张力扩大法YAG激光后囊膜切开术治疗后发障的有效性和安全性研究

Efficacy and safety of tension-expanding YAG laser posterior capsulotomy in the treatment of posterior capsular opacification

目的探讨张力扩大法Nd:YAG激光后囊膜切开术治疗白内障术后晶状体后囊膜混浊(PCO)的有效性及安全性。方法回顾性病例研究。对2022年7月至2022年12月在皖南医学院附属宣城医院Nd:YAG激光后囊膜切开术的50例(56只眼)PCO患者临床资料进行分析。按手术方式不同分为张力扩大法组(28只眼)和圆形切开法组(28只眼),记录术中激光单次最小切开能量、点数、总能量、手术时间,术前、术后1 d、1周和1个月检查患眼裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压以及眼前黑影症状发生率。黑影症状发生率比较采用卡方检验,激光参数比较采用独立样本t检验。各个时间点的UCVA、BCVA、眼压比较采用重复测量的方差分析。结果圆形切开组和张力扩大法组术后UCVA(logMAR)、BCVA(logMAR)较术前均有明显提高,差异均有统计学意义(均P<0.001),但2组间比较差异无统计学意义(P>0.05)。张力扩大法组和圆形切开组在激光单次最小切开能量,激光总点数、总能量、手术时间差异均有统计学意义(均P<0.001),且前者明显低于后者。张力扩大法组和圆形切开组术后眼压(IOP)较术前差异均无统计学意义(均P>0.05)。张力扩大法组在术后各时间点出现黑影症状所占比例低于圆形切开组,差异没有统计学意义(均P>0.05)。结论张力扩大法Nd:YAG激光后囊膜切开法治疗IOL眼晶状体后囊膜混浊:更小的激光能量,更短的手术时间,更少的并发症。

Objective To assess the efficacy and safety of Nd:YAG laser posterior capsulotomy with tension expansion in the treatment of posterior capsular opacification(PCO)in intraocular lens(IOL)eyes.Methods A retrospective case study.56 eyes of 50 patients with PCO who underwent Nd:YAG laser posterior capsulotomy inthe Affiliated Xuancheng Hospital of WanNan Medical Collegefrom July 2022 to December 2022 were retrospectively analyzed.According to different surgical methods,they were divided into tension expansion group(28 eyes)and circular capsulotomy group(28 eyes).Patients were reviewed at 1 day,1 week,and 1 month after the surgery.The minimum single laser cut energy,total number of laser points,total energy,operation time and uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),intraocular pressure(IOP)and floater symptoms were recorded.Data were analyzed by Chi-square test,repeated measure analysis of variance(ANOVA)and independent sample t test.Results UCVA(logMAR)and BCVA(LogMAR)in the circular capsulotomy group and the tension expansion group were significantly higher than those before surgery,with statistical significance(P<0.001),but there was no significant difference between the two groups(P>0.05).There were significant differences in the minimum single laser cut energy,total number of laser points,total energy,and operation time between the tension expansion group and the circular capsulotomy group(P<0.01),and the former is significantly lower than the latter.There was no significant difference in IOP between the tension expansion group and the circular capsulotomy group(P>0.05).The proportion of dark shadow symptoms in the tension expansion group was seriously lower than that in the circular capsulotomy group at each time period after the operation(P<0.01).Conclusions Tension expand Nd:YAG laser posterior capsulotomy technique in the treatment of posterior capsular opacification in IOL eyes:smaller laser energy,shorter operation time and fewer complications.