Nd:YAG激光后囊膜切开术对人工晶状体位置的影响:基于CASIA2的研究

目的　使用新型眼前节OCT CASIA2评估Nd:YAG 激光后囊膜切开术治疗后囊膜混浊（PCO）对人工晶状体（IOL）稳定性的影响。方法　前瞻性自身对照研究。纳入于川北医学院附属医院眼科诊断为PCO拟行Nd:YAG激光后囊膜切开术的患者，分别于激光前、激光后1 h、激光后1个月进行视力、眼压、眼前节和眼底检查，并使用CASIA2测量IOL倾斜和偏心的大小、方向，以及前房深度（ACD）。结果　本研究共纳入33例33眼患者，裸眼视力和最佳矫正视力分别从激光前的（0.771±0.375）logMAR和（0.608±0.369）logMAR提高到激光后1个月的（0.347±0.271）logMAR和（0.094±0.095）logMAR（均为P<0.001）。散瞳状态下，激光前、激光后1 h、激光后1个月IOL的倾斜度分别为（4.482±1.408）°、（4.541±1.343）°、（4.458±1.399）°,IOL的偏心量分别为（0.176±0.107）mm、（0.193±0.117）mm、（0.180±0.114）mm。激光前与激光后相比，IOL倾斜度和偏心量的差异均无统计学意义（均为P>0.05）。散瞳与非散瞳状态比较，IOL倾斜度和偏心量的差异均无统计学意义（均为P>0.05）。散瞳状态下ACD激光前为（3.842±0.278）mm，激光后1 h增加了0.019 mm，激光后1个月增加了0.012 mm，激光前后ACD相比,差异均有统计学意义（均为P<0.05）。结论　Nd:YAG激光后囊膜切开术是治疗PCO安全有效的方法，术后患眼视力显著提高，手术对IOL倾斜和偏心无明显影响，但可能造成IOL一定程度的轴向移位。

Effect of Nd:YAG laser capsulotomy on the position of intraocular lens by CASIA2

Objective　To evaluate the effect of the Nd:YAG laser capsulotomy for treating posterior capsule opacification (PCO) on the stability of intraocular lens (IOL) using a new anterior segment OCT CASIA2.Methods　This study was a prospective self-control study. A total of 33 patients (33 eyes) who were diagnosed with PCO and underwent Nd:YAG laser capsulotomy at the Ophthalmology Department of Affiliated Hospital of North Sichuan Medical College were selected in this study. Their visual acuity, intraocular pressure, anterior segment and fundus were examined preoperatively, 1 hour and 1 month postoperatively. In addition, the size and direction of IOL tilt and decentration, as well as the anterior chamber depth (ACD) were measured by CASIA2.Results　The uncorrected visual acuity (UCVA) and best corrected distant visual acuity (BCDVA) were improved from (0.771±0.375) logMAR and (0.608±0.369) logMAR preoperatively to (0.347±0.271) logMAR and (0.094±0.095) logMAR one month postoperatively (all P<0.001). Under the mydriatic conditions, the IOL tilt was (4.482±1.408)°, (4.541±1.343)°, and (4.458±1.399)°, and the IOL decentration was (0.176±0.107) mm, (0.193±0.117) mm, and (0.180±0.114) mm preoperatively, 1 hour and 1 month postoperatively. The IOL tilt and decentration showed no statistically significant differences before and after the laser surgery, under mydriatic conditions and non-mydriatic conditions (all P＞0.05). Preoperative ACD was (3.842±0.278) mm. One hour and one month postoperatively, ACD increased by 0.019 mm and 0.012 mm respectively, and the differences were statistically significant (all P<0.05).Conclusion　Nd:YAG laser capsulotomy is a safe and effective method for the treatment of PCO. The visual acuity is significantly improved postoperatively. The surgery has no significant effect on the IOL tilt and decentration, but may cause axial displacement.