Lens Power, Axial Length-to-Corneal Radius Ratio, and Association with Diabetic Retinopathy in the Adult Population with Type 2 Diabetes
Lens Power, Axial Length-to-Corneal Radius Ratio, and Association with Diabetic Retinopathy in the Adult Population with Type 2 Diabetes
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2 型糖尿病成人人群的晶状体屈光力、眼轴长度与角膜半径之比以及与糖尿病视网膜病变的关联
DOI：
10.1016/j.ophtha.2016.10.041
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发表时间：
2017-03-01
期刊：
影响因子：
13.7
通讯作者：
Zou, Haidong
中科院分区：
文献类型：
--
作者：
He, Jiangnan;Xu, Xian;Zou, Haidong
目的：计算晶状体屈光力，并确定2型糖尿病（T2DM）成年人群的眼部生物测量数据与糖尿病视网膜病变（DR）之间的关系。
设计：基于人群的横断面研究。
参与者：来自上海长宁区北新泾社区的2型糖尿病患者。
方法：采用随机整群抽样法确定北新泾社区的成年2型糖尿病患者。通过能获得最佳矫正视力的主观验光确定等效球镜度（SE）。使用IOLMaster测量眼轴长度（AL）、角膜屈光力（CP）和前房深度（ACD）。根据国际糖尿病视网膜病变分类标准评估糖尿病视网膜病变和糖尿病黄斑水肿（DME）。
主要观察指标：使用Bennette - Rabbetts公式计算晶状体屈光力。眼轴长度与角膜曲率半径之比（AL/CR比）定义为眼轴长度除以平均角膜曲率半径。
结果：分析纳入了2057名受试者的4011只眼（均患有T2DM）。在对年龄、性别、糖尿病病程、糖化血红蛋白A1c、血清肌酐、体重指数、收缩压和白内障进行调整的多变量逻辑回归模型中，将数值分为四分位数后，晶状体屈光力与任何糖尿病视网膜病变之间存在趋势关联（P = 0.01），AL/CR比与任何糖尿病视网膜病变之间存在趋势关联（P = 0.02），AL与任何糖尿病视网膜病变之间存在趋势关联（P = 0.03），晶状体屈光力与中度糖尿病视网膜病变之间存在趋势关联（P = 0.02），AL与中度糖尿病视网膜病变之间存在趋势关联（P = 0.02）；AL/CR比较高的眼发生任何糖尿病视网膜病变的可能性较低（比值比[OR]，0.43；95%置信区间[CI]，0.24 - 0.78；每增加1，P = 0.01），发生中度糖尿病视网膜病变的可能性也较低（OR，0.44；95%CI，0.21 - 0.93；每增加1，P = 0.03），AL较长的眼发生任何糖尿病视网膜病变的可能性较低（OR，0.88；95%CI，0.81 - 0.95；每增加1毫米，P = 0.002）或发生中度糖尿病视网膜病变的可能性较低（OR，0.89；95%CI，0.80 - 0.98；每增加1毫米，P = 0.02），SE较高的眼发生任何糖尿病视网膜病变的可能性较高（OR，1.08；95%CI，1.03 - 1.13；每增加1屈光度，P = 0.003）。
结论：在2型糖尿病患者中，晶状体屈光力、AL/CR比和AL与任何糖尿病视网膜病变及中度糖尿病视网膜病变的存在相关。这些发现表明，眼球伸长在对糖尿病视网膜病变的保护作用中起主要作用，晶状体屈光力和其他屈光成分也有贡献。（C）2016美国眼科学会
Purpose: To calculate crystalline lens power and to determine the relationship between ocular biometry and diabetic retinopathy (DR) in an adult population with type 2 diabetes mellitus (T2DM).Design: Cross-sectional, population-based study.Participants: Patients with T2DM from the Beixinjing community, Changning district, Shanghai.Methods: Random clustering sampling was used to identify adults with T2DM in the Beixinjing community. Spherical equivalent (SE) was determined by subjective refraction that achieved the best corrected vision. Axial length (AL), corneal power (CP), and anterior chamber depth (ACD) were measured using the IOLMaster. Diabetic retinopathy and diabetic macular edema (DME) were assessed according to the international DR classification.Main Outcome Measures: The crystalline lens power was calculated using the Bennette-Rabbetts formula. The AL-to-corneal radius ratio (AL/CR ratio) was defined as the axial length divided by the mean corneal radius of curvature.Results: A total of 4011 eyes of 2057 subjects with T2DM were included in the analysis. In multivariate logistic models adjusting for age, sex, duration of diabetes, glycosylated hemoglobin A1c, serum creatinine, body mass index, systolic blood pressure, and cataract, after categorizing values into quartiles, there were trend associations between lens power and any DR (P = 0.01), between AL/CR ratio and any DR (P = 0.02), and between AL and any DR (P = 0.03), between lens power and moderate DR (P = 0.02), and between AL and moderate DR (P = 0.02); eyes with higher AL/CR ratio were less likely to have any DR (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.24-0.78; P = 0.01 per 1 increase) and moderate DR (OR, 0.44; 95% CI, 0.21-0.93; P = 0.03 per 1 increase), eyes with longer AL were less likely to have any DR (OR, 0.88; 95% CI, 0.81-0.95; P = 0.002 per millimeter increase) or moderate DR (OR, 0.89; 95% CI, 0.80-0.98; P = 0.02 per millimeter increase), and eyes with higher SE were more likely to have any DR (OR, 1.08; 95% CI, 1.03-1.13; P = 0.003 per diopter increase).Conclusions: In persons with T2DM, lens power, AL/CR ratio, and AL were associated with the presence of any DR and moderate DR. These findings suggested that globe elongation plays a major role in protective effects against DR, with contributions from lens power and other refractive components. (C) 2016 by the American Academy of Ophthalmology