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。

An Improved Nd:YAG Laser Posterior Capsulotomy Technique for the Treatment of Posterior Capsule Opacification

Objective: To compare the efficacy of the improved Nd:YAG laser posterior capsulotomy technique(the tension line method) with the traditional cruciate Nd:YAG laser posterior capsulotomy technique.Methods: In this prospective, controlled study, 57 simple cataract patients (60 eyes) who had undergone intraocular lens implantation participated from December 2014 to December 2015 at the Eye Hospital,Wenzhou Medical Universtiy. They were enrolled after developing posterior capsular opacification (PCO) that needed Nd:YAG laser posterior capsulotomy. Patients were randomly divided into two groups of 30 eyes each based on different Nd:YAG laser capsulotomy techniques (the tension line group and the cruciategroup) for treatment. Patients were reviewed on the first day, and at one week and one month after the capsulotomy was completed. Laser single minimum cut energy, points, total energy, operation time and uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical diopters, cylindrical diopters, spherical equivalents (SE), and intraocular pressure (IOP) were recorded as well as reports of floater symptoms. Data were analyzed using independent sample t test, Chi-square test, and repeated measurements ANOVA. Results: There were obvious improvements in UCVA (F=82.23, 67.60, P<0.001)and BCVA (F=40.08, 34.78, P<0.001)(LogMAR) after capsulotomy both in the cruciate line group and the tension group, there was no statistically significant difference between the two groups (P>0.05). The laser single minimum cut energy, points, total energy, and operation time of the tension line group were significantly lower than the cruciate group (t=3.55, 5.79, 6.19, 8.26, P<0.01). IOP in the tension line group was lower than that before surgery (F=3.48, P=0.031), there was no statistically significant difference between the two groups. There was no obvious difference between the groups in the number of eyes with floater symptoms. There was a significant decrease in postoperative cylindrical diopters in both groups(F=9.54, 4.78, P<0.05), there was no statistically significant difference between the two groups. There was no significant change in postoperative spherical diopters and SE in both groups, and also there was no significant difference between the two groups. Conclusions: The improved Nd:YAG laser posterior capsulotomy technique (the tension line method) for the treatment of intraocular lens posterior capsular opacification is safe and effective. Compared with the traditional cruciate technique, the improved technique uses less laser energy, has a shorter operation time.