糖尿病患者行玻璃体视网膜手术对角膜内皮细胞的影响

摘要

AIM: To explore the effects of vitreoretinal surgery in diabetics and non -diabetic patients on corneal endothelial cell density and morphology. METHODS: Sixty patients with diabetes ( diabetic group) and 60 non-diabetic patients ( control group ) was collected, of which 30 cases of diabetic group and 30 cases in the control group underwent vitrectomy combined with silicone oil tamponade surgery, 30 cases of diabetic patients and 30 control patients ( lenticular vitreoretinal combined with silicone oil tamponade surgery) .To detect the corneal endothelial cell density ( CD ) , coefficient of variation of endothelial cell area ( CV ) , percentage of hexagonal cells ( RHC ) of two groups of patients 1 day before surgery and three months after surgery. The differences of two groups were compared before and after surgery in corneal endothelial cell changes. RESULTS: After vitrectomy combined with silicone oil surgery, there were significant differences on the coefficient of variation of corneal endothelial cells and the percentage of hexagonal cells between the diabetic and control groups.In the diabetic and control groups, obvious differences were also found in corneal endothelial cell density, coefficient of variation and the percentage of hexagonal cells after lenticular vitreoretinal combined with silicone oil tamponade surgery. The different values for groups of diabetic and non-diabetic all were statistically significant in corneal endothelial cell density, coefficient of variation and the percentage of hexagonal cells before and after surgery. CONCLUSION: The effects of vitrectomy combined with silicone oil tamponade surgery on cornea endothelial cell were mainly reflected on changes of corneal topography.Compared with the non-diabetic group, the changes in corneal endothelial cell shape and destiny of diabetic patients underwent lenticular vitrectomy with silicone oil tamponade surgery are more evidently. Therefore, the strict examination of preoperative corneal endothelial cell has important significant for diabetic patients postoperative visual recovery.%目的：探讨糖尿病患者与非糖尿病患者行玻璃体视网膜手术前后对角膜内皮细胞密度和形态学的影响。　　方法：收集60例患有糖尿病患者（糖尿病组）和60例非糖尿病患者（对照组），其中30例糖尿病组和30例对照组患者行玻璃体切割联合硅油填充手术，30例糖尿病组和30例对照组患者行晶状体玻璃体切割联合硅油填充手术。检测两组患者术前1 d及术后3 mo角膜内皮细胞密度（ cell densities ， CD ）、内皮细胞面积变异系数（ coefficient of variation ，CV ）、六角形细胞百分比值（ ratio of hexagonal cells ，RHC）。比较两组患者手术前后角膜内皮细胞变化的差异。　　结果：玻璃体切割联合硅油填充术在糖尿病组与对照组角膜内皮细胞变异系数和六角形细胞百分比手术前后相比差异均有统计学意义，晶状体玻璃体切割联合硅油填充术在糖尿病组和对照组角膜内皮细胞密度、变异系数及六角形细胞百分比手术前后相比差异均有统计学意义；晶状体玻璃体切割联合硅油填充术在糖尿病组手术前后角膜内皮细胞密度、变异系数、六角形细胞百分比的差值与对照组相比差异有统计学意义。　　结论：玻璃体切割联合硅油填充手术对角膜的影响主要表现在角膜内皮细胞的形态改变；而与非糖尿病患者相比，糖尿病患者行晶状体玻璃体切割联合硅油填充术角膜内皮细胞形态、密度的改变较非糖尿病患者明显，因此术前角膜内皮细胞的严格检查对于糖尿病患者术后视觉的恢复具有重要意义。