Intraocular pressure elevation following Nd:YAG laser posterior capsulotomy

Intraocular pressures (IOP) and tonographic outflow facilities were measured following neodymium (Nd): YAG laser posterior capsulotomy in 13 pseudophakic and 8 aphakic eyes. Mean intraocular pressure (IOP) peaked by three hours with a mean increase of 13 mmHg, remained elevated by 5 mmHg at 24 hours but returned to baseline by one week. Fourteen eyes (67%) had greater than or equal to 10 mmHg elevation and eight (38%) had greater than or equal to 40 mmHg maximum IOP. All the patients who eventually demonstrated a greater than or equal to 10 mmHg elevation within six hours of the capsulotomy initially had an IOP elevation greater than or equal to 5 mmHg at one hour. The mean outflow facility was reduced from 0.18 microl/min/mmHg before capsulotomy to 0.08 microl/min/mmHg (55%, P less than 0.0001) at four hours and was still decreased at 0.13 microl/min/mmHg (27%, P less than 0.05) at one week. Seventy-five percent of aphakic and 15% of pseudophakic patients had maximum IOP greater than or equal to 40 mmHg (P less than 0.01). Measurements should be performed one hour postlaser in all patients for IOP and three to four hours in aphakic patients, glaucomatous patients, patients receiving greater than or equal to 200 mjoules total laser energy, and patients with greater than or equal to 5 mmHg elevation at one hour in order to detect and treat significant IOP elevations.     

Effect of pilocarpine in treatment of intraocular pressure elevation following neodymium: YAG laser posterior capsulotomy

A prospective study was conducted in 30 eyes of 30 patients to determine if pilocarpine would prevent increased intraocular pressure following Q-switched neodymium (Nd):YAG laser posterior capsulotomy. Fifteen eyes were given pilocarpine 4%, immediately following laser therapy and every hour until bedtime. Fifteen eyes served as untreated controls. Our results show that without prophylactic therapy, 10 of 15 eyes (67%) had a post-laser intraocular pressure (IOP) elevation of greater than 10 mmHg, while only one of 15 (6.6%) of the pilocarpine-treated eyes had a rise of that magnitude. The facility of outflow was reduced by 42% in the untreated eyes in contrast to an increase of 3% in those eyes treated with pilocarpine. Thus, pilocarpine 4% is effective in reducing the incidence and magnitude of elevated IOP following Nd:YAG posterior capsulotomy.     

2mm直径Nd:YAG激光后囊膜切开术的视野变化

目的观察2mm直径后囊膜切开术后的视野变化并分析其相关因素。方法20例后囊膜Ⅱ级混浊患者行NdYAG激光2mm直径后囊膜切开术,术后90d计算机静态视野检查,行同样白内障术后后囊膜透明组21例检查视野。结果2mm后囊膜组中心30°及周边60°视野结果,平均偏差(MD)(-8.65±3.96)、模式标准差PSD(5.71±2.60)、中心10°总光敏感度(289.30±43.63)dB、周边60°总光敏感度(558.20±197.27)dB、后囊膜透明组MD(-2.93±3.10)、PSD(2.38±1.46)、中心10°总光敏感度(341.55±42.90)dB、周边60°总光敏感度(992.00±256.05)dB。经单因素方差分析两组的MD、PSD、中心10°及周边60°总光敏感度差异有显著性意义(P<0.01)。结论2mm直径后囊膜切开孔会引起视网膜平均光敏感度的下降,并伴视岛的部分明显压陷。     

Use of Nd:YAG laser capsulotomy

Surgery for cataract removal has become successively refined such that posterior capsular opacification is the most common problem presenting after modern cataract extraction. Various techniques and treatments exist to manage patients with posterior capsular opacification using Nd:YAG capsulotomy. There are many possible variations in initial assessment, pre-laser treatments, laser techniques, and follow-up routines. The literature on the use of Nd:YAG laser for capsulotomy was reviewed and interpreted. This article presents the currently available knowledge in a format that allows the practitioner to tailor an evidence-based protocol for treating patients with symptomatic posterior capsule opacification.     

Suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy

Nd:YAG laser posterior capsulotomy is the commonest procedure for posterior capsule thickening following cataract surgery. Complications following this laser surgery are relatively few, and this is ordinarily a safe and effective procedure. Herein a case is described of suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy. To the best of the authors' knowledge, this is the first report of this complication.Patients undergoing this procedure should be warned of this rare but potentially devastating complication.     

早期Nd:YAG激光后囊切开预防青壮年白内障术后后囊混浊

目的：寻找预防青壮年白内障术后后囊混浊的简单方法。

方法：在行白内障超声乳化吸出联合人工晶状体植入后1mo行Nd：YAG激光后囊切开。

结果：观察组21眼经3a随访,3眼出现后囊混浊。对照组20眼,3a时12眼发生后囊混浊,与观察组比较,Z=-3.04,P=0.002,两组差异有统计学意义。

结论：Nd：YAG激光预防性后囊切开,可有效地防止青壮年白内障术后后囊混浊的发生。     

Q开关Nd:YAG激光治疗后囊膜混浊

目的:探讨Q开关Nd:YAG激光后囊膜切开术治疗后囊膜混浊的疗效及安全性。方法:回顾性分析行Q开关Nd:YAG激光后囊膜切开术后囊膜混浊患者165例(193眼),记录手术前后视力、眼压及并发症,并进行统计学分析。结果:①后囊膜一次性切开成功率为100%,所用激光脉冲数平均24±21.7次,激光总能量4~451mJ;②91.2%(176眼)视力较术前提高;③59.6%(115眼)出现一过性眼压升高;手术前后眼压变化与是否植入人工晶状体、所用激光脉冲数以及白内障手术与后囊膜切开术间隔时间有关;④19.3%(32眼)出现人工晶状体损伤。结论:Q开关Nd:YAG激光后囊膜切开术治疗后囊膜混浊安全、有效,但应严格掌握适应证,并合理选择激光参数。     

Early complications following Q-switched neodymium: YAG laser posterior capsulotomy

A prospective evaluation was conducted of Q-switched neodymium: YAG laser capsulotomy in 53 eyes followed for one postoperative month. The first 31 eyes were seen at two-hour intervals for the first eight hours, and the remaining eyes were checked only at the second postoperative hour during that day. Eighty-nine percent of eyes required a pulse setting of less than 1.7 mJ to successfully penetrate the posterior capsule. Visual acuity was improved in 91% of eyes. A transient immediate postoperative intraocular pressure (IOP) elevation was seen in over 75% of treated eyes, and one-third had an IOP elevation greater than 10 mmHg over the preoperative IOP. This elevation was most common in glaucomatous eyes and occurred in almost one-half of the treated eyes by the second postoperative hour. This IOP change did not correlate with the degree of inflammation, bleeding, anterior chamber debris, or total energy delivered. Minimal iris bleeding occurred in 9% of treated eyes and was associated with iridocapsular adhesions. Eighty-one percent of eyes with posterior chamber implants developed some degree of lens damage.     

Q开关Nd：YAG激光治疗后发性白内障临床观察

目的　探讨 Q开关 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。方法　回顾性分析行 Q开关 Nd:YAG激光后囊膜切开术后发性白内障患者 16 5例 193眼 ,记录手术前后视力、眼压及并发症 ,并进行统计学分析。结果　 (1)后囊膜一次性切开成功率为 10 0 % ,所用激光脉冲数平均 2 4± 2 1.7次 ,激光总能量平均 5 9.3± 6 6 .2 m J;(2 ) 91.2 % (176眼 )视力较术前提高 ;(3) 5 9.6 % (115眼 )出现一过性眼压升高 ;手术前后眼压变化与是否植入人工晶状体、所用激光脉冲数以及白内障手术与后囊膜切开术间隔时间有关 ;(4) 19.3% (32眼 )出现人工晶状体损伤。结论　 Q开关 Nd:YAG激光后囊膜切开术治疗后发性白内障安全、有效 ,但应严格掌握手术适应证 ,并合理选择激光参数。     

