AIM: To evaluate the impact of 4 different intraocular lenses(IOLs) on posterior capsule opacification(PCO) by comparing the neodymium: yttrium-aluminum-garnet(Nd:YAG) laser capsulotomy rates.METHODS: This retrospecti...AIM: To evaluate the impact of 4 different intraocular lenses(IOLs) on posterior capsule opacification(PCO) by comparing the neodymium: yttrium-aluminum-garnet(Nd:YAG) laser capsulotomy rates.METHODS: This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies.· RESULTS: An Nd:YAG laser posterior capsulotomy was performed in 153(3.07%) of the 4970 eyes. The mean follow-up time was 84 mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1-and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared.· CONCLUSION: In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design(1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate.展开更多
Purpose: To determine the effect of anterior capsule polishing (APC) on the rate of posterior capsule opacification (PCO) as assessed by the need for laser posterior capsulotomy. Setting: University-based clinical pra...Purpose: To determine the effect of anterior capsule polishing (APC) on the rate of posterior capsule opacification (PCO) as assessed by the need for laser posterior capsulotomy. Setting: University-based clinical practice, Jules Stein Eye Institute, Los Angles, California, USA. Methods: This study involved a retrospective review of eyes that underwent phacoemulsification and intraocular lens implantation between September 1991 and June 1999. Lens epithelial cells in the 763 study eyes were mechanically debrided or polished from the inside surface of the anterior capsules using a pair of Shepherd-Rentsch (Morning STAAR Inc.) capsule polishers. The 484 control eyes that had surgery earlier in the series were not polished. The rate of laser capsulotomy in the ACP and the non-ACP groups was compared using a Kaplan-Meier survival analysis. Multivariate regression was performed to determine if variables other than ACP influenced the need for laser posterior capsulotomy. Results: We identified 763 eyes that had ACP and 484 that did not. At the 24-month follow-up interval, 26.6% of the eyes in the ACP group had received a capsulotomy versus 19.50% in the non-APC. Next, a separate study was done using only one eye per patient, taking the patient as the unit of analysis. Again the capsulotomy rate was higher in the ACP group compared to the non-ACP (1.02 per 100 person-months of follow-up vs. 0.74 per 100 person-months of follow-up). Finally, a third Kaplan-Meier analysis was done on 52 patients that had one eye treated with the ACP procedure and the other eye with the non-ACP procedure. Although the log-rank test showed the statistical significant of this analysis to be borderline, the results again favored the non-ACP group with a lower capsulotomy rate. Multivariate analysis showed very similar results to the above univariate studies. The mean time to capsulotomy was 46 months for the polished group and 70 months for the unpolished group. The severity of cataract (p = 0.46) and the type of haptics (p = 0.86) did not influence the rate of capsulotomy. Plate haptic IOLS had a higher rate of capsulotomy than loop haptic IOLS (p = 0.001). Conclusions: Polishing of the anterior capsule with Shepherd-Rentsch polishers may unexpectedly increase the rate of posterior capsule opacification in eyes with round-edge silicone lenses.展开更多
AIM: To estimate the cumulative probability of Nd:YAG capsulotomy at a teaching institution and evaluate secondary risk factors.METHODS: The records of all patients who underwent phacoemulsification with intraocular l...AIM: To estimate the cumulative probability of Nd:YAG capsulotomy at a teaching institution and evaluate secondary risk factors.METHODS: The records of all patients who underwent phacoemulsification with intraocular lens(IOL) placement between 2005-2010 were retrospectively reviewed. The cumulative probability of Nd:YAG capsulotomy(capsulotomy) was calculated using KaplanMeier survival analysis and secondary risk factors were evaluated using the Cox proportional hazards regression model. RESULTS: One thousand three hundred and fifty four charts were reviewed. A total of 70 capsulotomies wereperformed. The mean follow-up was 19.4 mo(standard deviation 17 mo). The cumulative probability of capsulotomy was 4% at 1 year, 