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目的:调查无糖尿病和糖尿病患者单纯超声乳化术后黄斑囊样水肿(post-operative cystoid macular edema,pCME)的发生率及其与术中累积释放能量(cumulative dissipated energy,CDE)、超声乳化时间的关系。方法:研究纳入116例无糖尿病患者(A组)和101例糖尿病接受超声乳化手术患者(B组)。术前,两组经频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)和眼底荧光造影(fundus fluorescein angiography,FFA)检测,均未发现黄斑病变或糖尿病黄斑水肿的表现。术后记录超声乳化相关指标。术后每2mo进行FFA检查。出现pCME迹象的患者再次进行SDOCT评估。结果:单纯超声乳化术后,两组之间的pCME发生率有显著差异(A组:6.9%,B组:15.8%,P=0.03)。24例患者中,出现19例亚临床pCME。pCME的发生和超声乳化参数(CDE、超声乳化时间和晶状体硬度)显著相关。发生pCME和未发生pCME患者之间糖化血红蛋白(glycosylated hemoglobin,Hb A1c)有显著差异(P=0.005)。黄斑囊样水肿和眼轴长度无相关性。结论:单纯超声乳化术后,无糖尿病和糖尿病患者pCME的发生率有显著差异。大多数患pCME的患者为亚临床表现。CDE和超声乳化时间是pCME的重要影响因素和预测因素。良好的血糖控制可以预防pCME发生。
Objective: To investigate the incidence of post-operative cystoid macular edema (pCME) in patients without diabetes mellitus and diabetes mellitus and its relationship with the cumulative dissipated energy (CDE), phacoemulsification time relationship. METHODS: A total of 116 patients without diabetes (group A) and 101 patients with diabetes undergoing phacoemulsification (group B) were enrolled. Preoperatively, no macular degeneration or diabetic macular edema was observed in both groups detected by spectral-domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA). Postoperative records of phacoemulsification related indicators. Postoperative FFA examination every 2 months. Patients with signs of pCME were retested for SDOCT. RESULTS: After phacoemulsification alone, there was a significant difference in the incidence of pCME between the two groups (A: 6.9%, B: 15.8%, P = 0.03). Of the 24 patients, 19 had subclinical pCME. The occurrence of pCME was significantly correlated with phacoemulsification parameters (CDE, phacoemulsification time and lens hardness). There was a significant difference in glycosylated hemoglobin (Hb A1c) between patients with and without pCME (P = 0.005). Macular cyst edema and axial length no correlation. Conclusions: The incidence of pCME in non-diabetic and diabetic patients after phacoemulsification was significantly different. Most patients with pCME are subclinical. CDE and phacoemulsification time are important influencing factors and predictors of pCME. Good glycemic control can prevent pCME from occurring.