| Objective:With the improvement of people's living standard,diabetes is no longer a rare disease in China.It has become truly a common disease and a high incidence of diabetes and its associated complications that threaten the world's major public health problems.Diabetes can cause many complications in the eye,the eye function caused serious harm,one of the most common and harm the heaviest is diabetic retinopathy(DR).With the increasing number of people with diabetes and the increasing number of DR patients,DR has become the third most blinding eye disease after cataract and glaucoma in China.It was also the first blinding eye disease in the working population.DR is one of the most common microvascular complications of diabetes mellitus,which is the response of the metabolic disorders,endocrine system and blood system to the retina.Clinically,DR can be divided into the fertile diabetic retinopathy(NPDR)and proliferative diabetic retinopathy(PDR).DR patients are not in a minority of cataracts,and the cataracts are not the same.DR patients usually have a cataract that is older and more mature than normal cataracts.Cataracts not only affect the vision of DR patients,but also hinder doctors' observation of DR patients' fundus conditions.In some ways,DR's condition has been hidden,which interferes with the timely treatment of DR.Therefore,DR patients should receive cataract surgery in time,but the postoperative efficacy is noteworthy.Existing studies have shown that in patients with PDR,because intraocular angiogenesis factor has been launched course,intraocular micro environment balance is broken,after cataract surgery,more easy to accelerate the development of DR condition.But for NPDR patients,the speed of DR development after cataract surgery has not changed.This study on patients with NPDR cataract phacoemulsification combined artificial lens implantation and the fundus of follow-up after the surgery,is meant to explore whether routine cataract phacoemulsification combined intraocular lens implant surgery could accelerate NPDR progression in patients of phacoemulsification for cataract surgery NPDR patients receiving treatment in a timely manner to provide evidence-based learning basis,also for NPDR combined cataract patient treatment provides a new train of thought.Methods:1.Selected cases:86 cases of patients with cataract phacoemulsification combined with intraocular lens implantation in the hospital between January 2015 and February 2016 were selected.49 cases were male and 37 female were female.Age 44-86 years old,average age(67± 5)years,preoperative binocular diagnosis was NPDR,with mild 57 cases,moderate to 19 cases,and severe 10 cases.The surgical eye was the experimental group and the non-surgical eye was the control group.2.The preoperative examination:open hole and corrected vision,slit-lamp,intraocular pressure,light color vision inspection,AB eye,eye axis,corneal curvature,corneal endothelial counting,OCT macular area,fundus photography and so on,clear the DR in installment.3.The average blood glucose control of preoperative patients was no more than lOmmol/L.4.Surgical method:all patients had cataract phacoemulsification combined with intraocular lens implantation.5.Follow-up observation:in postoperative 1 month,march,June,September and December for review,review check the slit lamp,visual acuity,intraocular pressure,mydriatic fundus examination,fundus camera parallel,OCT macular area inspection,necessary:fundus angiography examination.6.Using SPSS 20.0 statistical software for data analysis,counting data bank card square test;P<0.05 indicates that the difference is statistically significant.Results:1.All patients in the experimental group had the smooth operation and the first stage was implanted with posterior chamber type artificial crystal.The postoperative condition was good,there was no continuous corneal edema,no obvious anterior chamber inflammatory reaction,the artificial crystal position was positive,and the incision was closed.2.Post-operative comfort:most of the patients had no obvious discomfort in the eyes,and a few stimuli such as foreign body sensation,photophobia,and eye redness disappeared after 1?3 days after surgery.The symptoms of photophobia,due to the sudden increase in the amount of light in the eye,usually disappear within1?2 months.3.Postoperative vision:in the eyes of 86 cases,there were 75 patients with the best visual acuity in the postoperative period,and 8 cases with 0.1?0.4,with 3 cases of<0.1.see table 1.4.Progress of DR disease4.1 in 1 year of follow-up time,experimental diabetic retinopathy in 63 cases,control group 20 cases,fundus retinal characterized by increased bleeding,cotton wool spots and pole of the rigid seepage after increased,part of the retina edema.Compared with the control group,the experimental group showed more IRMA and cotton flocculation retinal hemorrhage and microhemangioma,and some patients were accompanied by new angiogenesis of the new angiogenesis,which was seen in the nasal side.The difference is significant(P<0.05)see table 2.4.2 there were 14 cases of macular edema in the experimental group,and there were 3 cases in the control group.DME characterized by edema in the macular area or accompanied by rigid seepage,OCT examination showed the macular area outline is not clear,center concave becomes shallow,or disappear,nerve cortical thickening,interlayer in capsule on sample liquid cavity,center light off the concave under a buildup of fluid,etc.The difference is significant(P<0.05)see table 3.4.3 the effects of blood glucose and diabetes on the progression of postoperative lesions were affected by the preoperative fasting blood glucose of>7.0 mmol/L,with 27 eyes(77.1%)with varying degrees of progression.Preoperative blood glucose was no more than 7.0 mmol/L,and 26 eyes(50.9%)developed different levels of pathological changes.In the 18 patients with 18 eyes,17 eyes were developed at different levels in half a year,20 eyes were treated with>5 years and less than 10 years,and 14 eyes had progressed in different degrees in half a year.Of the 48 eyes,the 22 eyes have progressed in different degrees.Conclusion 1.In the experimental group,the rate of DR progress was accelerated,and the incidence of macular edema was relatively greater,while the control group showed less progress in DR.The progress of DR in the experimental group and the control group showed that in NPDR patients,the cataract phacoemulsification surgery could accelerate the progress of DR.2.In this study,according to the results of NPDR with cataract patient has obviously improved vision after cataract surgery,surgical curative effect is clear,transparent artificial lens cataract surgery for observation of fundus lesions and provide corresponding treatment has created excellent conditions.However,postoperative follow-up should be strengthened and the treatment should be treated as necessary,which is crucial for the development of DR after prevention and control. |
PDF Full Text Request