【摘要】 目的:超声乳化白内障摘除联合人工晶体植入后后发性白内障发病率较高,观察Nd:YAG激光治疗人工晶体植入术后后囊混浊效果,分析单次脉冲能量及激光聚焦点与效果的关系。方法:(1)试验对象:收集2006-01/2007-06来本院就诊的超声乳化白内障摘除人工晶体植入手术术后发生后囊混浊的患者112例122只眼,男52例,女60例,年龄8～85岁。根据后囊混浊膜的厚薄分级:1级膜为半透明,2级膜为灰白色,3级膜为膜致密并有部分晶体皮质。考虑到行OCT检查的可行性,本组观察病例仅取1～2级后囊混浊患者。1级67只眼,2级55只眼。纳入病例标准:①手术前视力低于0.2。②术前眼压低于2.79kPa。③后囊混浊分级2级(含2级)以下。④双眼未发生视网膜脱离。⑤患者对治疗知情同意。(2)试验方法及评估:对患者行Nd:YAG激光晶状体后囊膜切开术,分别于手术前、术后1周、1个月、3个月进行视力、眼压、黄斑区视网膜神经纤维层厚度的光学相干断层扫描检查,并对比观察单次激光脉冲能量大小组视网膜厚度变化。Nd:YAG激光晶状体后囊膜切开囊膜瓣直径4～5mm,平均单次脉冲能量为1～10mJ。术后平均随访时间6个月。结果:纳入患者112例122只眼,均进入结果分析。①95.08%的患眼术后视力较术前视力提高,79.51%术后视力提高2行及以上,黄斑囊样水肿2只眼(占1.63%)。②眼压术后升高者5例(占4.09%),人工晶体损伤3例(占2.46%),未出现晶体脱位、玻璃体脱出等并发症。③黄斑区视网膜厚度于术后1周与1个月明显增厚,与术前比较,差异具有显著性意义(P<0.05);术后3个月与术前视网膜厚度差异无显著性(P>0.05);激光脉冲能量大小组术后1月黄斑区视网膜厚度差异有显著性(P<0.05)。结论:激光后囊膜切开术可有效提高视力,控制单次激光脉冲能量与后囊的准确聚焦可有效降低并发症发生,对黄斑区视网膜改变OCT检查可早期发现病变并方便随访观察。更多还原

【Abstract】 AIM: Phacoemulsification and intraocular lens (IOL) implantation can induce after-cataract in a high percentage, this study is designed to observe the effect of Neodymium-YAG (Nd:YAG) laser on posterior capsular opacification (PCO) after IOL, and analyze the relationship of the effect with single pulse power and laser focus. METHODS: (1)Objects: A total of 112 patients (122 eyes) with PCO after phacoemulsification and IOL implantation were collected from January 2006 to June 2007 in the People’s Hospital of Linyi City, aged from 8 to 85 years (male 52, female 60). Grading was done according to the thickness of PCO: half-transparent membrane as grade 1, gray and white membrane as grade 2, and dense membrane with lenticular cortex for grade 3. For the need of the trial, only patients with grade 1 (67 eyes) and 2 (55 eyes) were observed. Inclusive criteria:①Preoperative visual acuity below 0.2.②Preoperative intraocular pressure (IOP) below 2.79 kPa.③PCO grade 2 or below.④No detached retina appeared in two eyes.⑤Informed consents were obtained from the patients.(2)Method and evaluation: Patients with PCO were treated by the Nd:YAG laser with capsulectomy technique. The visual acuity, IOP and the macular retinal thickness examined by optical coherence tomography (OCT) were observed at preoperation, 1 week, 1 month and 3 months after postoperation; also the comparison of retinal thickness in two groups with different single pulse laser powers was made. The diameter of posterior capsulectomy was 4-5 mm, and the average single pulse laser power was 1-10 mJ. The mean follow-up after surgery was 6 months. RESULTS: All the 112 cases (122 eyes) were involved in the result analysis.①The vision of 95.08% patients after capsulectomy was improved, and the vision of 79.51% patients increased by 2 levels or above, moreover the macular edema was found in 2 eyes (1.63%).②IOP in 5 eyes (4.09%) were elevated and IOL in 3 eyes (2.46%) was damaged. No complications with IOL dislocation and vitreous moving were found.③The macular retinal thickness at 1 week and 1 month after surgery increased markedly, and the difference was significant (P < 0.05); no significant difference was found at 3 months (P > 0.05); the difference of macular retinal thickness at 1 month after surgery between 2 groups was significant (P < 0.05). CONCLUSION: Nd:YAG laser can increase the vision effectively, and proper single pulse laser power and accurate focus can lower incidence rate of complications. Also OCT is helpful to detect the macular retinal thickness and the follow-ups.更多还原