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Abstract：
OBJECTIVE: Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland.
METHODS: In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey\'s post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant.
RESULTS: The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05).
CONCLUSIONS: Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.
METHODS: In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey\'s post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant.
RESULTS: The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05).
CONCLUSIONS: Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.
摘要：
目的：角膜内皮细胞（ECD）的特征是有限的再生潜能，这在糖尿病患者中也受到损害。这项回顾性研究包括27例患者，年龄58.1±13.6，女性16例，男性11例，在2013年至2017年期间，在Sosnowiec的St.Barbara医院接受了23号玻璃体切除术联合白内障手术（晶状体玻璃体切除术）和进一步的Ex-PRESS分流植入，波兰。
方法：在我们的研究中，我们区分了4个时期:初始时期;超声玻璃体切除术和去除油填塞后;植入Ex-PRESS分流术后3个月和12个月.在P<0.05的统计学显著性水平下进行统计学分析。它包括方差分析（ANOVA）和Tukey的事后检验，以确定观察期之间ECD细胞密度/mm2的差异。还进行了配对样品t-Student检验以确定PPV之前和之后以及Ex-PRESS分流之前和之后的视敏度值的差异是否具有统计学意义。
结果：ECD细胞的初始计数为2381.1±249，降至1872.8±350.7细胞/mm2，最终降至1677.9±327。观察到ECD细胞密度/mm2之间的差异具有统计学意义：PPV后vs.ECD的初始数量（p=0.000138）；Ex-PRESS分流后3个月前与初始ECD数（p=0.000138）；ExPRESS分流后12个月与ECD的初始数量(p=0000138)。分析视力的变化，我们观察到Ex-PRESS分流之前和之后3个月(p=0.007944)以及PPV之前和之后(p=0.060334)的恶化。反过来,相关分析表明，有统计学意义，中度,积极的关系。Ex-PRESS分流后视力与ECD细胞/mm2密度之间的关系具有统计学意义（r=0.521381；p<0.05）。
结论：无论糖尿病并发症的观察期和眼科治疗的选择，我们观察到ECD细胞数量减少和视力下降。是的,因此,合理地向患者提供有关拟议程序的完整信息，并考虑风险-收益平衡。
方法：在我们的研究中，我们区分了4个时期:初始时期;超声玻璃体切除术和去除油填塞后;植入Ex-PRESS分流术后3个月和12个月.在P<0.05的统计学显著性水平下进行统计学分析。它包括方差分析（ANOVA）和Tukey的事后检验，以确定观察期之间ECD细胞密度/mm2的差异。还进行了配对样品t-Student检验以确定PPV之前和之后以及Ex-PRESS分流之前和之后的视敏度值的差异是否具有统计学意义。
结果：ECD细胞的初始计数为2381.1±249，降至1872.8±350.7细胞/mm2，最终降至1677.9±327。观察到ECD细胞密度/mm2之间的差异具有统计学意义：PPV后vs.ECD的初始数量（p=0.000138）；Ex-PRESS分流后3个月前与初始ECD数（p=0.000138）；ExPRESS分流后12个月与ECD的初始数量(p=0000138)。分析视力的变化，我们观察到Ex-PRESS分流之前和之后3个月(p=0.007944)以及PPV之前和之后(p=0.060334)的恶化。反过来,相关分析表明，有统计学意义，中度,积极的关系。Ex-PRESS分流后视力与ECD细胞/mm2密度之间的关系具有统计学意义（r=0.521381；p<0.05）。
结论：无论糖尿病并发症的观察期和眼科治疗的选择，我们观察到ECD细胞数量减少和视力下降。是的,因此,合理地向患者提供有关拟议程序的完整信息，并考虑风险-收益平衡。
