不同能量Nd:YAG激光治疗对慢性闭角型青光眼临床前期患者视功能及眼内压水平的影响

Effect of different energy Nd:YAG laser treatment on visual function and intraocular pressure in patients with chronic angle-closure glaucoma in preclinical stage

目的探究不同能量Nd:YAG激光治疗对慢性闭角型青光眼(acute-angle closure glaucoma,ACG)临床前期患者视功能及眼内压水平的影响。方法选取2022年9月至2023年12月江西医专第一附属医院收治的60例(87眼)慢性ACG患者作为研究对象,按就诊时间编号(1~60号)分为A组[1~20号,n=20(28眼),予低能量(≤2 mJ)Nd:YAG激光治疗]、B组[21~40号,n=20(30眼),予中能量(3~5 mJ)Nd:YAG激光治疗]、C组[41~60号,n=20(29眼),予高能量(8~10 mJ)Nd:YAG激光治疗]。比较3组手术前后最佳矫正视力、眼内压、前房指标、角膜内皮细胞指标及术后并发症发生情况。结果3组手术前后各时间点组内、组间最佳矫正视力比较差异均无统计学意义。术后1周、1个月、3个月,3组眼内压均低于术前,中央前房深度均深于术前,鼻侧前房房角均大于术前,差异有统计学意义(P<0.05);3组术前眼内压、中央前房深度、鼻侧前房房角及术后各时间点组内、组间眼内压、中央前房深度、鼻侧前房房角两两比较差异均无统计学意义。术后1周、1个月、3个月,B组角膜内皮细胞密度小于术前,C组平均细胞面积大于术前,最大细胞面积、角膜内皮细胞密度均小于术前,但术后1、3个月C组角膜内皮细胞密度均大于术后1周,且术后3个月大于术后1个月,差异有统计学意义(P<0.05);3组各指标其他时间点两两比较差异均无统计学意义。术后1周、1个月、3个月,A组、B组平均细胞面积均小于C组,最大细胞面积、角膜内皮细胞密度均大于C组,且A组角膜内皮细胞密度大于B组,差异有统计学意义(P<0.05);而A组与B组平均细胞面积、最大细胞面积比较差异无统计学意义。C组术后并发症发生率高于A组与B组,差异有统计学意义(P<0.05),A组与B组术后并发症发生率比较差异无统计学意义。结论低、中、高3种不同的能量Nd:YAG激光治疗慢性ACG临床前期患者对其视功能、眼内压水平、前房指标改善效果一致,但能量越高对角膜内皮细胞损伤越大,并发症发生率越高,安全性越低。

Objective To investigate the effects of different energy Nd:YAG laser treatment on visual function and intraocular pressure in pa-tients with chronic angle-closure glaucoma(ACG)in preclinical stage.Methods A total of 60 patients(87 eyes)with chronic ACG admitted to the First Affiliated Hospital of Jiangxi Medical College from September 2022 to December 2023 were selected as the study subjects,and they were divid-ed into the group A(1-20,n=20[28 eyes],and given low energy[≤2 mJ]Nd:YAG laser treatment),the group B(21-40,n=20[30 eyes],given medi-um energy[3-5 mJ]Nd:YAG laser treatment),the group C(41-60,20 cases[29 eyes],given high energy[8-10 mJ]Nd:YAG laser treatment)accord-ing to the visit time number 1-60.The best corrected visual acuity,intraocular pressure,anterior chamber index,corneal endothelial cell index and postoperative complications were compared among the three groups before and after operation.Results There were no significant differences in the best corrected visual acuity within group and inter-group among the three groups at each time point before and after operation.At 1 week,1 month and 3 months after operation,the intraocular pressure of the three groups were lower than those before operation,the central anterior chamber depth were deeper than those before operation,and the nasal anterior chamber Angle were greater than those before operation,and the differences were sta-tistically significant(P<0.05);there were no statistically significant differences in intraocular pressure,central anterior chamber depth,nasal anterior chamber Angle before operation and pairwise comparison of intraocular pressure,central anterior chamber depth,nasal anterior chamber Angle with-in group and inter-group among the three groups at each time point after operation.At 1 week,1 month and 3 months after operation,the density of corneal endothelial cells in the group B were lower than those before operation,the average cell area in the group C were higher than those before op-eration,the maximum cell area and corneal endothelial cell density were lower than those before operation,but the density of corneal endothelial cells in the group C at 1 and 3 months after operation were higher than 1 week after operation,and 3 month after operation was higher than 1 months after operation,and the differences were statistically significant(P<0.05),there were no statistically significant differences in other pairwise compar-isons of each index among the three groups at other time points;at 1 week,1 month and 3 months after operation,the average cell area in the group A and the group B were lower than those in the group C,the maximum cell area and corneal endothelial cell density were higher than those in the group C,and the density of corneal endothelial cell in the group A were higher than those in the group B,and the differences were statistically signif-icant(P<0.05),there were no significant differences in average cell area and maximum cell area between the group A and the group B.The inci-dence of postoperative complications in the group C was higher than that in the group A and the group B,and the differences were statistically signifi-cant(P<0.05),but there was no statistically significant difference between the group A and the group B.Conclusion Low,medium and high energy Nd:YAG laser therapy has the same improvement effect on visual function,intraocular pressure and anterior chamber indexes in patients with chron-ic ACG in pre-clinical stage,but the higher energy,the greater the damage to corneal endothelial cells,the higher the incidence of complications and the lower the safety.