后发性白内障患者行YAG激光后囊切开术后人工晶状体的偏移及眼轴的改变

摘要

目的:研究后发障患者在行YAG激光后囊切开术后人工晶体有无发生偏移,以及眼轴是否发生变化.方法:收集白内障超声乳化并人工晶体植入术后不同时间段内发生后发性白内障患者14例18眼.所有患者在行YAG激光术前均先参照标准对数视力表验光并获得最佳矫正视力,以眼前节OCT获得眼前段图像,并以CMOS测得眼轴.本研究中定义瞳孔所在的水平面与人工晶体的前表面所成的夹角为人工晶体偏移度(简称偏移度,单位:度).完成相关检查后,对患者逐一行YAG激光后囊切开术,术后双氯芬酸钠滴眼液滴术眼一次,术后1h,1wk后对患眼行验光,眼前节OCT及CMOS检查.分别记录患眼人工晶状体的偏移度、眼轴长度及最佳矫正视力,并以SPSS进行统计分析.结果:YAG激光术前各例眼的平均偏移度为2.896±2.286度,平均眼轴为23.56±0.55 mm;术后1h平均偏移度为4.702±2.991度,平均眼轴为23.40±0.59 mm;YAG术后1h较术前相比最佳矫正视力提高了平均3.72±1.74行.YAG术后1wk回访患者有9例12眼,此12眼的YAG术后1h的平均偏移度为3.175±1.791度,术后1wk的平均偏移度为3.434±1.835度.YAG术后1h与术前相比人工晶体偏移度的差异有统计学意义;术后1h与术前相比眼轴的差异无统计学意义;YAG术后1wk与术后1h人工晶体偏移度的差异无统计学意义;YAG术后1h较术前提高的最佳矫正视力行数与术后1h较术前人工晶体偏移度的差值具有相关性,相关系数为-0.523.结论:后发障患者行YAG激光后囊切开术后人工晶体发生偏移,而眼轴长度几乎不变;且YAG术后人工晶体发生的偏移量越小,最佳矫正视力提高越多.%AIM: To study the tilt of the intraocular lens (IOL) after Nd:YAG capsulotomy (YAG) and variation of the axial length (AL) in patients with posterior capsular opacification (PCO).METHODS: The study involved 18 eyes of 14 patients with PCO after uncomplicated phacoemulsification surgery and IOL implantation.All patients had taken examinations,including testing best corrected visual acuity (BCVA) by using standard logarithmic visual acuity chart,images of ocular anterior segment and AL by OCT.After the examinations,YAG was operated upon all patients.Each eye received one drop of Diclofenac Sodium Eye Drops immediately after YAG,and patients had taken examinations listed above again.One week later,BCVA and OCT were tested as well.Data (BCVA,tilt of IOLs,and AL) were recorded and analyzed statistically by SPSS.RESULTS: Mean patient age was 73.93±6.94y,including 5 males and 9 females,8 left eyes and 10 right eyes,altogether 14 patients with 18 eyes.In this study,tilt of IOLs was defined as the angle of anterior surface of IOL and pupil plane (briefly called Tilt,unit:°).Before YAG,mean Tilt was 2.896±2.286°,mean AL was 23.56±0.55mm.1h after YAG,mean Tilt was 4.702±2.991°,mean AL was 23.40±0.59mm,and BCVA enhanced 3.72±1.74 lines.1wk after YAG,9 patients with 12 eyes were involved in the study.The mean Tilt of these 12 eyes was 3.175±1.791° 1h after YAG and 3.434±1.835° 1wk after YAG.There were significant differences between Tilt before YAG and Tilt 1h after YAG.There were no significant differences between AL before YAG and AL 1h after YAG.There were no significant differences between Tilt 1h after YAG and Tilt 1wk after YAG.The lines of enhancement of BCVA 1h after YAG was correlated to differences between Tilt before YAG and Tilt 1h after YAG,of which the correlation coefficient was-0.523.CONCLUSION: IOLs of patients with PCO tilted after YAG,while AL rarely changed.After YAG,the less IOLs tilted,the more BCVA enhanced.