硅凝胶襻板式人工晶状体在YAG激光晶状体囊膜切开术后迟发性后脱位

目的:观察白内障手术植入硅凝胶襻板式人工晶状体的稳定性,分析其偏心和后脱位的相关原因。方法-结果:我们报道了3例顺利行白内障超声乳化并硅凝胶襻板式人工晶状体植入手术的患者,在术后发生人工晶状体后脱位。1例出现在因高度前囊收缩行扇形晶状体前囊切开术后4a,另2例分别出现在晶状体后囊切开术后早期和术后3mo。3者均在顺利行晶状体后囊切开术后发生脱离。患者均无外伤病史或其他促发事件。结论:硅凝胶襻板式人工晶状体似乎由于较差的囊粘附性易于脱位,因为它们仅是通过襻的纤维变性融合而固定。如果前囊或后囊破裂,囊收缩产生的力量可以导致放射状撕裂的扩展,进而引起植入晶状体的后脱位。尽管其他类型人工晶状体在这方面优于硅凝胶襻板式人工晶状体,但是已植入此种人工晶状体,在进行YAG激光晶状体囊切开术时,告知他们潜在人工晶状体后脱位风险是术后早期或晚期并发症是非常重要的。     

Nd:YAG激光在散大瞳孔后对IOL术后PCO治疗的体会

目的:探讨Nd:YAG激光在散大瞳孔后治疗人工晶状体(IOL)植入术后后发性白内障的方法和效果。方法:应用Nd:YAG激光机对500例后发性白内障行激光后囊切开术。结果:切开术成功率为99.8%,视力增进者97.2%。结论:Nd:YAG激光于散大瞳孔后治疗后发性白内障IOL损伤小、视力提高显著。     

A new technique for Nd:YAG laser posterior capsulotomy

AIM: To investigate the effects of a new opening pattern in neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy on visual function.METHODS: This technique was conducted along a circular pattern. The energy ranged between 0.8 and 1.2 mJ/pulse was consumed and mean total energy levels were 74±21 mJ (mean±standard deviation:SD, from 40 to 167) and laser shots aimed at 150 µm away behind a datum point and went along an imaginary line which extends 0.5 mm inside from optic margin and into the circular en bloc pattern. Vitreous stands were attached with fragment and then they were cut off by the laser after circular application. The circular fragment was completely separated from vitreous, and then this fragment was quickly sunk in intravitreal space.RESULTS: The follow-up period ranges from at least a week to 40mo, making 15.8mo on average. The procedural outcome showed 96% (74 eyes out of the 77 eyes) enhancement in patients’ visual acuity. Cystoid macular edema or retinal detachment was not observed in any of the patients during follow-up periods.CONCLUSION: This new technique is expected to improve the weaknesses that the conventional procedures have by adding the process to cut off vitreous stands attached with the fragment by the laser to the circular application.     

The effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations

Objective: To assess the effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations. Study Design: Retrospective comparative study.Participants: Twenty-four eyes of 24 consecutive pseudophakic patients with symptomatic PCO, who presented for Nd:YAG laser posterior capsulotomy at our clinic, were included in this study.Methods: The wave front aberrations of the entire optical path of 24 pseudophakic eyes of 24 patients before, and 1 month after, Nd:YAG laser posterior capsulotomy were measured using the Nidek Optical Path Difference (OPD) scan aberrometer. Total, tilt, and high-order aberrations, and total coma, total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were analyzed statistically. Secondary measures included changes in visual acuity and refraction, and repeatability of wave front measurements in the fellow eye.Results: Before Nd:YAG laser posterior capsulotomy, the total higher-order aberrations root mean-square (RMS) wave front aberration was 2.08 (SD 2.20) μm, with total trefoil being a major contributor at 1.19 (SD 1.15) μm. One month after the procedure, significant decreases in total, tilt, and high-order aberrations, and total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were noted (p < 0.05). No significant changes in total coma aberrations were found (p > 0.05). Additionally, significant improvement in visual acuity without significant change in refraction was observed. No statistically significant differences were detected in any of the RMS values of wave front measurements taken 1 month later in the fellow eye.Conclusions: Nd:YAG laser posterior capsulotomy causes significant decrease in ocular wave front aberrations measured using the Nidek-OPD scan aberrometer, which can account for a better optical quality after the procedure. Further research to examine the impact of wave front aberrations in visual function after Nd:YAG laser posterior capsulotomy is needed.     

Nd：YAG激光治疗后发性白内障术后眼底并发症的临床观察

目的探讨Nd：YAG激光治疗后发性白内障术后的眼底并发症。方法回顾性分析Nd：YAG激光治疗后发性白内障患者497例（497眼）,其中出现眼底并发症的患者48例（48眼）。对出现眼底并发症的48眼进行裂隙灯、眼科B型超声、检眼镜、荧光素眼底血管造影（FFA）、光学相干断层扫描（OCT）检查。结果Nd：YAG激光治疗后发性白内障后眼底并发症的发病率为9.66%,其中15眼（31.25%）玻璃体前界膜破裂、6眼（12.50%）玻璃体后脱离、8眼（16.67%）视网膜裂孔及6眼（12.50%）视网膜脱离。黄斑裂孔和新生血管性青光眼是较为严重且少见的并发症,分别有1眼（2.0%）和3眼（6.25%）发生,需行睫状体冷凝和滤过手术。各类并发症的发生率与激光治疗的时机、激光发射能量、激光激发的部位、患者原眼部疾患等因素相关。结论提高对Nd：YAG激光治疗后发性白内障术后可能出现眼底并发症的认识,避免各类严重并发症的出现,对已出现的并发症应早期治疗。     

Nd:YAG激光治疗后发性白内障的临床观察

目的:探讨Nd:YAG激光治疗后发性白内障的临床效果。方法:后发性白内障患者203例224眼,经详细眼科检查,散瞳后,采用国产Nd:YAG激光(波长1064μm)进行激光治疗,激光瞄准光聚焦于后囊膜表面,环形切开后囊膜,切开直径约3～4mm。激光后定期复查。对治疗前后视力,采用SPSS11.0统计软件进行统计分析比较。结果:本组患者均为一次性激光切开成功,成功率为100%;视力均获提高,经统计学处理,治疗前后视力有显著性差异(P<0.01)。结论:Nd:YAG激光是治疗后发性白内障安全有效的方法。     

YAG激光后囊切开术治疗晚期囊袋阻滞综合征伴后发性白内障

目的：观察YAG激光后囊切开术治疗晚期囊袋阻滞综合征伴后发性白内障的疗效。

方法：对临床确诊为囊袋阻滞综合征伴后发性白内障的13例18眼患者行YAG激光后囊切开术,观察术后1,4,24h; 1,2wk的非矫正远视力、眼压、房水、玻璃体及主观症状的变化。

结果：YAG激光后囊切开术治疗囊袋阻滞综合征伴后发性白内障,可以提高患者非矫正远视力; 部分患者可出现前房内游走颗粒,但不引起炎症反应; 术后1,4,24h部分患者会引起一过性眼压升高,甚至需降眼压治疗,但术前术后眼压变化无统计学意义; 所有患者术后均出现玻璃体混浊加重,眼前漂浮影增多,但均在2wk内恢复。

