不同类型人工晶体眼晶状体后囊膜混浊对老年患者视功能的影响

目的探讨两种不同类型人工晶体眼晶状体后囊膜混浊(PCO)对老年患者视功能的影响。方法对超声乳化白内障摘除人工晶体植入术后发生PCO的37例(41只眼)患者进行分型。其中纤维增殖型30例(34只眼),类珍珠样小体型7例(7只眼)。两组患者分别于掺钕钇铝石榴石(Nd:YAG)激光晶状体后囊切开术前及术后1周进行患眼及对侧眼最佳矫正视力、对比敏感度、立体视觉、色觉等视功能检查。结果术前所有患眼最佳矫正中位数为0.2218,与对侧眼0.8000比较,差异有统计学意义(P<0.05)。其中纤维增殖型PCO组最佳矫正视力中位数为0.2218,与类珍珠样小体型PCO组(0.8239)比较,差异有统计学意义(P<0.05)。Nd:YAG激光晶状体后囊切开术前所有患眼各空间频率对比敏感度均有不同程度降低。类珍珠样小体型PCO组患眼各空间频率的对比敏感度较纤维增殖型PCO组降低更显著,差异有统计学意义(P<0.05)。术后两组PCO患者视力及各空间频率的对比敏感度差异均无统计学意义。Nd:YAG激光晶状体后囊切开术前立体视觉检查显示:类珍珠样小体型PCO患者立体视功能均异常(100.0%);纤维增殖型PCO患者中立体视阳性13例(43.3%),无立体视17例(56.7%),差异有统计学意义(P<0.05)。术后两组患者立体视功能均有不同程度提高,差异无统计学意义。术前Titmus立体视功能检查类珍珠样小体型PCO组均异常;纤维增殖型PCO组正常5例(16.7%),两组间差异有统计学意义(P<0.05),术后两组间差异无统计学意义。术前全部患者均存在色觉异常,主要表现在蓝紫色及绿色辨别能力下降,术后两组患者色觉障碍均有提高,但蓝紫色觉改善不明显。结论人工晶体眼PCO对老年患者的最佳矫正视力、对比敏感度、立体视觉均可产生影响,对类珍珠样小体型PCO比纤维增殖型PCO影响更大。Nd:YAG激光晶状体后囊切开术可以有效改善各种类型PCO患者的视功能。

Effect of different types of posterior capsule opacification on the visual functions in pseudophakic eyes of elderly patients

Objective To evaluate the visual functions in pseudophakic eyes of elderly patients with 2 types of posterior capsule opacification (PCO). Methods Forty-one eyes (37 patients) with PCO after intraocular lens implantation were enrolled in this study,34 eyes (30 patients) with fibrosis type PCO and 7 eyes (7 patients) with elschnig-pearl-type PCO.Visual acuity,contrast sensitivity,stereoscopic vision and color vision were examined before and 1 week after neodymium- yttrium aluminum garnet(Nd:YAG) laser posterior capsulotomy.Results Before capsulotomy,the median logMAR visual acuity of all PCO eyes was 0.2218 and that of the other eyes without PCO was 0.8000,the difference was significant(P<0.05).The median logMAR visual acuity of the fibrosis- type PCO group was 0.2218,and there was a significant difference (P<0.05) when compared with that of the elschnig-pearl-type PCO group (0.8239).Contrast sensitivity decreased at all spatial frequencies of all PCO eyes,but it decreased more in the elschnig-pearl-type PCO eyes.After capsulotomy,no significant difference was found between the 2 groups in visual acuity or contrast sensitivity at all spatial frequencies (P>0.05).Before capsulotomy,no elschnig-pearl-type PCO patients had stereoscopic vision,but 13 fibrosis-type PCO patients had it (P<0.05).But,the significance disappeared after capsulotomy(P>0.05).Before capsulotomy,the color visions of all PCO eyes were abnormal.After capsulotomy,they were all improved,but not significantly improved in blue and purpl.Conclusions Vision functions in elderly patients with PCO of pseudophakic eyes are impaired in different ways.Patients with pearl-type PCO have worse vision functions than those with fibrosis-type PCO.And Nd:YAG laser posterior capsulotomy can improve the visual functions of both types of PCO patients.