后发性白内障行Nd:YAG激光后囊膜切开术后视觉质量改变

Changes of visual quality after Nd: YAG laser posterior capsular dissection to the patient with after-cataract

目的：观察分析白内障人工晶状体植入术后后发性白内障（ posterior capsule opacification,PCO）患者行Nd：YAG激光后囊膜切开术前后视力、全眼高阶像差（ total high-order aberration, tHOA ）、调制传递函数（ modulation transfer function,MTF）、视觉质量的变化。 方法：选取2014-06/2015-09来我院就诊的白内障人工晶状体植入术后PCO患者共100例100眼,年龄47-80（平均65.52±7.01）岁,所有患者均行Nd：YAG激光后囊膜切开术（激光孔径≥5 mm ）治疗,观察激光术前后最佳矫正视力（ best corrected vision acuity,BCVA）的变化,应用iTrace视觉功能分析仪分别测量分析3 mm和5 mm瞳孔直径下激光术前后全眼总高阶像差tHOA及MTF的变化。结果：所有Nd：YAG激光手术顺利,未发生明显术中、术后意外情况及并发症,BCVA：术前0.451±0.023,术后0.763±0.025,手术前后 BCVA 差异有统计学意义（ P〈0.01）。3 mm瞳孔直径下术前 tHOA 0.551±0.031,术后 tHOA 0.214±0.011,手术前后3 mm瞳孔直径下tHOA 差异有统计学意义（P 〈0.01）。3mm瞳孔直径下激光术后在5、10、15、20、25、30 c/d 6种空间频率下 MTF tHOA 值（0.644±0.023、0.497±0.011、0.311±0.015、0.202±0.018、0.056±0.027、0.041±0.011）较术前（0.401±0.021、0.261±0.026、0.179±0.012、0.108±0.014、0.031±0.016、0.022±0.021）显著提高,差异有统计学意义（P〈0.05）。5mm瞳孔直径下术前 tHOA 0.752±0.028,术后 tHOA 0.361±0.014,激光术前后5 mm瞳孔直径下tHOA 差异有统计学意义（ P 〈0.01）。5 mm瞳孔直径下激光术后在5、10、15、20、25、30 c/d 6种空间频率下 MTF tHOA 值（0.426±0.027、0.209±0.018、0.172±0.013、0.116±0.015、0.049±0.010、0.034±0.014）较术前（0.234±0.021、0.102±0.019、0.088±0.016、0.058±0.022、0.021±0.014、0.016±0.011）显著提高,差异有统计学意义（P〈0.05）。 结论：PCO 患者行 Nd：YAG 激光后囊膜切开术治疗后BCVA提高、tHOA 降低、MTF值增大、患眼的视觉质量明显提高。

AIM：To observe and analyze visual quality changes of the patients with posterior capsule opacification （ PCO ） Nd：YAG laser posterior capsular dissection, including the change of the best corrected vision acuity （ BCVA ） , total high- order aberration （ tHOA ） , and the modulation transfer function （ MTF） . METHODS：In this prospective observational study, 100 cases of patients （ 100 eyes ） with posterior cataract underwent Nd：YAG laser posterior capsular dissection （ posterior capsular diameter dissected was 5mm or higher）. The mean age was 65. 52±7. 01 years old. The change of the BCVA was collected. The tHOA and MTF under the 3mm and 5mm pupil diameter were assessed by iTrace respectively before and after Nd：YAG laser posterior capsular dissection. RESULTS：All the surgery went well without obvious intraoperative and postoperative complications happened. The preoperative BCVA was 0. 451 ± 0. 023 while the postoperative BCVA was 0. 763±0. 025. The difference of BCVA before and after Nd： YAG laser surgery was statistically significant （P〈0. 01）. At 3mm pupil diameter, the tHOA preoperative was 0. 551 ± 0. 031 while the postoperative tHOA was 0. 214± 0. 011, the differences were significance （P〈0. 05）. At 3mm pupil diameter while the spatial frequencies （ 5cpd, 10cpd, 15cpd, 20cpd, 25cpd, 30cpd ） respectively, the MTF tHOA value postoperative （0. 644±0. 023, 0. 49±0. 011, 0. 311±0. 015, 0.202±0. 018, 0. 056±0. 027, 0. 041±0. 011） were significantly higher than that preoperative （0. 401±0. 021, 0. 261±0. 026,0. 179±0. 012, 0. 108±0. 014, 0. 031±0. 016, 0. 022±0. 021）, and the difference has statistical significance （P〈0. 05）. At 5mm pupil diameter, the tHOA preoperative was 0. 752±0.028 while the postoperative tHOA was 0. 361±0. 014, the differences were significance （P〈0. 01）. At 5mm pupil diameter while the spatial frequencies （ 5cpd, 10cpd, 15cpd, 20cpd, 25cpd, 30cpd） respectively the MTF tHOA value postoperative （0. 426±0. 027, 0. 209±0. 018, 0. 172±0. 013, 0. 116±0. 015, 0. 049±0. 010, 0. 034±0. 014 ） were significantly higher than that preoperative （0. 234±0. 021, 0. 102±0. 019, 0. 088±0. 016, 0. 058±0. 022, 0. 021±0. 014, 0.016 ± 0. 011 ）, and the difference had statistical significance （P〈0. 05）. CONCLUSION： Patients with posterior capsule opacification （ PCO ） Nd：YAG laser posterior capsular dissection can help improve BCVA, reduce tHOA, increase MTF tHOA values, and significantly improve visual quality of patients.