后囊混浊激光治疗与角膜内皮细胞丢失的临床研究

为研究人晶体后囊混浊行Ｎｄ：ＹＡＧ激光切开术对角膜内皮细胞的影响，用Ｎｄ：ＹＡＧ激光治疗３３例（３３只眼）后囊混浊切开，在激光前与激光后７天检测内皮细胞。结果①激光前角膜内皮细胞平均密度为２４０１个／ｍｍ２，激光后７天内皮细胞密度为２３０１个／ｍｍ２，内皮细胞丢失率为４．３８％，六边形细胞丢失率６．５８％。②激光后与激光前的内皮细胞密度及六边形细胞百分数均有统计学显著性差异（分别为ｔ＝３．６１，ｐ＜０．０５；ｔ＝４．２８，ｐ＜０．０１）。③切开后囊所用激光总能量与内皮细胞丢失无相关性，而单次激光能量则与其有统计学上相关性（ｒ＝０．４３６４，ｐ＜０．０５）。结论Ｎｄ：ＹＡＧ激光行后囊混浊切开时，其对角膜内皮细胞有一定的影响，为减少对内皮细胞的损害，单次低量，多次的切开后囊的激光使用为最佳方法。     

Nd∶YAG激光截囊术后并发症观察

我们应用Ｎｄ：ＹＡＧ激光对２０３例（２２１只眼）白内障囊外摘除术后患者行晶体后囊切开术，经平均随访１０．５个月（１～９６个月），４７．０６％的术限矫正视力达０．５以上，术后发生裂孔源性视网膜脱离３只眼（１．３６％），大泡性角膜炎１只眼（０．４５％）。尽管本组病例未发生黄斑囊样水肿及青光眼等并发症，但已有文献报道。提示对Ｎｄ：ＹＡＧ激光截囊术后患者，仍需在术后不断观察，以便及时发现和治疗这些并发症。     

Nd：YAG激光截囊术后并发症观察

我们应用Ｎｄ：ＹＡＧ激光对２０３例（２２１只眼）白内障囊外摘除术后患者和地晶体后囊切开术，经平均随访１０．５个月，４７．０６％的术眼矫正视力达０．５以上，术后发生裂孔源性视网膜脱离３只眼（１．３６％），大泡性我膜炎１只眼（０．４５％），尽管本组病例未发生黄斑囊样水肿及青光眼等并发症，但已有文献报道，提示对Ｎｄ：ＹＡＧ激光截囊术后患者，仍需在术后不断观察，以便及时发现和治疗这些并发症。     

后囊混浊激光治疗的临床研究

目的：研究了白内障囊外摘除或联合人工晶体植入术后囊混浊行激光治疗的临床意义。方法：Ｎｄ：ＹＡＧ治疗，行后囊混浊１９４例（１９４只眼）切开术，术后随访１～３２个月，平均为１４．２９±９．１８个月，结果：激光后视力０．５以上者占７１．７％；激光前后眼压变化不明显；本组研究范围内，未发现激光总能量与眼压增加有相关性。结论：Ｎｄ：ＹＡＧ激光是后囊混浊有效、方便、合理的重要治疗方法。     

儿童白内障术后Nd:YAG激光的早期治疗

目的 评价早期的Ｎｄ：ＹＡＧ激光晶状体后发开在儿童白内障中的应用价值。方法 １９９８～１９９９年８例患儿行白内障囊外摘出与人工晶状体植入后,在７～１０日内行Ｎｄ：ＹＡＧ激光晶状体后囊切开术。结果 患儿年龄５～１１岁,随访时间５月～１９月,平均１０月。７例患儿视轴区保持透明,１例因后囊浑浊再次行ＹＡＧ激光术,地浑浊的复发率达１２．５％,所有患儿无明显并发症。结论 早期Ｎｄ：ＹＡＧ激光晶状体后囊切开术     

