掺钕钇铝石榴石激光治疗人工晶状体眼晶状体后囊膜混浊的视功能评价方法

目的探讨对比敏感度和眩光敏感度检查在晶状体后囊膜混浊(posterior capsule opacification, PCO)患者视功能评价中的意义,为掺钕钇铝石榴石(neodymium-yttrium aluminum garnet,NdYAG)激光治疗晶状体PCO提供视功能评价方法.方法对67例(73只眼)超声乳化白内障吸除人工晶状体植入术后晶状体PCO患者行NdYAG激光晶状体后囊膜切开术,分别于手术前、后进行视力、对比敏感度和眩光敏感度检查,并加以分析.NdYAG激光晶状体后囊膜切开术采用环形切开向后翻转法,晶状体后囊膜瓣直径为5 mm,平均单次脉冲能量为(2.93±0.63) mJ,平均脉冲次数为(19.09±8.63)次,平均总能量为(57.47±36.05) mJ.术后平均随访时间(14±6)个月.结果术后视力、对比敏感度和眩光敏感度均较术前明显提高,差异有非常显著意义(P＜0.01).术前矫正视力≥0.8的16只眼手术前、后最佳矫正视力比较,差异无显著意义(P＞0.05);不同视角的对比敏感度和眩光敏感度比较,差异均有显著意义(P＜0.05).术前不同视力患者各频段的对比敏感度比较,差异均无显著意义(P＞0.05).术前不同视力患者低频段和中频段眩光敏感度间差异有显著意义(P＜0.05),高频段眩光敏感度间差异无显著意义(P＞0.05).术前晶状体后囊膜2级混浊者不同频段的平均对比敏感度和眩光敏感度与1级混浊者比较,差异均有显著意义(P＜0.05).NdYAG激光晶状体后囊膜切开术中人工晶状体出现激光损伤斑者5只眼(6.8%),术后无高眼压、黄斑囊样水肿、视网膜脱离和人工晶状体移位等并发症发生.结论对比敏感度和眩光敏感度检查可灵敏、全面反映晶状体PCO患者的视功能状态,可成为确定NdYAG激光晶状体后囊膜切开术手术时机和评价手术疗效的方法.

Evaluation of visual function following neodymium: YAG laser posterior capsulotomy

OBJECTIVE: To probe into the clinical application of contrast sensitivity and glare sensitivity in evaluating visual function of posterior capsular opacification (PCO) and also investigate the visual function criterion in performing neodymium:yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. METHODS: Measurements of visual acuity, contrast sensitivity and glare sensitivity were obtained from 73 pseudophakic eyes (67 cases) before and after Nd:YAG laser posterior capsulotomy and the results were analysed. The method of Nd:YAG laser surgery was posterior capsular circular resection. The diameter of capsular chip was 5 mm. The average energy of single pulse was (2.93 +/- 0.63) mJ and the mean total energy was (57.47 +/- 36.05) mJ. The average follow-up was (14 +/- 6) months. RESULTS: Visual acuity, contrast sensitivity curve and glare sensitivity curve improved in all cases postoperatively. Comparing the parameters of pre-laser and post-laser measurement, there was very significant difference (P < 0.01). The only postoperative complication was the laser spot in intraocular lens (IOL, 5 eyes, 6.8%). No retinal detachment, cystoid macular edema and dislocation of IOL were observed in this series. CONCLUSION: Contrast sensitivity and glare sensitivity can represent the visual function of PCO sensitively and completely. They can be regarded as evaluation criterion of surgical timing and effect of Nd:YAG laser posterior capsulotomy.