| Objective: To study the changes of corneal endothelium in different time periods after PHACO+PCIOL operation in diabetic patients,including corneal endothelial cell density(CD),average cell area(AVG),hexagonal cell ratio(HEX),coefficient of variation(CV),and analyze the relationship between the degree of fundus lesions and the best corrected visual acuity(BCVA)in diabetic patients 1 week after operation,and observe the changes of macular edema(CSME)in diabetic patients before and after operation,and provide some reference for clinical diagnosis and treatment.Methods:All patients underwent PHACO+PCIOL surgery from January2019 to January 2020 were randomly selected.One group consisted of 30patients(30eyes)with diabetic cataract,and the other group consisted of 30patients(30eyes)with non-diabetic cataract.The study recorded the best corrected visual acuity(BCVA)of each group before and after operation.The corneal endothelial cell density,average cell area,hexagonal cell ratio and coefficient of variation in central area were measured by Topcon Sp-3000p-type non-contact corneal endothelial meter before and 1 week and 1 month after operation.Preoperative and 1week after operation,japanese canon CR-2AF automatic mydriasis-free fundus camera and u.s OPTOVUE optical coherence tomography scanner(Optical Coherence Tomography)were used to photograph and scan the fundus conditions of patients with diabetes in the same period,to analyze the relationship between the degree of fundus lesions and the best corrected postoperative vision,to observe the patients with preoperative and postoperativeCSME,and to summarize the influencing factors and treatment measures of diabetic patients..RESULTS :1.There was no statistical difference in age,sex,blood glucose and other general data between preoperative diabetic cataract group and non-diabetic cataract group(P>0.05).Compared with the non-diabetic cataract group,the density of corneal endothelial cells,the percentage of hexagonal cells were lower in the diabetic cataract group,and the cell area and coefficient of variation were higher in the diabetic cataract group.But there was no significant difference between the two groups(P>0.05).2.Compared with the control group,the density of corneal endothelial cells and the ratio of hexagonal cells were significantly decreased,the cell area and coefficient of variation were significantly increased in the diabetic group after operation and the difference between the two groups was significant(P<0.05).3.The best corrected visual acuity(BCVA)ofpostoperative diabetic patients with non-proliferative stage lesions was significantly better than that of patients with proliferative stage lesions,and the difference was statistically significant(P<0.05),that is,the more serious the degree of fundus lesions,the worse the postoperative visual acuity.Before operation,there was no significant difference in the number of macular edema between the two groups,and the number of diabetic patients with macular edema after operation was significantly higher than that of non-diabetic cataract group(P<0.05).Conclusion:The morphology of corneal endothelial cells in diabetic patients with cataract is different from that in non-diabetic cataract patients,and corneal endothelial cells are more vulnerable to injury than non-diabetic patients during phacoemulsification,and their recovery is slow after operation.Therefore,the corneal endothelium should be concerned by cataract doctors.The more serious the fundus disease is in diabetic patients,the worse the postoperative curative effect is and the timely and correct treatment of fundus is needed,Taking different measures(including PRP,anti-VEGF,surgery,etc.)in different stages of different lesions of sugar net is an important guarantee to consolidate the postoperative curative effect of diabetic patients and improve the quality of life of diabetic patients.In addition to blood glucose control,diabetic patients should do early screening,early treatment and regular reexamination for fundus lesions. |
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