Nd：YAG激光及其联合氩激光虹膜切开术后虹膜病理组织学研究

对２５只青紫蓝兔４２只眼行激光虹膜切开术（Ｎｄ：ＹＡＧ激光、氩激光及Ｎｄ：ＹＡＧ激光联合氩激光虹膜切开），借助光镜、透射电镜及扫描电镜观察比较术后即刻至８个月击射位虹膜的组织结构改变。结果表明：（１）Ｎｄ：ＹＡＧ激光作用的靶组织的内部张力较组织厚度对治疗效果的影响更大。（２）兔眼＜２００μｍ的Ｎｄ：ＹＡＧ激光孔及＜４５０μｍ的氟激光、Ｎｄ：ＹＡＧ激光联合氩激光孔均在术后１周内关闭。病理组织学检查显示，氩激光孔的色素上皮增殖、迁移征象更为明显。（３）氩激光热凝虹膜如不充分，基质血管扩张充血，后继Ｎｄ：ＹＡＧ激光击射时有加重出血程度的可能。     

Nd：YAG激光及其联合氩激光虹膜切开术后虹膜病理组织…

对２５只青紫蓝兔４２只眼行激光虹膜切开术（Ｎｄ：ＹＡＧ激光，氩激光及Ｎｄ：ＹＡＧ激光联合氩激光虹膜切开），借助光镜，透射电镜及扫描电镜观察比较术后即刻至８个月击射位虹膜的组织结构改变。结果表明：（１）Ｎｄ：ＹＡＧ激光作用的靶组织的内部张力较组织厚度对治疗效果的影响更大。（２）兔眼＜２００μｍ的氩激光，Ｎｄ：ＹＡＧ激光联合氩孔均在术后１周内关闭。病理组织学检查显示，氩激光孔的色素上增殖，迁移征象更为     

白内障超声乳化术后恶性青光眼临床分析

目的　探讨白内障超声乳化术后恶性青光眼的治疗方法及效果。方法　回顾性研究２００７年１月～２０１３年１月我科收治的恶性青光眼患者１５例１６眼,均于５ｄ～３个月（平均１０ｄ）前行患眼的白内障超声乳化联合人工晶状体植入术,手术顺利完成,人工晶状体植入囊袋内。１１例１２眼经Ｎｄ:ＹＡＧ激光治疗,６例６眼经透明角膜周边虹膜切开联合周边囊膜悬韧带切除联合前部玻璃体切除术治疗（其中包括Ｎｄ:ＹＡＧ激光治疗后复发的２眼）。术后平均随访１３个月,观察术后视力、前房深度、眼压等,评估治疗效果。结果　１１例１２眼经Ｎｄ:ＹＡＧ激光治疗,其中治疗有效１０眼（８３．３％）。治疗后７ｄ患眼视力为０３４±０．０８,较治疗前的０．０８±０．０３显著提高（Ｐ＝０．００）。激光治疗后７ｄ患眼前房深度和眼压分别为（２．３０±０．２１）ｍｍ和（１５．５０±１．９６）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,与治疗前的（０．８３±０．１８）ｍｍ和（３５．１０±５．７８）ｍｍＨｇ相比,差异均有统计学意义（均为Ｐ＝０．００）。手术治疗后７ｄ患眼前房深度和眼压分别为（２．１５±０．２２）ｍｍ和（１４．５０±２．１７）ｍｍＨｇ,与治疗前的（０．４７±０．０８）ｍｍ和（３９．８３±４．４０）ｍｍＨｇ相比,差异均有统计学意义（均为Ｐ＝０．００）。末次随访时,激光治疗和手术治疗的患眼前房深度与眼压与治疗后７ｄ相比,差异均无统计学意义（均为Ｐ＞０．０５）。所有患眼均无严重并发症发生。结论　Ｎｄ:ＹＡＧ激光治疗白内障超声乳化术后人工晶状体眼的恶性青光眼,创伤小,操作简便,有效率高。经透明角膜周边虹膜切开联合周边囊膜悬韧带切除联合前部玻璃体切除术可有效解除房水逆流,手术效果肯定,可作为白内障超声乳化术后复杂恶性青光眼包括无Ｎｄ: ＹＡＧ激光治疗条件或治疗失败患者的有效的治疗方法。     

