes with age-related cataract and non-insulin dependent diabetes mellitus(diabetes group) and 31 cases 32 eyes age-related cataract (control group)were randomly chosen in this research.The phacoemulsification was performed through the clear corneal combined with the foldable intraocular lens implantation.The cell density(CD),proportion of hexagonal cell,coefficient of variation(CV) of the corneal endothelial cells were examined preoperatively and one week,one month,three months postoperatively.RESULTS:In the two groups,the level of postoperative CD,proportion of hexagonal cell decreased gradually,and the level of CV increased.Compared with the control group,corneal endothelial cells in diabetes group had a significant reduction in proportion of hexagonal cell (P<0.01) and increase in CV(P<0.01).There existed a significant difference in CD (P<0.01),proportion of hexagonal cell (P<0.01),CV(P<0.01) at three months postoperatively between the two groups,and especially more remarkable change was found in the diabetes group.Morphology of endothelial cells at the incision corneal showed a significant lower CD (P<0.05 at one week,one month postoperatively;P<0.01 at three months postoperatively) and proportion of hexagonal cell (P<0.01 at one week,one month postoperatively;P<0.05 at three months postoperatively),higher CV(P<0.01) than those at the central cornea at postoperative different time.CONCLUSION:There exists a continued cell loss in the corneal endothelium after phacoemulsification.The morphology of corneal endothelial cells in diabetes group,compared with that in the control group,present significantly abnormality.So the endothelial cells in diabetes group are easier to be damaged than those in control group during this surgery,and the velocity and validity of recovery in diabetes group are lower comparatively.In phacoemulsification through the clear corneal,the endothelial cells suffer from energy and mechanic injury.We should pay more attention to the mechanic injury for diabetes patient,because it can lead to more corneal endothelial cell loss.

R779.66