后發(fā)性白內障行Nd:YAG激光后囊膜切開術后視覺質量改變

張　斌，馬健利

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后發(fā)性白內障行Nd:YAG激光后囊膜切開術后視覺質量改變

張斌，馬健利

Department of Ophthalmology,Weifang Eye Hospital, Weifang 261041, Shandong Province, China

?METHODS:In this prospective observational study, 100 cases of patients (100 eyes) with posterior cataract underwent Nd:YAG laser posterior capsular dissection (posterior capsular diameter dissected was 5mm or higher). The mean age was 65.52±7.01 years old. The change of the BCVA was collected. The tHOA and MTF under the 3mm and 5mm pupil diameter were assessed by iTrace respectively before and after Nd:YAG laser posterior capsular dissection.

?RESULTS:All the surgery went well without obvious intraoperative and postoperative complications happened. The preoperative BCVA was 0.451±0.023 while the postoperative BCVA was 0.763±0.025. The difference of BCVA before and after Nd:YAG laser surgery was statistically significant (P<0.01). At 3mm pupil diameter, the tHOA preoperative was 0.551±0.031 while the postoperative tHOA was 0.214±0.011, the differences were significance (P<0.05). At 3mm pupil diameter while the spatial frequencies (5cpd, 10cpd, 15cpd, 20cpd, 25cpd, 30cpd) respectively, the MTF tHOA value postoperative (0.644±0.023, 0.49±0.011, 0.311±0.015, 0.202±0.018, 0.056±0.027, 0.041±0.011) were significantly higher than that preoperative (0.401±0.021, 0.261±0.026, 0.179±0.012, 0.108±0.014, 0.031±0.016, 0.022±0.021), and the difference has statistical significance (P<0.05). At 5mm pupil diameter, the tHOA preoperative was 0.752±0.028 while the postoperative tHOA was 0.361±0.014, the differences were significance (P<0.01). At 5mm pupil diameter while the spatial frequencies (5cpd, 10cpd, 15cpd, 20cpd, 25cpd, 30cpd) respectively the MTF tHOA value postoperative (0.426±0.027, 0.209±0.018, 0.172±0.013, 0.116±0.015, 0.049±0.010, 0.034±0.014) were significantly higher than that preoperative (0.234±0.021, 0.102±0.019, 0.088±0.016, 0.058±0.022, 0.021±0.014, 0.016±0.011), and the difference had statistical significance (P<0.05).

?CONCLUSION:Patients with posterior capsule opacification (PCO) Nd:YAG laser posterior capsular dissection can help improve BCVA, reduce tHOA, increase MTF tHOA values, and significantly improve visual quality of patients.

目的：觀察分析白內障人工晶狀體植入術后后發(fā)性白內障(posterior capsule opacification，PCO)患者行Nd:YAG激光后囊膜切開術前后視力、全眼高階像差(total high-order aberration,tHOA)、調制傳遞函數(shù)(modulation transfer function,MTF)、視覺質量的變化。

方法：選取2014-06/2015-09來我院就診的白內障人工晶狀體植入術后PCO患者共100例100眼，年齡47～80(平均65.52±7.01)歲，所有患者均行Nd:YAG激光后囊膜切開術(激光孔徑≥5mm)治療，觀察激光術前后最佳矯正視力(best corrected vision acuity,BCVA)的變化，應用iTrace視覺功能分析儀分別測量分析3mm和5mm瞳孔直徑下激光術前后全眼總高階像差tHOA及MTF的變化。

結果：所有Nd:YAG激光手術順利，未發(fā)生明顯術中、術后意外情況及并發(fā)癥，BCVA:術前0.451±0.023，術后0.763±0.025，手術前后BCVA 差異有統(tǒng)計學意義(P<0.01)。3mm瞳孔直徑下術前tHOA 0.551±0.031，術后tHOA 0.214±0.011,手術前后3mm瞳孔直徑下tHOA 差異有統(tǒng)計學意義(P<0.01)。3mm瞳孔直徑下激光術后在5、10、15、20、25、30c/d 6種空間頻率下MTF tHOA值(0.644±0.023、0.497±0.011、0.311±0.015、0.202±0.018、0.056±0.027、0.041±0.011)較術前(0.401±0.021、0.261±0.026、0.179±0.012、0.108±0.014、0.031±0.016、0.022±0.021)顯著提高，差異有統(tǒng)計學意義(P<0.05)。5mm瞳孔直徑下術前tHOA 0.752±0.028，術后tHOA 0.361±0.014，激光術前后5mm瞳孔直徑下tHOA 差異有統(tǒng)計學意義(P<0.01)。5mm瞳孔直徑下激光術后在5、10、15、20、25、30c/d 6種空間頻率下MTF tHOA值(0.426±0.027、0.209±0.018、0.172±0.013、0.116±0.015、0.049±0.010、0.034±0.014)較術前(0.234±0.021、0.102±0.019、0.088±0.016、0.058±0.022、0.021±0.014、0.016±0.011)顯著提高，差異有統(tǒng)計學意義(P<0.05)。

結論：PCO患者行Nd:YAG激光后囊膜切開術治療后BCVA提高、tHOA 降低、MTF值增大、患眼的視覺質量明顯提高。

后發(fā)性白內障；Nd:YAG激光后囊膜切開術；全眼高階像差；調制傳遞函數(shù)

引用：張斌，馬健利.后發(fā)性白內障行Nd:YAG激光后囊膜切開術后視覺質量改變.國際眼科雜志2016;16(11):2071-2074

0　引言

現(xiàn)代的白內障手術已經告別了復明手術的時代，成為一種屈光手術。而后發(fā)性白內障(posterior capsule opacification，PCO)是白內障術后最常見的并發(fā)癥，成年人的發(fā)生率約15%～50%，兒童幾乎高達100%[l]。PCO不僅造成白內障術后視覺質量的再次下降，影響手術效果，還影響患者的生活質量。本研究對白內障人工晶狀體植入術后發(fā)生PCO的患者，行Nd:YAG激光后囊膜切開術治療，檢測激光術前后最佳矯正視力(best corrected vision acuity,BCVA),應用iTrace視覺功能分析儀，檢測激光術前后總高階像差(total high-order aberration,tHOA)及調制傳遞函數(shù)(the modulation transfer function,MTF)分析手術前后視覺質量的變化。……