人工晶状体眼晶状体后囊膜混浊对视功能的影响

Influence of posterior capsule opacifi- cation on visual function

目的:探讨人工晶状体眼晶状体后囊膜混浊对患者最佳矫正视力、对比敏感度、立体视觉及色觉等诸项视功能的影响。方法:对30例患者(35眼)超声乳化白内障摘除人工晶状体植入术后,发生后囊膜混浊(posteriorcapsuleopacification,PCO)的患眼及对侧眼进行最佳矫正视力、对比敏感度、立体视觉及色觉等项检查。对患眼施行Nd:YAG激光晶状体后囊膜切开术。术后1wk重复上述视功能检查,将术前术后检查结果进行配对比较分析,单眼患者与对侧眼进行比较。结果:Nd:YAG激光晶状体后囊膜切开术前患眼的LogMAR视力平均(0.43±0.33),术后LogMAR视力平均(0.08±0.12),术后视力较术前提高差异有极显著性(P<0.05)。患眼各空间频率的对比敏感度较术前均有明显提高,差异有统计学极显著性(P<0.01);而对侧眼术前最佳矫正视力、各空间频率对比敏感度与术后复查结果比较差异无显著性(P>0.05)。采用颜少明《立体视觉检查图》检测显示,激光后囊膜切开术前立体视觉阳性13例(43%),其中2例(7%)具有中心立体视,无立体视者17例(57%);Titmus立体视觉检查卡检查显示22例患者(73%)立体视阳性,其中4例有中心立体视(13%),无立体视功能者8例(27%)。术后颜氏《立体视觉检查图》和Titmus立体视觉检查卡检测的立体视阳性分别为24例(80%)和28例(93%),其中分别有11例(37%)和15例(50%)达到中心立体视,术后的立体视觉较术前改善差异有显著性(P<0.05)。术前全部患眼存在色觉异常,主要表现在蓝紫色及绿色辨别能力下降,术后色觉障碍有一定程度提高,但蓝紫色觉改善不明显。结论:人工晶状体植入术后后囊膜混浊不仅影响患眼视力的康复,还对对比敏感度、立体视锐度、色觉等多种视功能有不同程度的影响。Nd:YAG激光晶状体后囊膜切开术是治疗PCO,提高视力和改善视功能的有效方法。

AIM： To evaluate the influences of posterior capsule opacification on vision function including visual acuity, contrast sensitivity ,stereoscopic acuity and color vision. METHODS： Measurements of visual acuity, contrast sensitivity ,stereoscopic acuity and color vision were obtain from 35 pseudophakic eyes （30 cases） before and 1 week after Nd： YAG laser posterior capsulotomy and results were analysed. RESULTS： The mean LogMAR acuity was （0.43±0.33） and （0.08±0.12） before and after surgery, respectively. The visual acuity ,contrast sensitivity at all spatial frequencies of patient＇s eyes markedly improved after surgery and the differences were significant （p〈0.05）. However, there was no significantly on other eyes before and after surgery. Using stereoscopic vision examination map of Yan shao ming and Titmus, 13 cases （43%） and 22 cases （73%） had stereoscopic vision, 2 cases （7%） and 4 cases （13%） had central stereoscopic vision, 17 cases （57%） and 8 cases （27%） lost stereoscopic vision before capsulotomy. After surgery, 24 cases （80%） and 28 cases （93%） had stereoscopic vision, 11 cases （37%） and 15 cases （50%） reached to central stereoscopic vision, respectively, the differences were extraordinary significant （P〈0.05）. Before capsulotomy, there was abnormal of color vision in all patient＇s eyes. After capsulotomy, the color vision of patient eyes improved, but there was no significant improvement in blue and purpl. CONCLUSION： Posterior capsule opacification of pseudophakic eyes influenced various vision function. Nd： YAG laser posterior capsulotomy can be regarded as effective treatment for improving patient＇s vision function.