Nd：YAG激光后囊膜切开术后黄斑区三维光学相干断层扫描观察

Macular changes observed by three-dimensional optical coherence tomography scanning after Nd:YAG laser posterior capsulotomy

目的:应用三维光学相干断层扫描仪观察Nd:YAG激光后囊膜切开对黄斑区视网膜的影响。方法:对超声乳化白内障术后后发性白内障患者65例79眼,依据后囊膜混浊的不同程度,使用不同输出能量的Nd:YAG激光进行治疗。术后10min及术后7d采用三维光学相干断层扫描(Topcon,3D-OCT-1000)检测眼底变化,并记录视力和眼前段情况。结果:后发性白内障患者79眼均成功施行Nd:YAG激光后囊膜切开术,术后患者视力均有不同程度提高,前房无炎性反应,仅6眼人工晶状体光学面出现小凹痕迹。术后10min,7d时患眼黄斑中心凹视网膜平均厚度(CMT)分别为201.36±41.27μm与197.23±36.54μm,比正常同年龄人群组CMT(189.95±43.57μm)略有增加,但两者与正常同年龄人群组比较差异没有统计学意义(P>0.05)。少数患者OCT表现为视网膜光感受器内外节连接(IS/OS)层不完整及黄斑中心凹视网膜各层次欠清晰。结论:Nd:YAG激光是治疗不同程度的后发性白内障安全有效的方法。3D-OCT显示Nd:YAG术后10min,7d的视网膜厚度较同年龄正常人群相似,结构未出现明显异常改变。操作技巧娴熟且激光能量选择适当能减小其对黄斑区视网膜的影响。

AIM：To investigate the effect of neodymium-doped yttrium aluminum garnet（Nd：YAG） laser posterior capsulotomy on foveal retina using three-dimensional ocular coherence tomography（3D-OCT） for posterior capsular opacification after uncomplicated phacoemulsification surgery and intraocular lens（IOL） implantation.METHODS：Our study included 65 patients（79 eyes） with posterior capsular opacification after phacoemul-sification surgery.Nd：YAG laser capsulotomy was performed with varied laser energy in all patients according to their different degrees of posterior opacification.3D-OCT was used to check fundus changes at 10 minutes and 7 days after the laser treatment.Best corrected visual acuity（BCVA） and anterior segment changes were also checked.RESULTS：All of the 79 eyes successfully underwent Nd：YAG capsulotomy,with improved postoperative BCVA in varying degrees.No inflammatory reactions were found in their anterior chambers,and only six of them presented pitting trace on the optical surface of IOL.At 10 minutes and 7 days after capsulotomy,the average macular retinal thickness（CMT） was 201.36±41.27μm and 197.23±36.54μm,respectively.Both were slightly thicker than that of normal group at the same age,whose CMT was 189.95±43.57μm averagely.But there were no statistically significant differences beween them（P0.05）.A discontinuous inner segment and outer segment（IS/OS） line and unclear structure of every layer on the macular area were detected in a small number of the patients.CONCLUSION：Nd：YAG laser capsulotomy is an effecitive and safe method of treating different kinds of posterior capsular opacification.Foveal thickness is similar with normal peer group and retinal structure has no obvious abnormal changes at 10 minutes and 7 days after Nd：YAG laser capsulotomy,as determined by 3D-OCT.Skilled operation techniques and appropriate laser energy could diminish its side effects on retina.