晶状体后囊皱褶Nd：YAG激光切开术

目的探讨Nd：YAG激光晶状体后囊皱褶切开术的效果。方法晶状体后囊皱褶33例（33眼）。术前爱尔卡因表麻下置CGP角膜接触镜,借助瞄准光,准确聚焦于皱褶上,发射Nd：YAG激光,单脉冲切开皱褶能量为0．4～1．0mJ,每次治疗总量为20—30mJ,平均（25±0．12）mJ。结果后囊皱褶激光切开术后矫正视力：1．0者22眼占66．67％,0．6—0．8者7眼占21．21％,0．5—0．7者4眼占12．12％。裂隙灯显微镜下观察未发生人工晶状体损伤,无玻璃体疝、黄斑囊样水肿或视网膜脱离等并发症。结论用Nd：YAG激光切开晶状体后囊皱褶,可增进视力,疗效良好。     

Nd：YAG激光后发膜性白内障切开术后眼压升高的预防

对接受Nd:YAG激光后发膜性白内障切开术的28眼随机分成0.5%噻吗心安组、2%匹罗卡品组和不同药对照组，观察术后眼压变化，对照组术后眼压升高发生率为100%，高峰眼压均在术后1-4小时内出现，防治术后眼压升高，实验组同对照组比较具有统计学意义（P<0.01)，噻吗心安组优于匹罗卡品组（P<0.01)。     

Nd:YAG激光后囊膜切开孔径大小对屈光度、眼压和黄斑厚度的影响

目的探讨Nd：YAG激光后囊膜切开孔径大小对后发性白内障患者术后屈光度、眼压和黄斑厚度的影响。方法回顾性分析Nd：YAG激光后囊膜切开术治疗后发性白内障患者76例（83只眼）,根据后囊膜切开孔径大小,将患者分为两组：A组3.5～4.5 mm,B组4.6～5.5 mm,观察术前以及术后1 d、1周、1个月患者最佳矫正视力（BCVA）、等效球镜（SE）、眼压和黄斑厚度的变化。结果 A组和B组术后BCVA均较术前明显提高（P〈0.05）,而两组间BCVA差异均无统计学意义（P〉0.05）。术后两组SE均较术前增加（P〈0.05）;术后1个月两组SE均高于术后1 d、1周（P〈0.05）,且B组患者SE大于A组（P〈0.05）。术后1 d两组眼压均较术前升高（P〈0.05）;而与术前相比,术后1周、1个月两组眼压差异无统计学意义（P〉0.05）;两组间眼压差异均无统计学意义（P〉0.05）。术后1 d、1周两组黄斑厚度均较术前增加（P〈0.05）;而术后1个月两组黄斑厚度与术前相比,差异无统计学意义（P〉0.05）;两组间黄斑厚度差异均无统计学意义（P〉0.05）。结论 Nd：YAG激光后囊膜切开孔径的大小与术后眼压、黄斑厚度的改变无关,但较大的切开孔径会引起更多的远视漂移。     

Nd:YAG激光晶状体前囊膜切除术后房水内丙二醛变化与眼压的关系

探讨Ｎｄ：ＹＡＧ激光晶状丛前囊膜切除术后暂时性眼压升高的发生机制,观察丹参和维生素Ｅ对眼压升高的影响。方法２４只兔随机分为４组,药物且激光手术前后应用丹参和维生素Ｅ。定期观察激光术后眼压和房水内丙二醛含量的变化。结果激光术后发生暂时性眼升高并伴随房水内ＭＤＡ含量明显增加。药物组术后房水内ＭＤＡ含量无明显增加并且术后性眼压升高的幅度明显降低。结论激光前囊膜切除术后暂时性眼压升高与术后房水内ＭＤＡ含量     

右旋噻吗心安之降眼压作用及其机理的研究

本文复习了右旋噻吗心安的理化性质,降眼压作用,房水药物动力学,安全性及噻吗心安降眼压作用机理的新观点。右旋噻吗心安能抑制房水分泌并降低眼压的作用已得到证实,其降眼压作用基本与β-受体阻滞作用无关。虽已提出用抑制多巴胺功能来解释噻吗心安的降眼压作用机理,并取得了一些证据,但此学说目前尚未得到公认,有待于进一步研究,尽管如此,根据现有的资料来看,右旋噻吗心安似乎是一个很有潜力的抗青光眼药物。     

