Nd:YAG激光后囊膜切开术后患者屈光改变及人工晶状体位置的临床观察

Clinical Observation of Refractive Change and Intraocular Lens Position in Patients After Nd:YAG Laser Posterior Capsulotomy

目的研究Nd:YAG激光后囊膜切开术后患者屈光改变及人工晶状体的位置。方法选取2022年6月至2023年1月郑州市第二人民医院收治的65例(65眼)后发性白内障患者进行前瞻性研究,均接受Nd:YAG激光后囊膜切开术,根据囊膜切口长度分为小孔径组(3.5~4.5 mm,33例33眼)、大孔径组(4.6~5.5 mm,32例32眼)。比较两组术前、术后1周、术后1个月、术后3个月的最佳矫正视力(BCVA)、屈光度、等效球镜(SE)、眼压、前房深度和黄斑厚度、人工晶体倾斜度、偏心量及并发症。结果两组患者术后1周、术后1个月、术后3个月BCVA均优于术前(P<0.05),但两组比较,差异无统计学意义(P>0.05);两组术后1周、术后1个月、术后3个月屈光度比较,差异无统计学意义(P>0.05);小孔径组、大孔径组术后1周、术后1个月、术后3个月眼压比较,差异无统计学意义(P>0.05);小孔径组、大孔径组术后1周、术后1个月、术后3个月前房深度和黄斑厚度比较,差异无统计学意义(P>0.05);小孔径组、大孔径组术后1周、术后1个月、术后3个月人工晶体倾斜度、偏心量比较,差异无统计学意义(P>0.05);大孔径组并发症发生率[9.38%(3/32)]与小孔径组[3.03%(1/33)]比较,差异无统计学意义(P>0.05)。结论Nd:YAG激光后囊膜切开术切开孔径3.5~5.5 mm,不引起具有临床意义的屈光改变及人工晶状体位置改变,不影响前房深度、黄斑厚度、眼压,其中4.6~5.5 mm大孔径切开在术后未见明显的远视漂移,两者均安全可靠。

Objective To study the refractive change and the position of intraocular lens after Nd:YAG laser posterior capsulotomy.Methods A prospective study was conducted on 65 patients(65 eyes)with posterior cataract treated in the Second People’s Hospital of Zhengzhou from June 2022 to January 2023.All patients underwent Nd:YAG laser posterior capsulotomy,according to the the incision length was divided into two groups,small aperture group(3.5-4.5 mm,33 eyes in 33 cases)and large aperture group(4.6-5.5 mm,32 eyes in 32 cases).The best corrected visual acuity(BCVA),diopter,sphere equivalent(SE),intraocular pressure,anterior chamber depth and macular thickness,intraocular lens inclination,eccentricity and complications were compared between the two groups before surgery,1 week after surgery,1 month after surgery and 3 months after surgery.Results At 1 week,1 month and 3 months after surgery,BCVA were better than those before surgery(P<0.05),but there was no statistical significance between the two groups(P>0.05).There was no significant difference in diopter between the two groups at 1 week,1 month and 3 months after surgery(P>0.05).There was no significant difference in intraocular pressure between small aperture group and large aperture group at 1 week,1 month and 3 months after surgery(P>0.05).There was no significant difference in anterior chamber depth and macular thickness between small aperture group and large aperture group at 1 week,1 month and 3 months after surgery(P>0.05).There was no significant difference in the inclination and eccentricity of intraocular lenses between the small aperture group and the large aperture group at 1 week,1 month and 3 months after surgery(P>0.05).There was no significant difference in the incidence of complications between the large aperture group[9.38%(3/32)]and the small aperture group[3.03%(1/33)](P>0.05).Conclusion Nd:YAG laser posterior capsulotomy with a diameter of 3.5-5.5 mm does not cause clinically significant dioptric changes and intraocular lens position changes,and does not affect anterior chamber depth,macular thickness and intraocular pressure.No significant farsighic drift was observed after 4.6-5.5 mm large aperture incision,both of which are safe and reliable.