人工晶状体植入术后角膜内皮变化

目的 评价白内障囊外摘出人工晶状体植入术后角膜内皮损伤情况。方法 使用Ｋｏｎａｎ非接触型角膜内皮分析仪观察２８眼白内障囊外摘出人工晶状体植入术前后角膜中央区内皮细胞变化。结果 ２８眼术后１月角膜内皮细胞密度下降２１．７４％、其中１４眼术后３月角膜内皮细胞密度下降１８．１２％，经统计学处理（Ｐ〈０．０１）。细胞形态学表现为代偿性扩大。结论 术前术后角膜内皮细胞测定，对严格掌握手术适应证和评判手术预后     

Nd:YAG激光治疗后发性白内障

目的评价Ｎｄ：ＹＡＧ激光后囊膜切开术治疗后发性白内障的疗效及安全性。探讨防止其并发症的有效方法。方法对９７例１１２眼后发性白内障行Ｎｄ：ＹＡＧ激光后囊膜切开术,随访、观察８～１６ｍｏ,并进行分析、讨论。结果截囊成功率１００％,增视率９８．２％,术后视力恢复≥０．５者７６眼,占６７．９％．并发症仅有术后眼压暂时性升高１５眼占１３．４％,轻度人工晶状体损伤６眼占７．８％．结论Ｎｄ：ＹＡＧ激光后囊膜切开术是治疗后发性白内障最安全有效的方法。准确瞄准和聚焦、低能量、射击次数少、后囊膜小切孔可有效防止其并发症     

Nd:YAG激光乳化白内障手术的临床研究

目的 研究NdYAG激光乳化白内障手术后前房的炎症反应、角膜内皮细胞密度的变化及影响因素。方法 在NdYAG激光乳化白内障手术术前和术后用非接触式角膜内皮显微镜测量角膜内皮细胞密度,用激光闪辉细胞仪测量前房闪光值。结果 NdYAG激光乳化白内障手术中所用的激光能量和晶状体核硬度相关（r=0.343,P=0.002）;手术后前房的炎症反应（r=0.381,P=0.004）、角膜内皮细胞的丧失数（r=0.320,P=0.021）均和手术中所用的激光脉冲数相关。结论 随着晶状体核硬度增加,手术后前房的炎症反应和角膜内皮细胞的丧失率均增加。     

Corneal endothelial damage after neodymium:YAG laser iridotomy

BACKGROUND AND OBJECTIVE: This study examined the long-term effect of neodynium:YAG (Nd:YAG) laser iridotomy on the corneal endothelium. PATIENTS AND METHODS: A prospective study was designed. Patients with narrow and occludable angles or fellow eye of acute angle closure glaucoma attack were treated with Nd:YAG laser iridotomy. For one year, 31 eyes of 21 patients underwent complete follow-up. Corneal endothelial specular microscopy was performed before and after laser iridotomy at 1, 3, 6, and 12 months. RESULTS: The decrease of endothelial cell density after YAG laser iridotomy was statistically significant at 1 month (P = 0.036), 6 months (P = 0.004), and 12 months (P = 0.000), respectively. The decrease was not statistically significant at 3 months (P = 0.467). Linear regression analysis indicated no statistical correlation between the percentage change in endothelial cell density and the total energy used during the treatment (1 month: P=0.08, 3 months: P= 0.3, 6 months: P=0.9, 12 months: P=0.2). CONCLUSION: This study demonstrated significant endothelial cell loss in the 1-year follow-up. The result suggested that Nd:YAG laser iridotomy may pose a long-term hazard to the corneal endothelium.     

激光周边虹膜切除术对角膜内皮细胞的影响

目的 探讨Nd∶YAG激光周边虹膜切除术对角膜内皮细胞的影响.方法 采用非接触式角膜内皮显微镜对40例Nd∶YAG激光周边虹膜切除术的患眼进行角膜内皮细胞的定性及定量观察.检测指标包括:所选区域平均细胞面积(AVE)、最大细胞面积(MAX)、最小细胞面积(MIN)、细胞密度(CD)、变异系数(CV)、细胞面积标准差(SD).激光治疗后1周、1个月、3个月、6个月随访,重复作角膜内皮细胞检查及眼科常规检查.采用SAS Version 9.12 Mixed Model统计分析比较激光治疗前与激光治疗后不同时期的角膜内皮细胞密度及形态的改变.结果 激光治疗前与激光治疗后不同时期的角膜内皮细胞密度、平均细胞面积、最大细胞面积、变异系数,细胞面积标准差均有统计学意义.而角膜内皮细胞的最小细胞面积激光治疗前后比较无统计学意义.结论 Nd∶YAG激光周边虹膜切除术对角膜内皮细胞有一定的损伤.     

