作者：梁敏，纪惠谦，李宇航 作者单位：青岛市第八人民医院眼科中心，山东 青岛 266100
【摘要】目的 探讨糖尿病性白内障病人的视网膜病变治疗时机及临床效果。方法 对120例（189只眼）糖尿病性白内障病人行散瞳眼底检查，45例(79只眼)因严重白内障眼底窥不清。65例(90只眼)接受眼底荧光造影，其中60只眼糖尿病性视网膜病变属于1～2期；30只眼属于3～5期，白内障手术前对其可见区域视网膜进行激光光凝。102例（157只眼）接受了白内障手术，植入人工晶体。白内障手术后有112只眼接受眼底荧光造影检查（包括术前曾行此检查的90只眼），对其中糖尿病性视网膜病变1～3期病人行局部视网膜光凝治疗，4～5期病人行全视网膜光凝治疗。结果 白内障术后眼底造影检查示糖尿病性视网膜病变1～2期40只眼，3期45只眼，4～5期共27只眼。10只眼放弃治疗，62只眼单纯行激光治疗。光凝治疗后随诊6～12个月，4只眼因玻璃体积血行玻璃体切除术，1只眼注入硅油。其他病眼视力稳定或提高，视网膜病变未见明显进展。26只眼发现黄斑水肿明显，玻璃体腔注射曲安奈德4 mg。结论 白内障术前及术后及时检查眼底，积极治疗，可控制视网膜病变进展。
【关键词】 糖尿病；白内障；视网膜病变
CLINICAL OBSERVATION OF THE TREATMENT FOR DIABETIC RETINOPATHY WITH CATARACT
LIANG MIN, JI HUIQIAN, LI YUHANG, et al
(Department of Ophthalmology Center, Qingdao No.8 People’s Hospital, Qingdao 266100, China)
［ABSTRACT］ObjectiveTo analyze the treatment timing and effect for diabetic retinopathy with cataract.Methods120 patients (189 eyes) of diabetic cataract were examined fundus after mydriasis before cataract operation. Fundus of 45 cases (79 eyes) were invisible due to cataract. 10 cases (20 eyes) refused fundus fluorescence angiography (FFA). 65 cases (90 eyes) were made in FFA. Diabetic retinopathy of 60 eyes were in 1-2 stage,the other 30 eyes were in 3-5 stage who were treated with photocoagulation in visible region before cataract operation. 102 cases (157eyes) were treated with phacoemulsification and intraocular lens implantation. 112 eyes were made in FFA after cataract operation (including 90 eyes which were made in FFA).ResultsThe retinopathy of 40 eyes were in 1-2 stage, 45 eyes were in 3 stage who were suggested local photocoagulation, 27 eyes were suggested panretinal photocoagulation in 4-5 stage. 10 eyes gave up treatment. 26 eyes with macular edema who were treated with intravitreous injection with 4 mg triamcinolone acetonide. Followingup lasted 6-12 months, among which 4 eyes were treated with vitrectomy according to vitreous hemorrhage. One of these 4 eyes was treated with silicone oil injection. 26 eyes with macular edema were treated with intravitreous injection with triamcinolone acetonide. The others have invariant or improved vision.ConclusionThe operation of intraocular lens implantation can accelerate the progression of diabetic retinopathy. So we must examine fundus after mydriasis preoperative, or FFA if necessary, photocoagulation in visible region must be performed duly. After the cataract operation, we must carefully check fundus,treat with photocoagulation in time.
［KEY WORDS］Diabetic mellitus; Cataract; Retinopathy
我国糖尿病的发病率近年来明显升高，糖尿病（DM）主要的致盲原因是白内障和糖尿病性视网膜病变（DR）。随着医疗设备和手术技巧的不断改进，在控制血糖的情况下，DM病人已经能够安全地进行白内障人工晶体植入术，术后视力显著提高。但是由于人们对DR的认识不足，特别是早期DR病人视力较好，往往忽视DR，错过了最佳治疗时机。因此，白内障术后继续治疗DR显得尤为重要。2005年10月～2007年10月，我科收治糖尿病性白内障病人眼底病变120例，现报告如下。
1 资料与方法
糖尿病性白内障病人120例（189只 眼），男56例，女64例；年龄46～84岁，平均62.5岁。DM病程1～24年，平均11年。在白内障术前行双眼散瞳眼底检查，其中45例 (79只眼) 因严重白内障眼底窥不清。另外75例（110只眼）按第6版《眼科学》公布的最新国际DR临床分类法进行分期[1]，其中62只眼属1～2期，48只眼属3～5期。65例（90只眼）在白内障术前行眼底血管造影（FFA）检查（采用日本产TOPCON TRC 50EX）。在白内障术前对属于3～5期的48只眼视网膜可见区域进行激光光凝。视网膜光凝用COHERENT Ultima 2000SE氩激光机治疗，其他病人未作治疗。102例（157只眼）接受了白内障手术，植入人工晶体。术后视力<0.1者10只眼，0.1～0.3者65只眼，0.4～0.8者37只眼。白内障手术后有112只眼接受FFA检查，包括术前曾行此检查的90只眼。
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