改良大孔径圆形Nd:YAG激光后囊膜切开术治疗后发性白内障36例临床观察

Clinical observation of 36 cases of modified large circular pattern Nd:YAG laser posterior capsulotomy

目的观察改良大孔径圆形Nd:YAG激光后囊膜切开术治疗后发性白内障的疗效和安全性。方法选取2017年11月至2018年8月铜陵市人民医院就诊的后发性白内障病人36例39眼,行改良大孔径圆形Nd:YAG激光后囊膜环形切开(直径为5.0~6.0 mm),能量设置单脉冲2 mJ,有效激光点数10~30点,然后切开后囊膜与玻璃体的牵拉,促进圆形后囊膜碎片与玻璃体完全分离,并下沉入玻璃体腔,术毕双氯芬酸钠滴眼液滴眼3 d。检查并比较术前、术后3 d、术后1月的视力、眼压、前房深度和黄斑体积(直径3 mm圆区)。结果所有病人中,无一例出现人工晶体偏位。术前、术后3 d、术后1月,眼压、前房深度、黄斑体积分别为(14.7±2.8)mmHg,(4.40±0.38)mm,(2.250±0.152)mm3;(15.2±2.6)mmHg,(4.38±0.43)mm,(2.254±0.154)mm3;(15.0±2.5)mmHg,(4.36±0.37)mm,(2.249±0.154)mm3,两两比较,均差异无统计学意义(P=0.262,0.496,0.337);术前、术后3 d、术后1月的最佳矫正视力(logMAR)分别为(0.56±0.28)、(0.11±0.33)和(0.08±0.70),术前与术后3 d、术后1月BCVA(log MAR)差异有统计学意义(P<0.001),术后3 d与术后1月BCVA(logMAR)差异无统计学意义(P>0.05)。结论改良大孔径圆形Nd:YAG激光后囊膜切开术能有效提高后发性白内障病人视力,且对病人眼压、前房深度和黄斑体积无影响,安全可行。

Objective To observe the efficacy and safety of modified large circular pattern Nd:YAG laser posterior capsulotomy.Methods 36 cases(39 eyes)with posterior capsular opacification were selected in our hospital from November 2017 to August 2018 in this prospective study.The laser posterior capsulotomy of all cases were conducted along a modified large circular pattern(diameter of 5.0 6.0 mm).The energy was set by 2mJ/pulse with efficient laser points from 10 to 30.Vitreous stands attached with fragment were cut off by the laser after circular application.The circular fragment was completely separated from vitreous,and then this fragment was quickly sunk in intravitreal space.Diclofenac sodium eye drops were used four times a day for 3 days,postopera tively.The best corrected visual acuity,intraocular pressure,anterior chamber depth,and macular volume(diameter of 3mm)were measured and compared preoperatively,3 days and 1 month postoperatively.Results There were no intraocular lens deviation in all patients.The intraocular pressure,anterior chamber depth and macular volume were(14.7±2.8)mmHg,(4.40±0.38)mm,(2.250±0.152)mm3;(15.2±2.6)mmHg,(4.38±0.43)mm,(2.254±0.154)mm3;(15.0±2.5)mmHg,(4.36±0.37)mm,(2.249±0.154)mm3,re spectively before and 3 days,1 month after surgery.The differences were not statistically significant(P=0.262,0.496,0.337).The best corrected visual acuity(logMAR)was(0.56±0.28),(0.11±0.33),(0.08±0.70),with statistically significant(P=0.000)dif ference,respectively before and 3 days,1 month after surgery.Conclusion The modified large circular pattern Nd:YAG laser pos terior capsulotomy is an effective and safe method for the treatment of posterior capsular opacification,which improves vision obvi ously with no side effect on the anterior chamber depth,intraocular pressure and macular volume.