应用Nd:YAG激光行虹膜周边切开术对角膜内皮细胞影响的临床观察

目的 分析闭角型青光眼患者行Nd:YAG激光虹膜周边切开术时,角膜内皮细胞的变化及其相关影响因素.方法 对35例(58眼)闭角型青光眼,应用Nd:YAG激光行虹膜周边切开术,术前、术后1周及术后1个月分别用角膜内皮镜进行定量、定性观察及统计分析,包括角膜内皮细胞密度、细胞面积、变异系数、六角形细胞百分数.结果 46眼(79.31％)经一次激光治疗成功切透虹膜、12眼(20.69％)经二次激光治疗成功切透虹膜.58眼术前、术后1周及术后1个月角膜内皮细胞密度、平均面积、变异系数、六边形细胞百分数差异均无统计学意义(P＞0.05).结论 应用Nd:YAG激光行虹膜周边切开术对角膜内皮细胞无明显损伤,效果确切且安全.     

改良式后囊膜切开术治疗人工晶状体眼晶状体后囊膜混浊

目的：探讨改良式的Nd:YAG激光后囊膜切开术（张力线法）治疗人工晶状体（IOL）眼晶状体后囊膜混浊（PCO）的临床疗效并和传统的十字切开法进行对比。方法：前瞻性对照研究。选取2014 年12月至2015 年12 月在温州医科大学附属眼视光医院因单纯白内障摘除联合IOL植入术后伴发PCO需要行Nd:YAG激光后囊膜切开的患者57 例（60 眼）,按手术方式不同随机分为张力线法组和十字切开法组,每组各30眼。在术后第1天、1周和1个月复查。记录激光单次最小切开能量、点数、总能量、 手术时间以及患眼裸眼视力（UCVA）、最佳矫正视力（BCVA）、球镜度、柱镜度、等效球镜度（SE）、眼压（IOP）以及是否有眼前黑影症状。数据采用独立样本t 检验、卡方检验、重复测量的方差分析等进行分析。结果：十字切开法组和张力线法组术后UCVA（LogMAR）（ F =82.23、67.60,P < 0.001）、BCVA（LogMAR）（ F =40.08、34.78,P < 0.001）较术前均有明显提高,但2组间比较差异无统计学意义（P > 0.05）。张力线法组的激光单次最小切开能量、点数、总能量、手术时间均明显低于十字切开法组（t =3.55、5.79、6.19、8.26,P < 0.01）。张力线法组术后IOP较术前降低（F =3.48,P =0.031）,十字切开法组术后IOP无明显改变（P > 0.05）,2 组间比较差异无统计学意义。张力线法组和十字切开法组在术后出现黑影症状眼所占比例差异无统计学意义。2组术后柱镜度较术前均明显降低（F =9.54、 4.78,P < 0.05）,2 组间比较差异无统计学意义。2 组术后球镜度、SE较术前均无明显改变,2 组间比较差异无统计学意义。结论：改良的Nd:YAG激光后囊膜切开法（张力线法）治疗IOL眼晶状体后囊膜混浊安全有效。该方法相比传统的十字切开法所使用的激光能量小,手术时间短。     

Corneal endothelial damage after Nd:YAG laser anterior capsulotomy

The Nd:YAG laser is used primarily in the management of posterior capsular opacification in patients who have had extracapsular cataract extraction. Despite wide clinical use little is known about its damaging effects on the ocular tissues particularly on the corneal endothelium. To evaluate the pathologic changes caused by high powered Nd:YAG laser pulses on the anterior segment of the eye we focused the beam of this laser on the anterior lens capsule in rabbit eyes. Six eyes underwent anterior capsulotomy and three power settings were used (3.4 mJ, 5.8 mJ, 8.6 mJ). The fellow eyes served as controls. We studied acute corneal endothelial changes 6 hours after the capsulotomy using transmission electron microscopy. Results indicate that especially in the high setting the laser energy can cause injury and destruction of endothelial cells and alterations in the Descement membrane. These effects may be crucial of patients with corneas in critical cell number after a cataract surgery.     

