目的:探讨在行超声乳化白内障吸除术的糖尿病患者,双氯芬酸钠滴眼液对于术后黄斑水肿的预防效果。方法:本研究采用前瞻性、随机对照临床试验。将行白内障超声乳化联合人工晶状体植入术而且无视网膜病变的糖尿病患者随机分成两组,A组(n=104)术前1d和术后4wk使用10g/L双氯芬酸钠滴眼液4次/d,联合术后4wk使用妥布霉素地塞米松滴眼液4次/d;B组(n=113)术后4wk只使用妥布霉素地塞米松滴眼液4次/d。观察最佳矫正视力、黄斑水肿的发病率和黄斑中央区视网膜厚度。结果:临床检查发现,A组黄斑水肿4眼(3.8%),B组黄斑水肿10眼(8.8%)。光学断层扫描检查发现,A组6眼(5.8%)发生黄斑水肿,B组12眼(10.6%)发生黄斑水肿。A组的黄斑中央区厚度小于B组(P<0.01)。结论:本研究提示对于需要行白内障手术的糖尿病患者,术前和术后使用双氯芬酸钠滴眼液,并联合术后使用妥布霉素地塞米松滴眼液,与术后单独使用妥布霉素地塞米松滴眼液相比,前者可以明显降低黄斑水肿的发病率。

AIM:To evaluate the efficacy of diclofenac sodium ophthalmic solution and a steroidal ophthalmic solution administered prophylactically against macular edema after phacoemulsificaition and intraocular lens implantation and to assess macular thickness changes using optical coherence tomography(OCT).METHODS:In this prospective study,patients with diabetes mellitus but without diabetic retinopathy were randomized to either the A group(n=104) or the B group(n=113).Patients in the A group received either tobramycin and dexamethasone ophthalmic suspension 4 times daily(qid) for approximately one day preoperatively and four weeks postoperatively plus diclofenac 1% qid for four weeks postoperatively.Patients in the B group received topical tobramycin and dexamethasone qid for approximately four weeks postoperatively alone.Outcome measures included macular edema incidence,central field retinal thickness as measured by OCT,and best-corrected visual acuity.RESULTS:Four eyes in A group and ten eyes in B group had clinically apparent macular edema.Based on OCT,six eyes in A group had macular edema,twelve eyes in B group.The central subfield retinal thickness values were significantly lower in the A group at four weeks than those in the B group.CONCLUSION:This study suggests that adding preoperative diclofenac sodium ophthalmic solution to postoperative topical dexamethasone significantly reduces the incidences of macular edema and suppresses increasing retinal thickening after cataract surgery in patients with diabetes mellitus.