Effects Of Blood Glucose Control On Cataract Surgery In Diabetic Patients

Purpose:To investigate the effect of blood glucose control on the results of ophthalmologic examination and postoperative complications in diabetic patients undergoing phacoemulsification and intraocular lens implantation.Methods:Clinical electronic records of85patients (124eyes) undergoing phacoemulsification and intraocular lens implantation were analyzed retrospectively. To observe of hemoglobin A1C values, the results of ophthalmologic examination and postoperative complications in patients with or without diabetes mellitus. Patients were followed up for6to12months with an average of8months. The number of diabetic patients was50(72eyes), while non-diabetic was35(52eyes). There were three groups according to the preoperative hemoglobin A1C values (HbAlc):control ideally for11eyes control generally for54eyes and control poorly for7eyes. Chi square test was used to analyze the association of conjunctival sac bacterial flora cultured, isolated and drug sensitivity test, anterior chamber cell grading and preoperative hemoglobin Alc values. Multiple Logistic regression was used to analysis risk factors of postoperative complications; Pearson product-moment correlation was used to analysis the association of temporary intraocular hypertension and hemoglobin Alc values. Multivariate Logistic regression analysis results showed that gender, age, the result of conjunctival bacterial culture and drug sensitive test and anterior chamber cell classification was not related to glycosylated hemoglobin Alc, P>0.05, which of these factors were not independent risk factors of postoperative complications. The postoperative corneal edema of8eyes account for6.45%, anterior chamber fibrous exudation and hemorrhage of3eyes account for2.42%, but only with mild symptoms, and recovered well after treatment.Results:The best corrected visual acuity after phacoemulsification and intraocular lens implantation was significant improved. The number of positive results of conjunctival sac bacterial flora culture and drug sensitivity test was17; the positive rate was15.89%. The difference between DM group with poor glycemic control and the control group was statistically significant (P<0.0063), that is the conjunctival sac bacterial culture and drug sensitive test is associated with high glycosylated hemoglobin Alc. All cases but one had happened hemorrhage during the surgery (0.81%). The anterior chamber inflammatory cells (+～++++) after operation exist for a day or more in51eyes (41.13%), diabetes with poor glycemic control compared with the control group was statistically significant (P<0.0063), that is the anterior chamber inflammatory cell value is associated with glycosylated hemoglobin Alc. The postoperative corneal edema were8eyes, account for6.45%, anterior chamber fibrous exudation and hemorrhage were3eyes, account for2.42%, but only with mild symptoms, but also recovered well after treatment. Postoperative transient elevated intraocular pressure were36eyes (account for29.03%), intraocular pressure was in the range of10～43mmHg, average16.7mmHg. There were25cases of elevated intraocular pressure occurred in24h (account for about69.44%), that the postoperative intraocular hypertension occurs mostly in the first days postoperatively. Through the Pearson product-moment correlation test, the results showed that the postoperative transient intraocular hypertension and glycosylated hemoglobin Alc values were positively correlated (P=0.013<0.05, two-sided test. The Pearson coefficient=0.313).Conclusion:Slightly higher blood glucose values preoperatively do not affect phacoemulsification and intraocular lens implantation, but pretty high level will increase the rate of transient elevated intraocular pressure and the rate of infection. Patients with diabetes should not only actively control the blood glucose at a stable level, but also actively cooperate with the examination and preventive treatment, so that achieve a better prognosis.