Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema
Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema
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DOI：
10.1007/s00417-002-0530-7
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发表时间：
2002-09-01
影响因子：
2.7
通讯作者：
Wedrich, A
中科院分区：
文献类型：
--
作者：
Krepler, K;Biowski, R;Wedrich, A
背景资料：据报道，与非糖尿病患者相比，糖尿病患者白内障手术后的结局更差-尤其是糖尿病视网膜病变患者。这项前瞻性研究计划在白内障手术后1年基线时无临床显著性黄斑水肿（CSME）的非增殖性糖尿病视网膜病变（NPDR）患者的同质组中评价视力结局、糖尿病视网膜病变进展和CSME发生率。研究方法：在18个月的时间内，前瞻性随访了所有接受白内障超声乳化术和后房型透镜植入术的轻中度糖尿病视网膜病变患者。术后1年评估结果，包括视力（VA）、视网膜病变进展和CSME发生率。将视网膜病变的进展和CSME的发生率与未手术的对侧眼进行比较。结果：在纳入的50例患者中，42例完成了1年随访。85%的患者VA改善，71%的患者VA优于0.5。白内障手术后12%的眼睛和未手术的10.8%的对侧眼睛发生视网膜病变进展。无患者发生增生性糖尿病视网膜病变的手术眼。CSME发生在13只手术眼（3.1%），其中5只为视网膜缺血，5只为非手术眼（13.5%）。缺血性黄斑水肿患者视力预后最差。结论：现代白内障手术似乎对糖尿病视网膜病变的进展没有影响。大多数NPDR患者的视力得到改善，但在发生黄斑水肿的患者中观察到较差的视力结果。
Background: Compared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients - especially in those with diabetic retinopathy. This prospective study was planned to evaluate visual outcome, progression of diabetic retinopathy, and incidence of clinically significant macular oedema (CSME), in a homogenous group of patients with non-proliferative diabetic retinopathy (NPDR) without CSME at baseline 1 year after cataract surgery. Methods: Over a period of 18 months, all consecutive patients with mild-to-moderate diabetic retinopathy who had cataract surgery with phacoemulsification and posterior chamber lens implantation were prospectively followed up. Outcomes were assessed 1 year postoperatively and included visual acuity (VA), progression of retmopathy, and incidence of CSME. Progression of retinopathy and incidence of CSME were compared to the nonoperated fellow eyes. Results: Of 50 patients included, 42 completed the 1-year follow-up. VA improved in 85% of patients, and was better than 0,5 in 7 1 %. Progression of retinopathy occurred in 12% of eyes after cataract surgery and in 10.8% of non-operated fellow eyes. No patient developed proliferative diabetic retinopathy in the operated eye. CSME occurred in 13 operated eyes (3 1 %), five of them with retinal ischemia, and in five non-operated eyes (13.5%). Patients with ischemic macular oedema had the worst prognosis regarding VA. Conclusion: Modern cataract surgery seems to have no influence on the progression of diabetic retinopathy. A visual improvement is achieved in the majority of patients with NPDR, but poorer visual outcome is observed in patients developing macular oedema.