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     

三种抗炎药物在Nd：YAG激光后囊膜切开术后应用的随机对照研究

背景Nd：YAG激光后囊膜切开术是治疗后发性白内障的重要手段,通常术后常规使用糖皮质激素滴眼液点眼以减轻患者术眼的前房炎症反应,但这存在升高眼压的潜在风险。目的比较氯替泼诺混悬滴眼液、妥布霉素地塞米松滴眼液和氟米龙滴眼液在Nd：YAG激光后囊膜切开术后局部应用的抗炎效果及对眼压的影响。方法采用随机对照研究设计,对接受Nd：YAG激光后囊膜切开术的127例患者171眼按随机数字表法随机分为4个组：氯替泼诺组35例47眼,采用氯替泼诺混悬滴眼液点眼;氟米龙组30例40眼,使用氟米龙滴眼液点眼;妥布霉素地塞米松组29例38眼,给予妥布霉素地塞米松滴眼液点眼;聚乙二醇组33例46眼,使用聚乙二醇滴眼液点眼。4个组均于Nd：YAG激光后囊膜切开术后开始点眼,每日6次,连续使用5d。分别于术前1h及术后1h、1d、3d、1周使用Glodmann眼压计测量眼压,在裂隙灯显微镜下按照Peizeng的标准对术眼的前房炎症反应程度进行评分。结果氯替泼诺组术眼术前1h,术后1h、1d、3d及1周的平均眼压分别为（18．2±4．7）、（20．1±5．7）、（18．7±5．5）、（19．0±4．1）和（19．5±3．5）mmHg;氟米龙组分别为（18．7±5．3）、（20．9±5．7）、（21．3±4．5）、（21．0±4．9）、（22．5±6．5）mmHg;妥布霉素地塞米松组分别为（17．9±6．3）、（20．3±6．1）、（23．0±3．7）、（24．7±4．9）、（24．5±6．5）mmHg;聚乙二醇组分别为（18．4±6．3）、（20．7±3．7）、（22．7±6．5）、（19．6±4．8）、（18．5±3．5）mmHg,4个组术眼眼压的总体比较差异有统计学意义（F组别3．876,P：0．023）;随着时间的延长,氯替泼诺组和聚乙二醇组眼压逐渐下降,而氟米龙组和妥布霉素地塞米松组眼压均高于术前,总体比较差异有统计学意义（F时间=3．801,P=0．031）。各组均未见其他明显眼部和全身药物相关性不良反应。氯替泼诺组和妥布霉素地塞米松组用药后房水细胞分级为1级和2级的百分比明显低于氟米龙组和聚乙二醇组,差异有统计学意义（H=8．276,P=0．012）;氯替泼诺组术眼I级房水闪辉的百分比为8％,氟米龙组为22％,妥布霉素地塞米松组为18％,聚乙二醇组为30％,各组房水闪辉严重程度的总体比较差异有统计学意义（H=9．305,P=0．000）。结论Nd：YAG激光后囊膜切开术后局部使用糖皮质激素能有效减轻患者术眼的前房炎症反应,其中氯替泼诺滴眼液抗炎疗效更好,对眼压影响较小,不良反应少,可作为Nd：YAG激光后囊膜切开术后的常规局部用药。     

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。     

Nd：YAG激光治疗后发膜性白内障术后眼压升高的探讨

本文探讨９５人１０４只眼Ｎｄ：ＹＡＧ激光治疗后发膜性白内障术后眼压升高的原因。以激光前后眼压升高差值≥５ｍｍＨｇ为标准，眼压差值≥５ｍｍＨｇ组与＜５ｍｍＨｇ组两组总能量分别是６１５．４１±１１２９．８０ｍＪ和２０３．７１±３４２．６６ｍＪ，经统计学处理有显著差异。我们将术前眼压分为≥２０ｍｍＨｇ组与＜２０ｍｍＨｇ两组，术前眼压≥２０ｍｍＨｇ组术后眼压升高≥５ｍｍＨｇ占７３％，术前眼压＜２０ｍｍＨｇ组术后眼压升高≥５ｍｍＨｇ的占４４％，两组比较有差异。结论：①术中能量的大小是术后眼压升高的主要因素，击射时总能量大，术后眼压升高明显。②术前眼压高低也可影响术后眼压。提示我们在击射时选择适当的能量，降低术前眼压，控制术后炎症则可有效地减少术后眼压升高的发生     

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.     

Endophthalmitis after Nd:YAG laser capsulotomy

A 63-year-old patient underwent a Nd:YAG laser capsulotomy, 5 months after an extracapsular cataract extraction. One day later endophthalmitis had developed. Staphylococcus epidermidis was cultured from the vitreous. We assume that this micro-organism, a pathogen of low virulence, had been sequestered in the capsular bag and was released into the vitreous after Nd:YAG capsulotomy.     

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.     

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.