两类Nd:YAG激光断线控制手术源性散光的疗效分析

Analysis of efficacy of controlling surgically-induced astigmatism by two-types of Nd:YAG laser cutting suture

目的 分析比较调 Q、非调 Q Nd:YAG激光断线对控制 ECCE手术源性散光的效果。方法 ECCE(切口缝合 5～ 7针 )加 IOL 植入术后 3个月或以上 ,角膜循规散光 >2 .0 0 D,矫正视力可提高 2行者行调 Q或非调 Q Nd:YAG激光断线术 ,共 178眼。根据散光度的大小选择性断线 1～ 3针 (131眼 )或全部断线 (4 7眼 ) ,断线后 1周 ,1、2、3个月分别测量角膜曲率及验光 ,记录角膜散光。结果 调 Q、非调 QYAG激光按计划一次断线成功率分别为 93.6 % (117/12 5 )、2 4.5 % (13/ 5 3) ,2种激光断线的疗效差异无显著性(P >0 .0 5 ) ;断线后角膜散光度明显减少 ,与断线前相比差异有显著性 (P <0 .0 1) ;全部断线 47眼中 42眼 (89% )转变为逆规散光。结论 非调 Q Nd:YAG激光断线操作更简便、安全 ;选择性断线可有效控制手术源性散光 ,不主张一次性全部断线。

Objective To evaluate the efficacy of controlling surgically-induced astigmatism by Q-switch and off-Q-switch Nd:YAG laser cutting suture.Methods One hundred and seventy-eight eyes of 146 patients with extracapsular cataract extraction and intraocular lens implantation underwent cutting sutures by Q-switch or off-Q-switch Nd:YAG laser at least 3 months postoperatively,whose surgically-induced astigmatism were above 2.00D.Corneal curvatures of 131 eyes with cutting selectively 1～3 sutures and 47 eyes with cutting all sutures were measured in the first week,first month, second month and third month after laser treatment, recording corneal astigmatism. Results The rate of the finished cutting suture by one lasing of Q-switch and off-Q-switch Nd:YAG laser were 93.6%(117/125) and 24.5%(13/53), respectively. There was no significant difference between the effects of two YAG lasers(P>0.05); Corneal astigmatism were markedly reduced after laser treatment(P<0.01); Corneal astigmatism of 42 eyes (89%)with cutting all sutures changed into against rule astigmatism. Conclusions Cutting suture by off-Q-switch Nd:YAG laser is simple and safe;Cutting sutures selectively can control effectively surgically-induced astigmatism. Cutting all sutures at the same time is not suggested.