目的：探讨不同血糖水平白内障患者超声乳化手术参数与眼前节参数及其相关性。方法：选取2023年3月至2024年4月我院收治的2型糖尿病性白内障患者45例45眼，根据糖化血红蛋白(HbA1c)水平分为A、B两组，A组18例18眼，HbA1c<7%； B组27例27眼，7%≤HbA1c<8.5%； 同时选取年龄相关性白内障患者94例94眼作为对照组C组。三组患者均接受白内障超声乳化吸除联合人工晶体植入手术治疗，记录三组患者的眼前节参数，包括角膜参数、前房参数及晶状体参数，分析三组患者超声乳化手术参数与眼前节参数的相关性，并比较三组患者的超声乳化手术参数的差异性。结果：在A组和B组糖尿病性白内障患者中，有效超声乳化时间(EPT)与角膜内皮细胞密度(CECD)呈负相关(r=-0.315，P=0.035)； 平均超声乳化时间(APT)与角膜前表面曲率半径呈正相关(r=0.402，P=0.006)，与角膜前表面平坦轴子午线曲率、角膜前表面陡峭轴子午线曲率、角膜前表面平均曲率、晶状体6 mm直径光密度值(PDZ3)呈负相关(均P<0.05)； 平均超声乳化能量(AVE)与晶状体密度平均值(LD-mean)、晶状体2 mm直径光密度值(PDZ1)、晶状体4 mm直径光密度值(PDZ2)、PDZ3呈正相关(均P<0.05)，与瞳孔直径呈负相关(r=-0.385，P=0.009)。在C组年龄相关性白内障患者中，EPT 与Pentacam核分级(PNS)密度分级、PDZ1、PDZ2、PDZ3呈正相关(均P<0.05)。AVE与PNS密度分级呈正相关(r=0.246，P=0.018)，与CECD呈负相关(r=-0.245，P=0.018)。A组和B组患者的EPT显著大于C组(P<0.05)，且B组的EPT和APT显著大于A组(P<0.05)。糖尿病性白内障患者的CECD、角膜密度(CD)、角膜后表面高度与糖尿病病程呈正相关(P<0.05)； 角膜后表面平坦轴子午线曲率、角膜后表面曲率半径与HbA1c呈正相关(P<0.05)，角膜总散光与HbA1c、早餐后2 h血糖、空腹胰岛素呈负相关(P<0.05)； CD值、晶状体厚度与空腹胰岛素值呈正相关(P<0.05)。结论：不同血糖水平白内障患者的超声乳化手术参数和血糖相关指标与眼前节参数具有不同程度的相关性。糖尿病性白内障患者术中EPT显著大于年龄相关性白内障患者，且血糖控制较差组的EPT和APT显著大于血糖控制较好组。

AIM:To analyze the characteristics and correlation of phacoemulsification parameters and anterior segment parameters in cataract patients with different blood glucose levels.METHODS:A total of 45 type 2 diabetic cataract patients(45 eyes)treated in our hospital from March 2023 to April 2024 were stratified into two groups based on glycosylated hemoglobin(HbA1c)levels: group A: HbA1c <7%(n=18)and group B: 7%≤HbA1c<8.5%(n=27); a total of 94 age-matched age-related cataract patients(94 eyes)were enrolled as the control group(group C). All underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters, including corneal, lens and anterior chamber measurements, were recorded. Correlations between phacoemulsification parameters and anterior segment parameters were analyzed, and differences among groups were compared.RESULTS: In groups A and B, effective phacoemulsification time(EPT)negatively correlated with corneal endothelial cell density(CECD)(r=-0.315, P=0.035). Average phacoemulsification time(APT)positively correlated with the anterior corneal surface radius of curvature(Rm; r=0.402, P=0.006)and negatively correlated with the flat axis meridian curvature(K1), steep axis meridian curvature(K2), mean curvature(Km)of the anterior corneal surface, and lens density at 6 mm zones(PDZ3; all P<0.05). Average phacoemulsification energy(AVE)positively correlated with mean lens density(LD-mean), lens density at 2 mm zones(PDZ1), lens density at 4 mm zones(PDZ2), and PDZ3(all P<0.05), and negatively with pupil diameter(r=-0.385, P=0.009). In the group C, EPT showed a positive correlation with Pentacam nucleus staging(PNS)density grade, PDZ1, PDZ2, and PDZ3(all P<0.05). A positive correlation was observed between AVE and PNS classification(r=0.246, P=0.018). Conversely, AVE exhibited a negative correlation with CECD(r=-0.245, P=0.018). EPT in groups A and B was higher than that in the group C(P<0.05). Both EPT and APT in the group B were higher than those in the group A(P<0.05). In diabetic cataract patients, CECD, corneal density(CD), and posterior corneal surface height positively correlated with diabetes duration(P<0.05). Posterior corneal surface K1 and Rm positively correlated with 7%≤HbA1c<8.5%(P<0.05). Total corneal astigmatism negatively correlated with HbA1c, 2-hour post-breakfast blood glucose(2hPBG), and fasting insulin(FINS; P<0.05). CD and lens thickness(LT)positively correlated with FINS(P<0.05).CONCLUSION: Phacoemulsification parameters and blood glucose-related indices exhibited varying degrees of correlation with anterior segment parameters in cataract patients with different blood glucose levels. EPT in diabetic cataract patients was higher than that in age-related cataract patients, while EPT and APT in diabetic cataract patients with poor glycemic control were higher than those with good glycemic control.

安徽省教育厅重点项目(No.2024AH050550)