Nd∶YAG激光对蓝光阻断性折叠式人工晶状体损伤作用的研究

Effects of blue light laser interdiction foldable intraocular lens on the injury induced by Nd∶YAG laser

目的探讨Q-开关掺钕钇铝石镏石(Nd∶YAG)激光对不同材料及类型的折叠式人工晶状体(IOL)的损伤作用,观察蓝光阻断性折叠式IOL的抗激光能力。方法选择蓝光阻断性折叠式IOL、紫外线吸收一片折叠式IOL、疏水性丙烯酸酯折叠式IOL、硅凝胶折叠式IOL4种+20D左右的折叠式IOL,分为4组,每组4枚。用Nd∶YAG激光治疗机将IOL光学部后表面平均分为8个扇形区,Nd∶YAG激光的输出能量分别为0.5、1.0、1.5、2.0、2.5、3.0、4.0、5.0mJ8个能量水平。同一能量水平激光在IOL光学部后表面同一区内由中心向周边部呈放射状依次击射50点。结果IOL损伤百分率:激光能量为0.5mJ和1.5mJ时前3组IOL与组4间差异有统计学意义(P<0.01);激光能量为2mJ时以上各组间差异无统计学意义(P>0.05)。组4自0.5mJ开始出现凿痕,其他3组的凿痕都在激光能量为2.0mJ时出现。经实体显微镜和扫描电镜观察,组4激光击射处有炸裂出现,其他IOL的凿痕均表现为小凹,但形态学上有区别。结论蓝光阻断性折叠式IOL抗激光能力优于硅凝胶折叠式IOL,与其他两种IOL类似。

Objective Today Nd： YAG laser posterior capsulotomy is the therapeutic method to deal with the increased thickness of posterior capsule after intraocular lens（IOL） implantation. But its damage to the IOL appeared to be frequent. This paper was to investigate the damage induced by Nd： YAG laser to foldable IOL and observe the resistant ability of blue light laser interdiction foldable IOL to laser irradiation, Methods Foldable IOL of Acrysof Natural SN60AT,Acrysof SA60AT,Sensar and SI-40 were used in this study. The posterior surface of the IOL optical zone was divided into 8 fan-shaped areas. Ophthalmic laser instrument（ MQ-12 Nd： YAG,ZEISS）was used to irradiate the posterior surface of 4 types IOLs for 50 times in each zone with the energy 0. 5,1.0,1.5,2.0,2.5,3.0,4.0,5.0 mJ respectively under the room air. The criterion of damage was defined as the immediate hoar-like damage following the laser shot. Results Percentage of IOL injury was significantly different in 4 types of IOLs group under the different laser energies（x^2 = 116. 64, P 〈 0.01 ）. The percentage of IOL injury was evidently increased in SI-40 group in comparison with Acrysof Natural SN60AT,Acrysof SA60AT,Sensar group under the laser energies of 0.5 mJ and 1.5 mJ （ P 〈 0. 01 ）. However,when the laser energy was over 2 mJ,there was no statistically significant difference in percentage of IOL injury among the four groups（ P 〉 0. 05 ）. SI-40 IOL showed the crack on the irradiation area under the stereo microscope and scanning electron microscope, however, Acrysof Natural SN60AT, Acrysof SA60AT, Sensar exhibited the injury only in fovea, indicating the distinctive injury in shape among the different types of IOL. Conclusion The resistant ability of Acrysof Natural SN60AT to laser injury is better than SI-40, but it is similar to Acrysof SA60AT and Sensar.