YAG激光玻璃体消融术治疗对生理性玻璃体混浊患者的影响

Effect of YAG Laser Vitreous Ablation on Patients with Physiologic Vitreous Opacity

目的研究YAG激光玻璃体消融术治疗对生理性玻璃体混浊疗效及对视力及视网膜结构影响。方法选取平顶山市第一人民医院2020年1月至2021年10月门诊收治的生理性玻璃体混浊患者126例,患眼共126只,采用随机数字法分为对照组和观察组,每组各63例,分别行玻璃体切割术和YAG激光玻璃体消融术治疗。测量两组患者术前和术后2 d、术后1周及术后3月的患眼最佳矫正视力、非接触眼压,采用光学相干断层扫描(OCT)测量患者术前和术后1周、术后1月、术后3月患眼视神经纤维层厚度(RNFL)、黄斑中心凹厚度(CMT)。采用眼前节彩照测量所有患者术前和术后3月患眼玻璃体内混浊物变化情况,采用问卷评价量表评价患者主观症状改善情况,并随访3月观察两组患者的眼部并发症发生情况。结果观察组的症状改善有效率和玻璃体内混浊物完全消失率均明显高于对照组,差异有统计学意义(P<0.05);两组患者手术前和手术后3个月的非接触眼压、最佳矫正视力和上方、下方、鼻侧、颞侧的RNFL及CMT值比较,差异无统计学意义(P>0.05);观察组患者的并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论YAG激光玻璃体消融术能够有效改善玻璃体混浊患眼症状,且对患眼视力和视网膜结构无不良影响,疗效确切且安全。

Objective To study the effect of YAG laser vitreous ablation on physiologic vitreous opacity and the effect on visual acuity and retinal structure.Methods A total of 126 patients with physiologic vitreous opacification treated in the outpatient department of our hospital from January 2020 to October 2021 were selected and divided into a control group and an observation group by random number method,with 63 cases in each group receiving vitrectomy and YAG laser vitreous ablation,respectively.The optimal corrected visual acuity and non-contact intraocular pressure in the affected eye were measured before and 2 days after surgery,1 week after surgery,and 3 months after surgery.Optical coherence tomography(OCT)was used to measure the retinal nerve fiber layer(RNFL)thickness and central macular thickness(CMT)in the affected eye before surgery and 1 week after surgery,1 month after surgery,and 3 months after surgery.The changes in vitreous opacities in all patients before and 3 months after surgery were measured by anterior segment color photography.The improvement of subjective symptoms was evaluated by a questionnaire evaluation scale.The incidence of ocular complications in both groups was observed at 3 months followup.Results The efficiency of symptom improvement and the complete disappearance rate of glass turbidity in the observation group were significantly higher than in the control group,the difference was statistically significant(P<0.05).There was no significant difference in non-contact intraocular pressure,optimal corrected visual acuity,RNFL,and CMT values above,below,nasal and temporal between 2 groups before and 3 months after surgery(P>0.05).The incidence of complications in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion YAG laser vitreous ablation can effectively improve the symptoms of vitreous opacity and has no adverse effects on the visual acuity and retinal structure of the affected eye.It is effective and safe.