ND-yag激光后囊切开术后眼压的变化

Hassan Hashim Thiab
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引用次数: 1

摘要

背景:后囊膜混浊(PCO)又称白内障后混浊,是有计划的白内障囊外摘除术(ECCE)伴或不伴人工晶状体(IOL)植入术后的常见并发症。本研究的目的是评估Nd-Yag激光后囊膜切开术(LPC)治疗PCO后眼压(IOP)的变化。Nd-Yag LPC是一种安全且无创的手术,可以作为门诊手术进行。患者与方法:选取alyarmuk教学医院青光眼科符合入选标准的有症状的完整后囊膜混浊(PCO)患者100只眼,为期6个月,其中无晶状体64只眼,假性晶状体36只眼,另一只眼作为对照。手术前使用Goldmann眼压计(GAT)和裂隙灯检查测量激光前眼压基线。使用1% tropicamide滴眼液扩大瞳孔。使用1-2次丙帕卡因滴眼液进行表面麻醉,使用Nd: YAG激光(VISULAS YAG III Carl Zeiss Meditec AG AG Germany),在晶状体后囊膜上开一个3-4 mm的开口,以保证尽可能少的消耗能量。术后1小时、24小时和1周再次评估IOP。结果:术前、术后1小时、24小时、1周检查眼压。P5mmHg 46眼(46%),>10mmHg 24眼(24%),差异有统计学意义。每一位IOP在一小时等于或大于22 mmHg的患者都接受了抗青光眼药物来控制IOP的升高。24小时时,两组IOP均降至平均13.24 mmHg。无晶状体和假晶状体组在IOP变化方面没有区别。所有治疗眼在Nd-Yag激光应用前和应用后一周用Snellen图表记录最佳矫正视力(VA)。在进行中央囊腔切开术后,所有患者的VA均增加。没有一只眼的激光后VA低于激光治疗前。结论:Nd-Yag激光光破坏术是一种安全有效的治疗PCO的方法。然而,有几个已知的并发症,如眼压明显升高,在囊膜切开后,只有我们能尽量减少它们的频率,或者更好的是,完全避免它们,我们才能接受Nd-Yag LPC作为我们努力恢复眼压的安全手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Changes in intraocular pressure after ND-yag laser posterior capsulotomy
Background: The posterior capsule opacification (PCO) is also known as after catract is a common complication after planned extra capsular cataract extraction (ECCE) with or without intraocular lens (IOL) implantation. The aim of this study was to evaluate the changes in intraocular pressure(IOP) after Nd-Yag laser posterior capsulotomy(LPC) for PCO. The Nd-Yag LPC is a safe and noninvasive procedure and can be performed as an outpatient procedure. Patients & Methods: A total of one hundred eyes with symptomatic intact posterior capsule opacification (PCO) at Glaucoma Department of Alyarmouk Teaching Hospital fulfilling the inclusion criteria were enrolled in the study over a period of 6 months, 64 eyes were aphakic and 36 eyes were pseudophakic, the fellow eye was used as control. The base line pre-laser IOP was measured with the help of Goldmann Applanation Tonometer (GAT) and slit lamp examination before procedure. The pupils were dilated by using 1% tropicamide eye drops. Proparacaine eye drops were used 1-2 times for topical anesthesia, using Nd: YAG laser (VISULAS YAG III Carl Zeiss Meditec AG Germany), an opening of 3-4 mm was made in the posterior lens capsule, ensuring use of least possible energy. IOP was again assessed 1 hours, 24 hour and one week after the procedure. Results: IOP was checked before laser, at one hour, 24 hour and one week after laser. There was statistically significant (P<0. 001) rise in IOP at one hour in both aphakic and pseudophakic groups from a mean of 12.54 mmHg before laser to a mean of 20.79 mmHg at one hour with an average of 8.35 mmHg from baseline measurement. IOP at one hour rises from 2-5 mmHg in 30 eyes (30%), >5mmHg in 46 eyes (46%) and >10mmHg in 24 eyes (24%). Every patient had an IOP at one hour equal to or greater than 22 mmHg received anti-glaucoma drugs to control the rise in IOP. At 24 hours IOP decreased to a mean of 13.24 mmHg in both groups. No distinction was made between the aphakic and the pseudophakic groups with regard to IOP changes. In all treated eyes, best corrected visual acuity (VA) was recorded before and at one week after Nd-Yag laser application by Snellen's chart. After performing a central capsulotomy VA increased in all patients. In no eye was the post-laser VA lower than before laser treatment. Conclusion: Photo-disruption with Nd-Yag laser is a safe and an effective method in management of PCO. However, there are several complications known to follow capsulotomy as significant rise in IOP and only if we can minimize their frequency or, better still, avoid them altogether, can we accept Nd-Yag LPC as a safe procedure in our effort to restore vision in cases of PCO.
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