The role of anterior hyaloid face integrity on retinal complications during Nd: YAG laser capsulotomy

Background

This study evaluated anterior hyaloid damage (AHD), AHD-related Nd:YAG laser parameters, and retinal complications in subjects that underwent Nd:YAG laser posterior capsulotomy for cataracts.

Methods

In this prospective, cross-sectional study, 277 pseudophakic eyes of 216 patients treated with Nd:YAG laser capsulotomy for posterior capsule opacification were enrolled. Pulse number, pulse energy, and total energy were noted for each eye. All procedures were performed with a sense of anterior hyaloid protection. Anterior hyaloid faces were assessed during procedure and 1 day after the procedure. Eyes with biomicroscopically invisible anterior hyaloid face were excluded from statistical analysis. Eyes with and without AHD were compared according to Nd:YAG laser parameters. Retinal complications were evaluated at day 1, week 1, month 1, and month 3.

Results

In 22 eyes (7.9 % of 277 eyes), the anterior hyaloid face couldn’t be assessed biomicroscopically. Anterior hyaloid damage was observed in 49 eyes (19.2 % of 255 eyes). The pulse number, pulse energy, and total energy were observed to be higher in eyes with AHD (P?<?.001, P?=?.024, P?<?.001, respectively). Cystoid macular edema was detected in five eyes (three with AHD) at 1-week examination. Localized retinal detachment occurred in one eye with AHD. Occurrence of retinal complication in the AHD(+) group was 12.7 times higher than in the AHD(?) group, adjusted for total energy used (P?<?0.001).

Conclusion

The risk of AHD may increase with high pulse number, pulse energy, and total energy. Anterior hyaloid face integrity should be considered for YAG laser-related retinal complications.     

Corneal Endothelial Damage with Neodymium:YAG Laser

Acute corneal endothelial changes following Nd:YAG laser application were evaluated in two series of rabbits. The first series underwent anterior capsulotomy, while the second series received laser applications at calculated distances ranging from 0.0 mm to 1.8 mm posterior to the endothelium. The rabbits were killed 24 hours after treatment and the endothelium evaluated with scanning electron microscopy. None of the eyes undergoing anterior capsulotomy showed endothelial damage, but the endothelium was focally denuded when laser shots were applied within 1.0 mm of it, and Descemet's membrane was disrupted by laser shots focused within 0.1 mm. Implications for clinical laser surgery are discussed.     

Comparison of laser iridotomy using short duration 532-nm Nd: YAG laser (PASCAL) vs conventional laser in dark irides

AIM: To evaluate the outcome of laser iridotomy using 532-nm Nd: YAG laser (PASCAL) with short pulse duration and Nd: YAG laser compared to conventional combined laser iridotomy. METHODS: Retrospective, nonrandomized, comparative case series. Forty-five eyes of 34 patients underwent laser iridotomy. Twenty-two eyes underwent iridotomy using short duration PASCAL and Nd: YAG laser, and 23 eyes underwent iridotomy using conventional combined laser method. The average settings of PASCAL were 60 μm and 700-900 mW with a short duration of 0.01s to reduce the total applied energy. The conventional laser was 50 μm and 700-900 mW for 0.1s. After photocoagulation with these laser, the Nd: YAG laser was added in each group. Endothelial cell counts of pre-iridotomy and 2mo after iridotomy were measured and compared. RESULTS: All eyes completed iridotomy successfully. The total energy used in the PASCAL group was 1.85±1.17 J. Compared to conventional laser 13.25±1.67 J, the energy used was very small due to the short exposure time of PASCAL. Endothelial cell counts were reduced by 0.88% in the PASCAL group and 6.72% in the conventional laser group (P=0.044). The change in corneal endothelial cell counts before and after iridotomy was significant in conventional combined laser iridotomy group (P=0.004). CONCLUSION: Combined PASCAL and Nd:YAG laser iridotomy is an effective and safe technique in the dark brown irides of Asians. Furthermore, the short duration of exposure in PASCAL offers the advantages of reducing the total energy used and minimizing the corneal damage.