Nd:YAG激光治疗后发性白内障术后眼底并发症的临床观察

Complications of the posterior ocular segment following the Nd:YAG capsulotomy

目的探讨Nd:YAG激光治疗后发性白内障术后的眼底并发症。方法回顾性分析Nd:YAG激光治疗后发性白内障患者497例(497眼),其中出现眼底并发症的患者48例(48眼)。对出现眼底并发症的48眼进行裂隙灯、眼科B型超声、检眼镜、荧光素眼底血管造影(FFA)、光学相干断层扫描(OCT)检查。结果Nd:YAG激光治疗后发性白内障后眼底并发症的发病率为9.66%,其中15眼(31.25%)玻璃体前界膜破裂、6眼(12.50%)玻璃体后脱离、8眼(16.67%)视网膜裂孔及6眼(12.50%)视网膜脱离。黄斑裂孔和新生血管性青光眼是较为严重且少见的并发症,分别有1眼(2.0%)和3眼(6.25%)发生,需行睫状体冷凝和滤过手术。各类并发症的发生率与激光治疗的时机、激光发射能量、激光激发的部位、患者原眼部疾患等因素相关。结论提高对Nd:YAG激光治疗后发性白内障术后可能出现眼底并发症的认识,避免各类严重并发症的出现,对已出现的并发症应早期治疗。

Background Nd：YAG is a main method to treat the after cataract,but its complications also are gradually concerned.ObjectiveThe aim of this study is to investigate the complications of posterior eye segment after Nd：YAG capsulotomy.MethodsThe clinical data of 497 eyes of 497 patients received Nd：YAG capsulotomy from 2000 to 2008 were retrospectively analyzed,and 48 patients of them with ocular fundus complications after capsulotomy were enrolled in this study.The slim lamp examination,B-sonography,ophthalmoscope,fluorescine fundus angiography（FFA）,optical coherence tomography（OCT） were performed based on the different complications.ResultsThe incidence of fundus complications after Nd：YAG in this study was 9.66%.The frequency of fundus complications was as follows：rupture of the anterior hyaloid face in 15 eyes（31.25%）,macular edema in 11 eyes（22.92%）,retinal tears in 8 eyes（16.67%）,posterior vitreous detachment in 6 eyes（12.50%）,retinal detachment in 6 eyes（12.50%）,neovascular glaucoma in 3（6.25%）and macular hole in 1 eye（2.0%）.In all of the complications,neovascular glaucoma damaged the visual function severely although undergone the cyclocryotherapy combined with suprachoroidal drainage.These complications were relevant to the emitting duration,energy,emitting site of laser and ocular disease.ConclusionIt is very important for the ophthalmologist to enhance the understanding of complications of the posterior eye segment after Nd：YAG capsulotomy.