不同直径激光后囊切开术效果的比较

Comparison of efficacy of laser capsulotomy with different diameters for the treatment of posterior capsular opacification

目的比较不同直径的Nd:YAG激光后囊切开术治疗后发性白内障的屈光状态及视觉质量。方法回顾性病例对照研究。纳入苏州大学理想眼科医院2021年1月至2021年12月Nd:YAG激光后囊切开术的后发性白内障51例(51只眼),根据后囊切开直径不同分为两组:A组25例(25只眼),直径<4 mm;B组26例(26只眼),直径≥4 mm。术后随访1个月,观察所有患者治疗前及治疗后1个月最佳矫正视力(BCVA,logMAR),眼的屈光状态(以等效球镜度SE表示),眼压,前房深度(ACD),眼内总高阶像差,眼内三叶草像差及眼内彗差。结果术后1个月,两组BCVA (logMAR)均较治疗前提高(均P<0.001);A组为0.16±0.08,B组为0.14±0.08,组间比较差异无统计学意义(t=0.81,P=0.420)。两组屈光状态较治疗前均有远视漂移现象;A组为(-0.49±0.22)D,B组为(-0.47±0.22)D,组间比较差异无统计学意义(t=-0.18,P=0.860)。两组前房深度均较治疗前加深(均P<0.05);A组为(4.05±0.39)mm,B组为(4.16±0.34)mm,组间比较差异无统计学意义(t=-0.99,P=0.324)。两组眼内总高阶像差、三叶草像差及彗差均较治疗前降低;A组分别为(0.57±0.14)、(0.24±0.03)、(0.17±0.02)μm;B组分别为(0.48±0.13)、(0.18±0.02)、(0.14±0.02)μm,B组均低于A组(t=2.57、8.02、4.84,P=0.013、P<0.001、P<0.001)。结论后发性白内障后囊激光切开术能有效改善视力及视觉质量,屈光状态呈远视漂移。后囊切开直径越大,视觉质量改善越明显。

Objective To compare the refractive status and visual quality after Nd:YAG laser capsulotomy with different diameters for the treatment of posterior capsular opacification(PCO).Methods This was a retrospective case-control study.A total of 51 eyes of 51 cases with PCO who received Nd:YAG laser capsulotomy from Jan.2021 to Dec.2021 in the Lixiang Eye Hospital of Soochou University were included.They were divided into group A and group B,based on the diameter of posterior capsulotomy.In group A(25 eyes of 25 cases),the diameter of posterior capsulotomy was<4 mm.In group B(26 eyes of 26 cases),the diameter of posterior capsulotomy was≥4 mm.The follow-up time was 1 month after surgery.Best corrected visual acuity(BCVA,logMAR),refractive status of the eye(expressed in equivalent spherical degree,SE),intraocular pressure,anterior chamber depth(ACD),total high-order aberration(tHOA),intraocular trefoil and coma of all patients were collected before and at 1 month after treatment.Results At 1 month after surgery,BCVA(logMAR)of both groups showed significant improvement compared with that before treatment(all P<0.001).BCVA in group A was 0.16±0.08,and 0.14±0.08 in group B.There was no statistically significant difference between the two groups(t=0.81,P=0.420).The refractive status of both groups had hyperopia drift compared with that before treatment.SE of group A was(-0.49±0.22)D,and(-0.47±0.22)D in group B.There was no statistically significant difference between the two groups(t=-0.18,P=0.860).ACD of both groups deepened compared with that before treatment(all P<0.05).ACD of group A was(4.05±0.39)mm,and(4.16±0.34)mm in group B.There was no statistically significant difference between the two groups(t=-0.99,P=0.324).Intraocular tHOA,trefoil and coma of both groups showed significant decreasing compared with those before treatment.Intraocular tHOA,trefoil and coma of group A was(0.57±0.14),(0.24±0.03),(0.17±0.02)μm was(0.48±0.13),(0.18±0.02),(0.14±0.02)μm respectively in group B.They were significantly in group B lower than in group A(t=2.57,8.02,4.84;P=0.013,P<0.001,P<0.001).Conclusion Nd:YAG laser treatment of PCO effectively improves vision and visual quality,the refractive status indicates a drift towards hyperopia after treatment.The larger the diameter of posterior capsulotomy,the greater the improvement in visual quality.