OPD-scan Ⅲ评价白内障术后前囊膜缩窄激光处理疗效  

OPD-scan Ⅲ for Evaluation of Anterior Capsular Contraction after Cataract Surgery with Nd:YAG Laser Treatment

作　　者：王于蓝[1,2,3,4] 方晓玲 袁胤 罗勤[1,2,3,4] WANG Yulan;FANG Xiaoling;YUAN Yin;LUO Qin(Shanghai Eye Diseases Prevention&Treatment Center/Shanghai Eye Hospital;Shanghai Key Laboratory of Ocular Fundus Diseases;Shanghai General Hospital;Shanghai Engineering Center for Visual Science and Photomedicine,Shanghai 200041,China)

机构地区：[1]上海市眼病防治中心/上海市眼科医院,上海200041 [2]上海市眼底病重点实验室 [3]上海市第一人民医院 [4]上海眼视觉与光医学工程技术研究中心,上海200041

出　　处：《中国实用眼科杂志》2018年第2期140-144,共5页Chinese Journal of Practical Ophthalmology

基　　金：上海市卫生和计划生育委员会科研课题(201640266).

摘　　要：目的评价OPD-scanⅢ像差仪在白内障术后前囊膜缩窄中早期诊断和激光处理前后视觉质量改善分析中的价值.方法对2016年1月至2017年1月在上海市眼病防治中心诊治的老年性白内障术后前囊膜缩窄患者13只眼进行平均发病时间统计,患眼屈光度、最佳矫正视力检查,OPD像差仪行散瞳至5 mm以上行眼像差检查和后照法影像记录.对所有患眼行Nd-YAG激光前囊膜多点松解切开.激光处理前与激光处理后1、2、4周及2、6、12、14月随访,平均最终随访时间(10.83±1.94)月.比较主要视觉症状改善率、球柱镜漂移量、眼内总像差值、眼内低阶及高阶像差值、视觉质量提升值.结果所有患眼出现视觉症状平均时间为术后(6.55±1.33)周,平均缩窄直径(3.67±0.59)mm.激光处理前后平均视力提高(0.90±0.71)行,主要视觉症状改善率100%.调制传递函数(Modulation Transfer Function,MTF)曲线4 mm面积比(AreaRatio,AR)由(19.02±2.31)提升至(36.52±9.63),差异有统计学意义(P<0.001).激光前后总像差从(3.62±4.80)下降至(2.03±1.95),差异有统计学意义(P<0.001);眼内高阶像差由(2.03±1.31)下降至(0.38±0.14),眼内低阶像差tilt(S1)值(1.16±0.36)下降至(0.59±0.43),二者差异分别具有统计学意义(P<0.001).激光术后4周无复发.结论白内障术后前囊膜缩窄出现视觉症状常见于术后6周左右,早期发现处理有利于迅速改善视觉症状,避免远期并发症和二次手术.OPD像差仪检查对评价前囊缩窄治疗前后疗效和视觉质量改变,具有良好临床参考价值.Objective To observe the clinical use of OPD-ScanⅢin evaluating the effect of Nd:YAG laser anterior capsular relaxing in treatment of postoperative anterior capsular contraction(ACC)patients.Methods Thirteen eyes of postoperative ACC collected from Shanghai Eye Diseases Prevention&Treatment Center during January 2016 to January 2017 were observed.Average onset time,refraction,best corrected visual acuity(BCVA),dilated pupil-image were recorded.Patients were followed up for 1 week,2 weeks,4 weeks,2 months,6 months,12 months,14 months(mean final follow-up time:10.83±1.94 months).OPD-scan was performed before and after the NdYAG laser lysis by at each follow up.Main visual symptoms,spherical and cylinder shift,total aberration(TA),internal low and high-order aberration(HO),MTF were compared before and after laser treatment.Results Average visual symptom onset time of ACC was 6.55±1.33 weeks post-operatively with mean residual capsular diameter of 3.67±0.59mm.Snellen visual acuity raised 0.90±0.71 line after laser with 100%subjective complain disappeared.MTF AreaRatio of 4mm was lifted from 19.02±2.31 to 36.52±9.63(P<0.001),TA decreased from 3.62±4.80 to 2.03±1.95(P<0.001),internal HO aberration decreased from 2.03±1.31 to 0.38±0.14(P<0.001),tilt(S1)value decreased form 1.16±0.36 to 0.59±0.43(P<0.001).No recurrence was observed.Conclusions Anterior capsular contraction symptoms mostly reported by patients around 6 weeks after cataract surgery.Early diagnosis and treatment could be effective and benefit for long term stability of IOLs.OPD-ScanⅢprovide sensitive data and images for evaluating the laser relaxing treatment.

关 键 词：波前像差 前囊膜缩窄 视觉质量 

分 类 号：R779.66[医药卫生—眼科]