Study On The Correlation Between Postoperative Complications And Physical Condition And Course Of Disease In PHACO

Objective:To investigate the correlation between complications such as macular edema,corneal endothelial cell injury after phacoemulsification cataract and physical condition and diabetes course in patients with diabetic cataract.And to observe the changes of retinal thickness and the density of corneal endothelial cells before and after surgery in patients with diabetic cataract.Methods:Using prospective research methods,we collected and investigated a total of 229 cases of diabetic cataract with phacoemulsification cataract extraction surgery in zhongshan hospital affiliated to guangzhou university of traditional Chinese medicine from June 2017 to March 2018 as experimental group.In addition,248 patients with simple senile cataract with phacoemulsification cataract extraction at the same time were selected as the control group.According to the TCM constitution classification and decision criteria promulgated by the Chinese society of traditional Chinese medicine and the physical classification and decision table of TCM,the questionnaire survey of all subjects was conducted and determined the physical type of TCM(eight types of constitution).We analyzed the physical distribution characteristics of traditional Chinese medicine.Patients with diabetic cataract were divided into three groups according to the duration of the disease(less than 5 years group,5 to 10 years group,more than 10 years group).To investigate the correlation between complications such as macular edema,corneal endothelial cell injury after phacoemulsification cataract and physical condition and diabetes course in patients with diabetic cataract.And to observe the changes of retinal thickness and the density of corneal endothelial cells before and after 1 week and 1 month after surgery in patients with diabetic cataract.Results:1.The physical distribution of the experimental group was 51 cases of Pinghe Constitution(22.27%),45 cases of Qi deficiency constitution(19.65%),37 cases of Yin deficiency Constitution(16.16%),22 cases of Yang deficiency Constitution(15.28%),30 cases of Phlegm-dampness constitution(10.53%)of phlegm,and 31 other constitutions.In the control group,there were 93 cases of Pinghe Constitution(37.50%),45 cases of Qi deficiency constitution(18.15%),35 cases(16.53%)of Yang deficiency constitution,30 cases of Yin deficiency Constitution(12.10%)and 39 other constitutions.2.There were 26 cases of macular edema in the experimental group,including 12 cases of Qi deficiency constitution,9 cases of Phlegm-dampness constitution,3 case of Yang deficiencys and 2 of Pinghe constitution,and the incidence of macular edema in the experimental group was 11.35%.Among the experimental group,the incidence of macular edema of Phlegm-dampness constitution,Qi deficiency constitution were higher than other physical macular edema(P<0.05).In the control group,there were 7 cases of macular edema after operation,including 5 cases of Qi deficiency constitution,1case of Yang deficiency constitution and one of mild quality constitution,and the incidence of macular edema after the control group was 2.82%.Among them,the incidence of macular edema in Qi deficiency constitution was higher than other constitutional types(P<0.05).The experimental group was more prone to macular edema than the control group(P<0.05).3.In the experimental group,the physical types of the corneal endothelial cell injury after operation were followed by: Phlegm-dampness constitution,Yin deficiency constitution,qi deficiency constitution and Pinghe constitution.The control group was qi deficiency constitution and Yin deficiency constitution.In both groups,the density of corneal endothelial cells(CCD)was significantly lower after surgery(P<0.01).And before and after operation,the CCD of the experimental group was significantly lower than the control group(P<0.01).4.In the experimental group,the thickness of the macular fovea of Yang deficiency constitution,Qi deficiency constitution and Phlegm-dampness constitution groups at each time point were increased after surgery(P<0.05).The retinal thickness of the macular fovea of Pinghe constitution group was increased in January after the surgery(P<0.05).The retinal thickness ofthe macular fovea of Yang deficiency constitution and Qi deficiency constitution groups at each time point in the control group were significantly increased after surgery(P<0.01).In the first week after surgery,the retinal thickness of the macular fossa of Pinghe constitution group was increased(P<0.05),and the postoperative period was no statistically significance(P>0.05).5.The incidence of macular edema was 2.22% in patients with diabetes less than 5 years(90 cases).The incidence of macular edema was 11.84% after5-10 years(76 cases).The incidence of macular edema was 23.81% more than10 years(63 cases).The incidence of macular edema in three groups was nonparametric test,and the difference was statistically significant(P <0.05).The incidence of macular edema in patients with diabetes and diabetic cataract was examined by Kendall correlation,and the correlation coefficient(r)=5.731,P<0.05,which was statistically significant.6.In the three groups of patients with different stages of diabetes,the retinal thickness and CCD were compared,and the variance analysis was statistically significant(P all<0.01).In addition,with time going,the retinal thickness of the macular center and CCD in the three groups respectively increased and decreased(P all<0.01).Conclusions:1.The common constitution of diabetic cataract is:Pinghe constitution,Qi deficiency constitution,Yin deficiency constitution,Yang deficiency constitution and Phlegm-dampness constitution.The common constitution of patients with simple senile cataract is: Pinghe constitution,Qi deficiency constitution,Yang deficiency constitution and Yin deficiency.2.The incidences of macular edema of Phlegm-dampness and Qi deficiency constitution were higher in patients with diabetic cataract than in other patients after PHACO.In patients with simple senile cataract,the incidence of macular edema after PHACO was higher in patients with qi deficiency type than other types.Patients with diabetic cataract were more likely to have macular edema after PHACO surgery compared to patients with simple senile cataract.3.Patients with diabetic cataract after PHACO are prone to suffer from corneal endothelial cell injury: Phlegm-dampness,Yin deficiency,qi deficiency and calm quality constitution.The constitutive type of cornealendothelium injury after PHACO surgery in patients with simple senile cataract is: Qi deficiency constitution and Yin deficiency constitution.Corneal endothelial cells in patients with diabetic cataract are more likely to be damaged than those with simple senile cataract.4.In patients with diabetic cataract,the thickness of the macular fovea of Yang deficiency,Qi deficiency,Phlegm-dampness and Pinghe constitution after PHACO were increased compared with that of the patients before operatio.In patients with simple senile cataract,patients with Yang-deficiency and Qi deficiency constitution were more likely to have thicker retinal thickness after PHACO than before surgery.Patients with diabetic cataract had significantly higher retinal thickness than patients with simple senile cataract,whether preoperative or after surgery.5.The diabetic course was related to the increased retinal thickness of the macular center,the decrease of corneal endothelial cell density and the incidence of macular edema in patients with diabetic cataract after surgery.With the extension of the course of diabetes,the thickness of the fovea in the macular center of the cataract was increased,the incidence of macular edema after PHACO was increased,and the corneal endothelial cells were more vulnerable to injury.