目的：比较手法小切口白内障手术与白内障超声乳化吸除联合人工晶状体植入对糖尿病合并年龄相关性白内障患者角膜内皮细胞的影响。

方法：选取2015-07/2017-12于我院就诊的128例128眼糖尿病合并年龄相关性白内障患者作为研究对象，根据手术方式不同将患者分为手法小切口组及超声组。观察术前及术后1、6wk患者视力和散光度以及角膜内皮细胞形态及功能。

结果：手法小切口组及超声组患者术前LogMAR视力为0.75±0.30、0.80±0.29，术后6wk为0.14±0.05及0.15±0.04(P<0.05)，散光度术前为0.87±0.28、0.84±0.27D，术后1wk升高至1.64±0.52、1.52±0.42D，术后6wk降至1.33±0.44及1.23±0.38D(P<0.05)； 术前角膜厚度为529.15±42.51、528.17±39.64μm，术后1wk升高至548.14±36.54、544.56±40.14μm，术后6wk降至531.01±42.15、529.64±44.12μm； 内皮细胞密度术前为2948.14±335.45、2894.17±365.21个/mm²，术后6wk降至2714.15±431.01、2689.22±333.45个/mm²； 六角形细胞比例术前为52.16%±10.11%、49.51%±11.07%，术后6wk降至37.48%±11.24%、39.31%±10.47%； 角膜变异系数由术前的38.45±5.64及40.17±5.69升高至43.27±4.85及44.01±4.91； 角膜厚度、内皮细胞密度、六角形细胞比例及角膜变异系数等指标组内不同时间点比较均有差异(P<0.05)，组间比较无差异(P>0.05)。

结论：手法小切口白内障与白内障超声乳化吸除联合人工晶状体植入均可改善糖尿病合并年龄相关性白内障患者视力，在术后视力恢复、角膜内皮细胞损伤方面无明显差异，疗效及安全性相当。

METHODS: Totally 128 eyes of 128 diabetic patients with age-related cataract treated in our hospital from July 2015 to December 2017 were divided into manual small incision group and ultrasound group according to different surgical methods. The visual acuity, astigmatism, morphology and function of corneal endothelial cells were observed before and 1 and 6wk after operation.

RESULTS: The preoperative LogMAR visual acuity of manual small-incision group and ultrasound group were 0.75±0.30 and 0.80±0.29, which decreased to 0.14±0.05 and 0.15±0.04 at 6wk after surgery(P<0.05). The astigmatism were 0.87±0.28D and 0.84±0.27D before surgery, which increased to 1.64±0.52D and 1.52±0.42D at 1wk after surgery, and 1.33±0.44D and 1.23±0.38D at 6wk after surgery. The preoperative corneal thickness of manual small-incision group and ultrasound group were 529.15±42.51μm and 528.17±39.64μm, respectively, increasing to 548.14±36.54μm and 544.56±40.14μm at 1wk after surgery, decreasing to 531.01±42.15μm and 529.64±44.12μm at 6wk after surgery. The postoperative endothelial cell density were 2948.14±335.45/mm², 2894.17±365.21/mm², decreasing to 2714.15±431.01/mm², 2689.22±333.45/mm² at 6wk after surgery. The proportions of hexagonal cells were 52.16±10.11% and 49.51±11.07% before surgery, decreasing to 37.48±11.24% and 39.31±10.47% at 6wk after surgery. The preoperative corneal variation coefficients were 38.45±5.64 and 40.17±5.69, increasing to 43.27±4.85 and 44.01±4.91. There were significant differences in corneal thickness, endothelial cell density, hexagonal cell ratio and corneal variation coefficient at differences time points in the same groups(P<0.05).There was no significant difference between the two groups(P>0.05).

CONCLUSION: Manual small incision cataract and phacoemulsification combined with intraocular lens implantation can improve the visual acuity of diabetes mellitus patients with age-related cataract. There is no significant difference in visual acuity recovery and corneal endothelial cell injury after operation. The efficacy and safety are comparable.