摘要　目的　研究糖尿病患者白内障超声乳化及人工晶状体植入术中的瞳孔收缩。方法　25例糖尿病患者与30例相应年龄对照病例的术眼，手术前用10g．L-1米多利滴眼，术中灌注的平衡液内加入肾上腺素。手术方法为撕囊，在后房内超声乳化及囊袋内植入PMMA人工晶状体。于术前、超声乳化后和术毕测量瞳孔的水平直径。结果　术前糖尿病患者和对照组之瞳孔大小分别为8.0±0.2mm和7.0±0.5mm，两组无明显差异(P＞0.05)，超声乳化后分别为7.0±0.5mm和4.5±0.2mm，术毕分别为6.0±0.3mm和4.0±0.3mm。超声乳化后和手术后糖尿病患者较对照组病例的瞳孔明显缩小(P＜0.05)。结论　糖尿病患者白内障手术中较对照组病例的瞳孔有明显缩小。

Pupil size in patients with diabetes mellitus during cataract surgery

　　CHEN Ya-Jing,HUANG Hong-Shen

　　Key words　cataract surgery;diabetes mellitus;pupil size

　　Abstract　Objective　To study the constriction of the pupil during phacoemulsification and intraocular lens(IOL) implantation in patients with diabetes mellitus.Methods　Before surgery 10g．L-1 medrine was applied topically to the eyes of 25 patients with diabetes mellitus and 30 eyes of age-matched controls.During the surgery,epinephrine was used after mixed with buffered saline solution.The surgical procedure included capsulorhexis,phacoemulsificant in the posterior chamber and implantation into the capsular bag of a PMMA IOL.Measurements of the horizontal pupillary diameter were taken before surgery,after phacoemulsification and at the end of the surgery.Results　There was no significant difference in pupil size between the controls and the diabetic group before the operation.Surgically induced miosis after phacoemulsification and at the end of operation were significantly more pronounced in the diabetic group than in the controls (P＜0.05).Conclusion　Constriction of the pupil during cataract surgery is more pronounced in diabetic eye as compared with the controls.

　　白内障摘出和后房型人工晶状体(PC-IOL)植入是目前治疗老年性或糖尿病性白内障最常用的复明手术。糖尿病患者较非糖尿病患者的手术并发症明显增多，在糖尿病患者手术中前房常有许多色素弥散或纤维素性反应，术后炎症反应也较明显。最近应用超声乳化(Phaco)施行白内障摘出，可缩短手术时间，减轻术后炎症，获得较好的视力恢复。本文研究伴有糖尿病的白内障Phaco摘出和PC-IOL植入术中瞳孔大小的改变，现报告如下。

　　1　材料和方法

　　1.1　一般资料　糖尿病白内障摘出术组：25例25只眼，男10例，女15例，年龄48～70a，平均65.5a，均为Ⅱ型糖尿病患者，平均病程12.5(8～20)a，经用裂隙灯显微镜检查未见有虹膜新生血管(虹膜红变)；对照组：30例30眼，男12例，女18例，年龄50～72a，平均61.2a，均除外有青光眼、葡萄膜炎或其他眼病。

　　1.2　方法　术前用10g．L-1米多利滴眼散瞳。手术在局麻下均由同一术者施行，术中BSS 500mL灌注液内加入1g．L-1肾上腺素0.3mL。距上方角巩膜缘1mm处，作5.5mm直线式巩膜隧道切口至透明角膜，连续环形撕囊，作晶状体水化分离和水分层，伸入斜面45°的钛金属Phaco头，在后房作晶状体核的Phaco吸除，于囊袋内植入PC-IOL,用BSS置换Healon，术毕创口自行关闭，无需缝线。在切开前房前、Phaco后与术毕均用测径器测量术眼瞳孔的大小，测量时前房均有房水或BSS充填。

　　2　结果

　　糖尿病患者和对照组病例手术中的瞳孔大小改变，见表1。2组病例术前瞳孔大小的差异无显著性(P＞0.05)，但在Phaco后和术毕糖尿病患者的瞳孔直径分别为4.5±0.2mm和4.0±0.3mm，较对照组的7.0±0.5mm和6.0±0.3mm明显缩小，2组瞳孔直径的差异有显著性(P＜0.05)。

    表1　糖尿病组与对照组术前、Phaco后及术毕瞳孔大小

　　Table 1　The pupil size measured before operation,after phacoemulsification and at the end of operation for controls and diabetic group　　　(mm)

Stage	Control	Diabetes	P
Pre-operation	8.0±0.2	7.0±0.5	＞0.05
Post-phacoemulsification	7.0±0.5	4.5±0.2	＜0.05
Post-operation	6.0±0.3	4.0±0.3	＜0.05

[1] [2] 下一页