后发性白内障形态及对视功能影响临床分析

The general clinical evaluation on of posterior capsule opacification morphology and affected visual function

目的 通过对后发性白内障（Posterior Capsule Opacification,PCO）的形态学及其对视功能影响的客观综合评价,为临床激光后囊切开术提供指导意义.方法 选择61例（67只眼）后发性白内障拟行Nd：YAG 激光后囊切开术的患者,充分散大瞳孔（直径〉6.00mm）,先采用裂隙灯加前置镜行主观评价,再行裂隙灯眼底后部反光裂隙照相,所得数码图像使用POCOman软件进行分析,得出PCO的POCOman半客观评分.于Nd：YAG激光后囊切开术前、术后分别测量其最佳矫正视力（best corrected visual acuity,BCVA）,同时使用自动眩光对比敏感度检查仪进行对比敏感度（contrast sensitivity,CS）和眩光对比敏感度（glare sensitivity,GS）的检测.分析统计不同类型、不同部位、不同程度PCO与视功能的关系.结果 珍珠型PCO在中心视力、各频段对比敏感度和眩光敏感度均低于纤维型PCO,且两者之间的差异有统计学意义（P〈0.05）;中央4.0mm珍珠型PCO在低、中频段对比敏感度和中频段眩光敏感度均低于中央2.0mm珍珠型PCO,差异有统计学意义（P〈0.05）.中央2.0mm纤维型PCO在中、高频段对比敏感度和低、中频眩光敏感度均低于中央4.0mm纤维型PCO,差异有统计学意义（P〈0.05）.中央2.0mm珍珠型PCO对最佳矫正视力的影响最为显著;中央4.0mm珍珠型PCO对对比敏感度和眩光敏感度的影响最为显著.随着PCO程度的增加,中心视力、全频段对比敏感度和全频段眩光敏感度逐渐下降.其间的差异有统计学意义.POCOman评分与最佳矫正视力、各频段对比敏感度、低中频段眩光敏感度的变化呈正相关（P〈0.05）,差异有统计学意义.结论 对后发性白内障行形态学及其对视功能受损的客观综合评价,可成为判断Nd：YAG激光晶状体后囊膜切开术手术时机和评价手术疗效的方法.

Objective To investigate the correlation between the change in visual fimction and the difference in morphology character of posterior capsule opacification.Methods Following dilation of the pupil,67 standardized digital retroillumination images of eyes （61 cases） with PCO were selected using slit-lamp photographic system （digital camera,computer included）.The images were analyzed with POCOman software by masked examiners.Measurements of best corrected visual acuity,contrast sensitivity and glare sensitivity were obtained before and 1 week after Nd：YAG laser capsulotomy.The correlation between visual function and different morphologic characters of PCO were analyzed.Results Best corrected visual aeuity,contrast sensitivity and glare sensitivity at all spatial frequency in pearl-type PCO were lower than that of fibrosis-type PCO,there were statistically significant differences between them（P〈0.05）.Contrast sensitivity at low,medium spatial frequency and glare sensitivity at medium spatial frequency in central 4.0mm pearl-type PCO were lower than that of central 2.0mm pearl-type PCO,there were statistically significant differences between them（P〈0.05）.Contrast sensitivity at medium,high spatial frequency and glare sensitivity at low,medium spatial frequency in central 2.0mm fibrosis-type PCO were lower than that of central 4.0mm fibrosis-type PCO, there were statistically significant differences between them （P 〈 0.05 ）. The improvements in BCVA were mostly correlated to pearl in the central 2.0mm. The improvements in CS and GS were mostly correlated to pearl in the central 4.0mm. There were positive correlation between POCOman score and the difference in BCVA, CS, GS （P 〈 0.05 ）, expect for glare sensitivity at high spatial frequency. Conclusions To objectively evaluate the morphologic characters of PCO and the change of visual function can provide clinical evaluation criterion of PCO, surgical timing and effect of Nd：YAG laser posterior capsulotomy.