5% at 2 year, and 9% at 3 year. Multivariate analysis demonstrated an increased risk with younger age(HR = 1.03, CI 1.01-1.05, P = 0.007), placement of sulcus IOL(HR = 2.57, CI 1.32-4.99, P = 0.005), ocular trauma(HR = 2.34, CI 1.13-4.83, P = 0.02), and phacoemulsification by a more experienced surgeon(HR = 4.32, CI 1.89-9.87, P = 0.001).CONCLUSION: Cumulative probability of capsulotomy was lower than previously reported. Posterior capsule opacification was strongly associated with younger age and factors associated with high-risk cataract surgery. Surgeon awareness to the risk factors that correlate with posterior capsulotomy may allow for more thorough pre-operative disclosure and enhance patient satisfaction.展开更多
目的应用双通道视觉质量分析系统研究后发性白内障行Nd：YAG激光切开术后患者眼内散射的变化，客观评价术后视觉质量。方法回顾性临床病例对照研究。对2007年5月至2013年12月在天津市眼科医院就诊的42例行白内障超声乳化＋人工晶状体植...目的应用双通道视觉质量分析系统研究后发性白内障行Nd：YAG激光切开术后患者眼内散射的变化，客观评价术后视觉质量。方法回顾性临床病例对照研究。对2007年5月至2013年12月在天津市眼科医院就诊的42例行白内障超声乳化＋人工晶状体植入术后患有后发性白内障纤维型Ⅱ级及Ⅱ级以下膜，明显影响视力的患者行Nd：YAG激光切开术。术前及术后2周散瞳前测量最佳矫正视力（BCVA），并将瞳孔充分散大，用裂隙灯数码相机进行眼底红光反射照相，联合Image Pro Plus6．0软件测量激光孔的大小。采用OQAS Ⅱ视觉质量分析系统测量4mm瞳孔下手术前后的客观散射指数（OSI），OQAS值（OVs），斯特列尔比（sR）和调制传递函数（MTF）。结果后发性白内障行Nd：YAG激光切开术后2周，BCVA明显提高，logMAR视力由术前平均0．541提高到术后0．137，术后OSI值（3．263±2．118），较术前（12．14±3．511）明显减小，差异有统计学意义（t=16．818，P〈0．05），术后SR、MTF以及OVs较术前均有明显提高，差异有统计学意义（P〈0．05）。结论后发性白内障行Nd：YAG激光切开术后2周，最佳矫正视力明显提高，眼内散射明显减小，术后视觉质量显著提高。展开更多
文摘AIM: To evaluate the impact of 4 different intraocular lenses(IOLs) on posterior capsule opacification(PCO) by comparing the neodymium: yttrium-aluminum-garnet(Nd:YAG) laser capsulotomy rates.METHODS: This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies.· RESULTS: An Nd:YAG laser posterior capsulotomy was performed in 153(3.07%) of the 4970 eyes. The mean follow-up time was 84 mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1-and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared.· CONCLUSION: In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design(1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate.
文摘Purpose: To determine the effect of anterior capsule polishing (APC) on the rate of posterior capsule opacification (PCO) as assessed by the need for laser posterior capsulotomy. Setting: University-based clinical practice, Jules Stein Eye Institute, Los Angles, California, USA. Methods: This study involved a retrospective review of eyes that underwent phacoemulsification and intraocular lens implantation between September 1991 and June 1999. Lens epithelial cells in the 763 study eyes were mechanically debrided or polished from the inside surface of the anterior capsules using a pair of Shepherd-Rentsch (Morning STAAR Inc.) capsule polishers. The 484 control eyes that had surgery earlier in the series were not polished. The rate of laser capsulotomy in the ACP and the non-ACP groups was compared using a Kaplan-Meier survival analysis. Multivariate regression was performed to determine if variables other than ACP influenced the need for laser posterior capsulotomy. Results: We identified 763 eyes that had ACP and 484 that did not. At the 24-month follow-up interval, 26.6% of the eyes in the ACP group had received a capsulotomy versus 19.50% in the non-APC. Next, a separate study was done using only one eye per patient, taking the patient as the unit of analysis. Again the capsulotomy rate was higher in the ACP group compared to the non-ACP (1.02 per 100 person-months of follow-up vs. 0.74 per 100 person-months of follow-up). Finally, a third Kaplan-Meier analysis was done on 52 patients that had one eye treated with the ACP procedure and the other eye with the non-ACP procedure. Although the log-rank test showed the statistical significant of this analysis to be borderline, the results again favored the non-ACP group with a lower capsulotomy rate. Multivariate analysis showed very similar results to the above univariate studies. The mean time to capsulotomy was 46 months for the polished group and 70 months for the unpolished group. The severity of cataract (p = 0.46) and the type of haptics (p = 0.86) did not influence the rate of capsulotomy. Plate haptic IOLS had a higher rate of capsulotomy than loop haptic IOLS (p = 0.001). Conclusions: Polishing of the anterior capsule with Shepherd-Rentsch polishers may unexpectedly increase the rate of posterior capsule opacification in eyes with round-edge silicone lenses.
