【作者】 王建民；

【导师】 李建平；

【作者基本信息】 山东大学 ， 眼科学， 2014， 硕士

【摘要】 [背景及目的]后发性白内障是白内障摘除术后引起患者视力再次下降的最常见原因,同时也是白内障术后最常见的并发症。术后晶状体囊残留的晶状体上皮细胞的增殖、迁移、纤维化生是形成后发性白内障的主要原因。随着现代白内障囊外摘除术的普及和超声乳化术的开展,这种并发症的发生越来越常见。成年人后发性白内障的发生率约为10%-40%,儿童几乎高达100%。目前临床上主要采用手术及Nd:YAG激光治疗后发性白内障,而后者被广泛应用。Nd:YAG激光后囊膜切开术是目前国内外治疗后发性白内障安全而有效的方法。Nd:YAG激光治疗后发性白内障操作简单,可在门诊开展。Nd:YAG激光治疗后发性白内障术后视力提高明显,并发症少。Nd:YAG激光术后最主要的并发症是一过性眼压升高和人工晶体损伤。Nd:YAG激光治疗后囊混浊的原理是等离子体效应,等离子体的微小爆破可形成冲击波,其以声波形式扩散可导致靶组织破解碎裂,击穿后囊膜等组织。等离子体的这种爆破其形成的冲击波的作用范围为球面,所以,在应用激光治疗眼部病变时应充分考虑到激光对靶组织以外的组织的影响,如对角膜内皮细胞等。本研究的目的在于探讨Nd:YAG激光治疗后发性白内障对角膜内皮影响的情况。[方法]本研究为回顾性研究,病例均选自山东大学附属济南市中心医院,分为两组,实验组：对32例(32眼)后发性白内障患者行YAG激光后囊切开术,激光瞄准光准确聚焦于后囊膜表面,激光能量应从最小能量开始,环形切开后囊膜,切开直径约为4.5mm。全部患者后囊膜均成功切开,未出现并发症。激光后定期复查,分别于术前0.5h、术后1d、1周、1个月与3个月测定术眼角膜内皮细胞密度及六边形细胞比例；同时选取32例、32眼(Phaco+IOL后,后囊混浊未行YAG激光后囊切开术)作为对照组。记录并分析两组内皮细胞变化趋势。[结果]两组随访期内角膜内皮细胞密度变化差异无统计学意义,但六边形细胞的比例下降程度实验组大于对照组。[结论]一定能量范围的YAG激光对角膜内皮细胞的密度无明显影响,而对内皮细胞的正常形态产生影响。更多还原

【Abstract】 [Background information and Objective] PCO after cataract surgery is the most common cause to visual acuity decreased,but also the most common complication of cataract surgery.Pco is caused by the lens epithelial cells retained in the capsular bag following surgery,which proliferate,migrate and transform to myofibroblasts.With the development of modern extracapsular cataract extraction and phacoemulsification popularization of development,this complication is more and more common.In the adult the rate of PCO is about10%-40%,the children are almost as high as100%. At present the main clinical treatments for PCO are operation and Nd:YAG laser,while the latter is widely used.Nd:YAG laser is a safe and effective method for PCO treatment at home and abroad. Nd:YAG laser is a simple treatment for after-cataract. Nd:YAG laser has been demonstrated to be a convenient,effective and safe treatment for posterior capsule opacification. The main complications were transient high intraocular pressure and injury to IOL.Nd:YAG laser treatment principle is the plasma effect,tiny plasma blasting can form shock wave,which can lead target tissues fragmentation in the form of sound wave diffusion,posterior capsular tissue breakdown.The impact range of wave is a spherical surface,so,the effect of other organizations except the target should be given full considerations in the laser application of the ocular lesions treatment,such as corneal endothelial cells.The purpose of this study is to explore the effect of YAG laser on corneal endothelial cellsin posterior capsule opacification. [methods] This is a retrospective research.All the subjects came from the Jinan central hospital affiliated to Shandong University.They were divided into two groups.Experimental group:32patients (32eyes) which had posterior capsule opacification were cured with YAG.Laser aiming light was focused on posterior capule and minimize the intial dose of laser energy to start the discission.Posterior circular capsulotomy was used,and the diameter was about4.5mm.The posterior capsules were successfully opened in all patients with no severe complications encountered.After the laser treatment,patients were checked regulaily, at the same time,corneal endothelial cell density and proportion of hexagonal cells were measured before the operation and1day,1week,1month and3months postoperative. Control group:32eyes had posterior capsule opacification (after Phaco+IoL) without YAG laser served as the control group.[Results] During the postoperative follow-up period,there was no statistically significant difference from corneal endothelial cell density changes,but the decrease of the hexagonal cells in the experimental group was more evident than in the control group.[Conclusion] A certain energy range of laser had no significant effect on corneal endothelial cell density,but can affect the endothelial cells with normal form.更多还原