结论：YAG激光后囊切开术治疗囊袋阻滞综合征伴后发性白内障,可以提高患者视力,但应严密观察患者眼压、前房内炎症反应等,及时给予处理。     

Nd:YAG laser capsulotomy rates following implantation of square-edged intraocular lenses: polymethyl methacrylate versus silicone versus acrylic

Objective: To study the influence of square-edged intraocular lenses (lOLs) on the development of posterior capsule opacification (PCO) and the requirement for laser capsulotomy.Design: Retrospective study.Participants: Three hundred seventy-seven eyes of 377 patients were included.Methods: All these patients underwent phacoemulsification and implantation of square polymethyl methacrylate (PMMA) (Aurolab), silicone (Tecnis Z9000), acrylic hydrophobic (AcrySof MA60AC and Sensar Optiedge), or acrylic hydrophilic (Akreos Adapt) lOLs with a minimum of 2 years’ follow-up. Only those cases in which Nd:YAG laser capsulotomy had been performed for visually significant PCO were evaluated.Results: Three hundred seventy-seven eyes of 377 patients were included in the study. Follow-up duration ranged from 24 to 54 (mean 40.27, SD 8.42) months. The incidence of PCO requiring Nd:YAG laser capsulotomy was found to be significantly less in the silicone lens group: 1.4% as compared with an incidence of 11.7% in the PMMA lens group (p = 0.018). In the square-edged acrylic group, visually significant PCO requiring Nd:YAG laser capsulotomy was observed in 3.6%, 4.8%, and 6.8% of eyes implanted with AcrySof MA60AC, Sensar Optiedge, and Akreos Adapt lOLs, respectively. In 5 of the 7 eyes (71.4%) exhibiting PCO in the PMMA group, the condition developed within the first 6 months. In the silicone and acrylic group, development of PCO was delayed.Conclusions: The rate of visually significant PCO as well as the need for Nd:YAG laser capsulotomy is influenced by IOL biomaterial in addition to square edge. It is significantly delayed with square-edged foldable acrylic and silicone lOLs compared with square-edged PMMA IOLs.     

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     

两种Nd:YAG激光后囊膜切开方式治疗后囊膜混浊的Meta分析

目的：系统评价两种Nd：YAG激光后囊膜切开方式治疗白内障术后后囊膜混浊的效果与安全性,为临床实践中后囊膜切开方式的选择提供可靠依据。

方法：计算机检索中文全文期刊数据库(CNKI)、万方数据库、维普数据库、PubMed、Medline、Cochrane Library搜集不同Nd：YAG激光后囊膜切开方式治疗后囊膜混浊的相关文章,检索时限定义为2000-01-01/2019-12-31,2位评价者独立进行文献检索、筛选、质量评价及数据提取,采用RevMan5.3软件进行Meta分析。以均值差(MD)与95%置信区间(CI)衡量计量资料的效应量,对术后最佳矫正视力(BCVA)、术后眼压、激光使用能量进行合并分析。以比值比(OR)衡量计数资料的效应量,对出现人工晶状体受损以及眼前黑影飘动的比例进行合并分析。

结果：共纳入7篇研究,包括行Nd：YAG激光圆形后囊膜切开和十字形后囊膜切开共计432眼。Meta分析结果显示：圆形后囊膜切开组和十字形后囊膜切开组患者术后BCVA无差异(MD=-0.01,95%CI：-0.03～0.01,P=0.32); 术后眼压无差异(MD=-0.60,95%CI：-1.31～0.11,P=0.10); 使用激光能量无差异(MD=18.82,95%CI：-11.88～49.51,P=0.23); 晶状体受损率无差异(OR=0.97,95%CI：0.50～1.87,P=0.93); 眼前黑影飘动发生率无差异(OR=2.88,95%CI：0.28～29.26, P=0.37)。

结论：在白内障术后发生后囊膜混浊的患者行Nd：YAG激光后囊膜切开治疗中,圆形后囊膜切开与十字形后囊膜切开在治疗效果与安全性方面均无明显差异。