基金Supported by In part by NEI Core Center,No.P30 EY014801Research to Prevent Blindness (RPB) Unrestricted Award and Department of Defense+1 种基金No.#W81XWH-09-1-0675VA Career Development Award(CDA2) and Stanley Glaser UM to Dr.Anat Galor
文摘AIM: To estimate the cumulative probability of Nd:YAG capsulotomy at a teaching institution and evaluate secondary risk factors.METHODS: The records of all patients who underwent phacoemulsification with intraocular lens(IOL) placement between 2005-2010 were retrospectively reviewed. The cumulative probability of Nd:YAG capsulotomy(capsulotomy) was calculated using KaplanMeier survival analysis and secondary risk factors were evaluated using the Cox proportional hazards regression model. RESULTS: One thousand three hundred and fifty four charts were reviewed. A total of 70 capsulotomies wereperformed. The mean follow-up was 19.4 mo(standard deviation 17 mo). The cumulative probability of capsulotomy was 4% at 1 year, 5% at 2 year, and 9% at 3 year. Multivariate analysis demonstrated an increased risk with younger age(HR = 1.03, CI 1.01-1.05, P = 0.007), placement of sulcus IOL(HR = 2.57, CI 1.32-4.99, P = 0.005), ocular trauma(HR = 2.34, CI 1.13-4.83, P = 0.02), and phacoemulsification by a more experienced surgeon(HR = 4.32, CI 1.89-9.87, P = 0.001).CONCLUSION: Cumulative probability of capsulotomy was lower than previously reported. Posterior capsule opacification was strongly associated with younger age and factors associated with high-risk cataract surgery. Surgeon awareness to the risk factors that correlate with posterior capsulotomy may allow for more thorough pre-operative disclosure and enhance patient satisfaction.
文摘目的应用双通道视觉质量分析系统研究后发性白内障行Nd：YAG激光切开术后患者眼内散射的变化，客观评价术后视觉质量。方法回顾性临床病例对照研究。对2007年5月至2013年12月在天津市眼科医院就诊的42例行白内障超声乳化＋人工晶状体植入术后患有后发性白内障纤维型Ⅱ级及Ⅱ级以下膜，明显影响视力的患者行Nd：YAG激光切开术。术前及术后2周散瞳前测量最佳矫正视力（BCVA），并将瞳孔充分散大，用裂隙灯数码相机进行眼底红光反射照相，联合Image Pro Plus6．0软件测量激光孔的大小。采用OQAS Ⅱ视觉质量分析系统测量4mm瞳孔下手术前后的客观散射指数（OSI），OQAS值（OVs），斯特列尔比（sR）和调制传递函数（MTF）。结果后发性白内障行Nd：YAG激光切开术后2周，BCVA明显提高，logMAR视力由术前平均0．541提高到术后0．137，术后OSI值（3．263±2．118），较术前（12．14±3．511）明显减小，差异有统计学意义（t=16．818，P〈0．05），术后SR、MTF以及OVs较术前均有明显提高，差异有统计学意义（P〈0．05）。结论后发性白内障行Nd：YAG激光切开术后2周，最佳矫正视力明显提高，眼内散射明显减小，术后视觉质量显著提高。
