后发性白内障Nd∶YAG激光后囊切开术后急性高眼压的临床处理及预后  

Management and prognosis of an acute intraocular pressure spike posterior to Nd∶YAG laser capsulotomy in patients with posterior capsular opacification

作　　者：卿国平[1] 王怀洲[1] 熊瑛[1] 王晓贞[1] 万修华[2] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100005 [2]北京市眼科研究所,100005

出　　处：《中华眼视光学与视觉科学杂志》2014年第12期750-753,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 分析后发性白内障行Nd∶YAG激光后囊切开术后出现急性眼压升高的临床处理及预后.方法 回顾性系列病例研究.收集2012年1月-2013年11月我院眼科门诊因后发性白内障行Nd∶YAG激光后囊切开术后出现急性眼压升高（≥40 mmHg,1 mmHg=0.133 kPa）的16例患者病例资料,并对其年龄、性别、白内障类型、治疗前后视力和眼压、激光治疗参数、高眼压处理经过及预后进行总结.结果 16例患者平均年龄（22.5±11.8）岁,其中男10例,女性6例.激光治疗前眼压11～22 mmHg,平均（17.3±3.5）mmHg,有2例患者在接受抗青光眼药物治疗;激光治疗后（3.6±1.3）h患者眼压升高至40～57 mmHg,平均（44.1±4.5）mmHg.12例患者药物降眼压处理后眼压下降,4例患者在药物降眼压后眼压仍高于40 mmHg,行前房穿刺放液术控制眼压.术后第2天,除1例患者眼压31 mmHg,其余均在21 mmHg以内.术后第2天平均眼压（14.7±4.1）mmHg,恢复至治疗前水平.随访6个月,末次随访眼压12～20 mmHg,平均（16.3±2.8）mmHg,与激光治疗前眼压差异无统计学意义（t=1.240,P＞0.05）.结论 后发性白内障行Nd∶YAG激光后囊切开术后急性眼压升高患者可以通过药物和（或）前房穿刺放液术降眼压,效果和预后良好.Objective To analyze the clinical characteristics and prognosis of an acute intraocular pressure （IOP） spike posterior to the Nd∶YAG laser capsulotomy in patients with posterior capsular opacification.Methods Medical charts of 16 patients who underwent Nd ∶YAG laser capsulotomy and presented with an IOP spike （≥40 mmHg,1 mmHg=0.133 kPa） after treatment in Beijing Tongren Eye Center from January 2012 to November 2013 were reviewed retrospectively.Main investigative aspects included age,gender,cataract subtypes,pre-and post-treatment visual acuity and IOP,Nd∶YAG laser parameters used in the treatment,the management of the acute IOP elevation and the clinical outcomes.Results Sixteen patients （10 males and 6 females） were enrolled in this retrospective study,with an average age of 22.5±11.8 years.Mean IOP level was 17.3±3.5（11-22）mmHg before laser capsulotomy.Two of the patients were receiving anti-glaucoma medication before the laser treatment.IOP increased immensely 3.6±1.3（2-6） hours after posterior laser capsulotomy,with an average of 44.1±4.5（40-57）mmHg.IOP was controlled in 12 patients after intensive anti-glaucoma medication.Nevertheless,the other four patients still had high IOP above 40 mmHg after medical intervention,and paracentisis was performed to reduce ocular hypertension.Except for one patient who still had an IOP of 31 mmHg,IOP was under control （≤ 21 mmHg） in all other patients by the second day.On follow-up day 3,IOP was 14.7±4.1（11-19）mmHg.IOP remained stable and was 16.3±2.8（12-20）mmHg on the last follow-up visit,which was not statistically different from baseline （t=1.240,P＞0.05）.Conclusion Intensive anti-glaucoma medication and/or paracentisis is safe and effective to reverse the IOP spike in patients with posterior capsular opacification posterior to Nd∶YAG laser capsulotomy.And the prognosis is excellent.

关 键 词：白内障 后发性 激光 固体 高眼压 预后 

分 类 号：R779.6[医药卫生—眼科]