方法：采用病例对照研究，将115例164眼白内障手术患者按术前HbA1c水平分四组：非糖尿病对照组30例43眼A组(HbA1c≤6.5%)； 糖尿病组：B组26例38眼(HbA1c≤6.5%)、C组28例40眼(6.5%8.0%)。采用角膜内皮镜检测术前； 术后1d； 1，2wk； 1mo的角膜内皮细胞密度、变异系数和六边形细胞比率等参数，对结果进行统计分析。

结果：术前各组患者角膜内皮细胞密度、变异系数、六边形细胞比例差异无统计学意义(P>0.05)。各组术后1d； 1，2wk和1mo角膜内皮细胞密度和六边形细胞比例较术前均明显下降，变异系数显著增大，差异有统计学意义(P<0.05)。糖尿病各组与对照组相比，术后六边形细胞比例减低显著，变异系数增大明显，差异有统计学意义(P<0.05)。A组和B组术后角膜内皮细胞密度减少，无统计学差异(P>0.05)。A组与C组、D组比较，术后角膜内皮细胞密度减少显著(P<0.05)。糖尿病各组间术后角膜内皮细胞密度和六边形细胞比例减少有差异，变异系数增大差异明显，均有统计学意义(P<0.05)。

结论：白内障超声乳化术对角膜内皮细胞形态均有一定程度损伤，HbA1c≤6.5%时术后角膜内皮损伤最小，糖尿病患者术前HbA1c值越高，术后损伤越重。

METHODS: With case-control study, 164 eyes from 115 cataract patients were divided into four groups according to the preoperative HbA1c level. Control group A: 43 eyes from 30 cases without diabetes(HbA1c≤6.5%). Diabetes groups: group B was consisted of 38 eyes from 26 cases(HbA1c≤6.5%), 40 eyes of 28 case was in group C(6.5% 8.0%). Corneal endothelial microscopy was used to detect the parameters like endothelial cell density(CD), coefficient of variation(CV), percentage of regular hexagonal cells(6A)between pre-operation and post-operation at 1d, 1, 2wk, 1mo. The results were analyzed.

RESULTS: The endothelial cell density, CV and 6A cell had no significant difference in four groups before treatment(P>0.05). The CD and 6A were decreased and CV was increased in all groups after operation of 1d, 1, 2wk and 1mo. The difference was statistically significant(P< 0.05). There were statistical differences of 6A and CV in diabetes groups compared with control group(P< 0.05). The decreasing of CD between group A and group B had no difference(P>0.05). There were statistical differences of CD in group C and group D compared with group A(P<0.05). There were statistical differences of CD, 6A and CV within diabetes groups(P<0.05).

CONCLUSION: Cataract phacoemulsification had certain degree damage on corneal endothelial cell. Corneal endothelial appeared the minimal injury when the postoperative HbA1c≤6.5%. For diabetic cataract patients, the higher HbA1c before, the heavier damaged after the surgery.