后发性白内障患者行后囊膜切开术后视觉相关生活质量的评价

Vision-related quality of life in posterior capsule opacification patients after Nd∶YAG laser capsulotomy

背景 后发性白内障（PCO）是超声乳化白内障摘出联合人工晶状体（IOL）植入术后的主要并发症,发病率高,其主流治疗方法是后囊膜切开术,但是目前缺乏对PCO行Nd∶YAG激光后囊膜切开术后患者生活质量的研究. 目的 评估PCO患者行Nd∶YAG激光后囊膜切开术后的视力及视觉相关的生活质量.方法 前瞻性横断面研究.收集2012年9-12月在温州医学院附属眼视光医院拟行Nd∶YAG激光治疗的PCO患者200例250眼,术前所有患者按视力损害的程度不同分为无或者轻度视力损伤（1级）、中度视力损伤（2级）、重度视力损伤（3级）和盲（4级）,并由同一位眼科医师对纳入的患者行Nd∶YAG激光后囊膜切开术.本研究的主要观察指标包括视力和美国国家眼科研究所视功能问卷-25（NEI-VFQ-25）调查问卷评分.分别于术前、术后3周检测并分析患者的单眼和双眼视力,采用NEI-VFQ-25对患者进行问卷调查,调查问卷中的各项条目分别计为0～4分,评价结果为调查问卷的累积分数.结果 所有患者Nd∶YAG激光后囊膜切开术术前双眼视力（LogMAR）及NEI-VFQ-25评分分别为0.47＆#177;0.44和59.1＆#177;13.0,术后3周分别为0.30＆#177;0.30和72.1＆#177;15.9,患者术后的双眼视力和NEI-VFQ-25评分较术前均明显改善,差异均有统计学意义（t=11.38、22.01,P＜0.05）.PCO患者行Nd∶YAG激光后囊膜切开术术后3周NEI-VFQ-25调查问卷中12类视觉生活质量相关的项目,如一般健康状态、总体视觉情况、眼痛、近距离工作、远距离工作、社交功能、精神健康状态、社会角色限制、独立性、驾驶、色彩视觉和周边视野等方面评分均较术前明显提高,差异均有统计学意义（均P＜0.05）.术前各级视力损害者行Nd∶YAG激光后囊膜切开术后在NEI-VFQ-25调查问卷评分均有明显改善（t=21.20、8.39、3.18,P＜0.05）. 结论 PCO患者Nd∶YAG激光后囊膜切开术后,视力联合视觉相关的生活质量问卷调查评分是评价患者生活质量的指标.

Background Posterior capsular opacification （PCO） is a main complication after phacoemulsification and intraocular lens（IOL） implantation,and its primary treatment is capsulotomy.However,the study on quality of life after Nd∶YAG laser posterior capsulotomy is lack.Objective This study was to evaluate visual acuity-and vision-related quality of life in the patients who received Nd ∶ YAG laser posterior capsulotomy.Methods Two hundred PCO patients （250 eyes） undergoing Nd∶YAG laser posterior capsulotomy were included in this prospective study from September 2012 to December 2012 in Affiliated Eye Hospital of Wenzhou Medical College.The visual acuities of the patients were graded into without and with mild visual damage （grade 1）,moderate visual damage （grade 2）,serious visual damage （grade 3） and blindness （grade 4）.Nd ∶ YAG laser capsulotomy was performed on all the patients by the same surgeon.The main observation indexes of this study included visual acuities and scores of National Eye Institute-Visual Function Questionnaire-25 （NEI-VFQ-25）.The monocular and binocular acuities as well as the NEI-VFQ-25 questionnaire scores were compared before and 3 weeks after operation.Each item in the questionnaire table was divided into 0-4 scores,and the accumulated points were used as assessing result.Results The binocular vision （LogMAR） and NEI-VFQ-25 questionnaire scores were 0.47＆#177;0.44 and 59.1＆#177; 13.0 in preoperation,0.30＆#177;0.30 and 72.1 ＆#177; 15.9 in postoperation,respectively,showing significant enhancements in vision and questionnaire scores after operation （t =11.38,22.01,both at P〈0.05）.The scores of each item from NEI-VFQ-25 table,such as general health status,overall vision,eye pain,near activities,distant activities,social functional,mental health,social role difficulties,independency,driving,color vision,perimetry,were improved 3 weeks after operation compared to before operation （all at P〈0.05）.The overall scores of NEI-VFQ-25 questionnaire were significantly elevated between before and after operation in various visual damage groups （t =21.20,8.39,3.18,all at P〈0.05）.Conclusions Visual acuity associated with vision-related quality of life questionnaires is an objective evaluating index for the patients following Nd∶YAG laser capsulotomy.