后发性白内障行Nd:YAG激光后囊膜切开术后视觉质量改变

目的：观察分析白内障人工晶状体植入术后后发性白内障( posterior capsule opacification,PCO)患者行Nd：YAG激光后囊膜切开术前后视力、全眼高阶像差( total high-order aberration, tHOA )、调制传递函数( modulation transfer function,MTF)、视觉质量的变化。
　　方法：选取2014-06/2015-09来我院就诊的白内障人工晶状体植入术后PCO患者共100例100眼,年龄47~80(平均65.52±7.01)岁,所有患者均行Nd：YAG激光后囊膜切开术(激光孔径≥5 mm )治疗,观察激光术前后最佳矫正视力( best corrected vision acuity,BCVA)的变化,应用iTrace视觉功能分析仪分别测量分析3 mm和5 mm瞳孔直径下激光术前后全眼总高阶像差tHOA及MTF的变化。结果：所有Nd：YAG激光手术顺利,未发生明显术中、术后意外情况及并发症,BCVA：术前0.451±0.023,术后0.763±0.025,手术前后 BCVA 差异有统计学意义( P<0.01)。3 mm瞳孔直径下术前 tHOA 0.551±0.031,术后 tHOA 0.214±0.011,手术前后3 mm瞳孔直径下tHOA 差异有统计学意义(P <0.01)。3mm瞳孔直径下激光术后在5、10、15、20、25、30 c/d 6种空间频率下 MTF tHOA 值(0.644±0.023、0.497±0.011、0.311±0.015、0.202±0.018、0.056±0.027、0.041±0.011)较术前(0.401±0.021、0.261±0.026、0.179±0.012、0.108±0.014、0.031±0.016、0.022±0.021)显著提高,差异有统计学意义(P<0.05)。5mm瞳孔直径下术前 tHOA 0.752±0.028,术后 tHOA 0.361±0.014,激光术前后5 mm瞳孔直径下tHOA 差异有统计学意义( P <0.01)。5 mm瞳孔直径下激光术后在5、10、15、20、25、30 c/d 6种空间频率下 MTF tHOA 值(0.426±0.027、0.209±0.018、0.172±0.013、0.116±0.015、0.049±0.010、0.034±0.014)较术前(0.234±0.021、0.102±0.019、0.088±0.016、0.058±0.022、0.021±0.014、0.016±0.011)显著提高,差异有统计学意义(P<0.05)。
　　结论：PCO 患者行 Nd：YAG 激光后囊膜切开术治疗后BCVA提高、tHOA 降低、MTF值增大、患眼的视觉质量明显提高。

Changes of visual quality after Nd:YAG laser posterior capsular dissection to the patient with after-cataract

AIM:To observe and analyze visual quality changes of the patients with posterior capsule opacification(PCO)Nd:YAG laser posterior capsular dissection, including the change of the best corrected vision acuity(BCVA), total high-order aberration(tHOA), and the modulation transfer function(MTF).

METHODS:In this prospective observational study, 100 cases of patients(100 eyes)with posterior cataract underwent Nd:YAG laser posterior capsular dissection(posterior capsular diameter dissected was 5mm or higher). The mean age was 65.52±7.01 years old. The change of the BCVA was collected. The tHOA and MTF under the 3mm and 5mm pupil diameter were assessed by iTrace respectively before and after Nd:YAG laser posterior capsular dissection.

RESULTS:All the surgery went well without obvious intraoperative and postoperative complications happened. The preoperative BCVA was 0.451±0.023 while the postoperative BCVA was 0.763±0.025. The difference of BCVA before and after Nd:YAG laser surgery was statistically significant(P<0.01). At 3mm pupil diameter, the tHOA preoperative was 0.551±0.031 while the postoperative tHOA was 0.214±0.011, the differences were significance(P<0.05). At 3mm pupil diameter while the spatial frequencies(5cpd, 10cpd, 15cpd, 20cpd, 25cpd, 30cpd)respectively, the MTF tHOA value postoperative(0.644±0.023, 0.49±0.011, 0.311±0.015, 0.202±0.018, 0.056±0.027, 0.041±0.011)were significantly higher than that preoperative(0.401±0.021, 0.261±0.026, 0.179±0.012, 0.108±0.014, 0.031±0.016, 0.022±0.021), and the difference has statistical significance(P<0.05). At 5mm pupil diameter, the tHOA preoperative was 0.752±0.028 while the postoperative tHOA was 0.361±0.014, the differences were significance(P<0.01). At 5mm pupil diameter while the spatial frequencies(5cpd, 10cpd, 15cpd, 20cpd, 25cpd, 30cpd)respectively the MTF tHOA value postoperative(0.426±0.027, 0.209±0.018, 0.172±0.013, 0.116±0.015, 0.049±0.010, 0.034±0.014)were significantly higher than that preoperative(0.234±0.021, 0.102±0.019, 0.088±0.016, 0.058±0.022, 0.021±0.014, 0.016±0.011), and the difference had statistical significance(P<0.05).

CONCLUSION:Patients with posterior capsule opacification(PCO)Nd:YAG laser posterior capsular dissection can help improve BCVA, reduce tHOA, increase MTF tHOA values, and significantly improve visual quality of patients.