Objective: To compare the efficacy of the improved Nd:YAG laser posterior capsulotomy technique(the tension line method) with the traditional cruciate Nd:YAG laser posterior capsulotomy technique.Methods: In this prospective, controlled study, 57 simple cataract patients (60 eyes) who had undergone intraocular lens implantation participated from December 2014 to December 2015 at the Eye Hospital,Wenzhou Medical Universtiy. They were enrolled after developing posterior capsular opacification (PCO) that needed Nd:YAG laser posterior capsulotomy. Patients were randomly divided into two groups of 30 eyes each based on different Nd:YAG laser capsulotomy techniques (the tension line group and the cruciate group) for treatment. Patients were reviewed on the first day, and at one week and one month after the capsulotomy was completed. Laser single minimum cut energy, points, total energy, operation time and uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical diopters, cylindrical diopters, spherical equivalents (SE), and intraocular pressure (IOP) were recorded as well as reports of floater symptoms. Data were analyzed using independent sample t test, Chi-square test, and repeated measurements ANOVA. Results: There were obvious improvements in UCVA (F=82.23, 67.60, P<0.001)and BCVA (F=40.08, 34.78, P<0.001)(LogMAR) after capsulotomy both in the cruciate line group and the tension group, there was no statistically significant difference between the two groups (P>0.05). The laser single minimum cut energy, points, total energy, and operation time of the tension line group were significantly lower than the cruciate group (t=3.55, 5.79, 6.19, 8.26, P<0.01). IOP in the tension line group was lower than that before surgery (F=3.48, P=0.031), there was no statistically significant difference between the two groups. There was no obvious difference between the groups in the number of eyes with floater symptoms. There was a significant decrease in postoperative cylindrical diopters in both groups(F=9.54, 4.78, P<0.05), there was no statistically significant difference between the two groups. There was no significant change in postoperative spherical diopters and SE in both groups, and also there was no significant difference between the two groups. Conclusions: The improved Nd:YAG laser posterior capsulotomy technique (the tension line method) for the treatment of intraocular lens posterior capsular opacification is safe and effective. Compared with the traditional cruciate technique, the improved technique uses less laser energy, has a shorter operation time.
郑丽娅,陈峰,郑景伟,沈丽君. 改良式后囊膜切开术治疗人工晶状体眼晶状体后囊膜混浊[J]. 中华眼视光学与视觉科学杂志, 2017, 19(12): 711-719.
Liya Zheng,Feng Chen,Jingwei Zheng,Lijun Shen. An Improved Nd:YAG Laser Posterior Capsulotomy Technique for the Treatment of Posterior Capsule Opacification. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(12): 711-719. DOI: 10.3760/cma.j.issn.1674-845X.2017.12.002
Patton N, Aslam TM, Bennett HG, et al. Does a small central Nd:YAG posterior capsulotomy improve peripheral fundal visualisation for the vitreoretinal surgeon? BMC Ophthalmol,2004, 4: 8. DOI: 10.1186/1471-2415-4-8.
[4]
Chua CN, Gibson A, Kazakos DC. Refractive changes following Nd:YAG capsulotomy. Eye (Lond), 2001, 15(Pt 3): 304-305.DOI: 10.1038/eye.2001.99.
[5]
Bhargava R, Kumar P, Phogat H, et al. Neodymium-yttrium aluminium garnet laser capsulotomy energy levels for posterior capsule opacification. J Ophthalmic Vis Res, 2015, 10(1): 37-42.DOI: 10.4103/2008-322X.156101.
[6]
Keates RH, Steinert RF, Puliafito CA, et al. Long-term follow-up of Nd:YAG laser posterior capsulotomy. J Am Intraocul Implant Soc, 1984, 10(2): 164-168. DOI: 10.1016/S0146-2776(84)80101-9.
[1]
Aron-Rosa D, Aron JJ, Griesemann M, et al. Use of the neodymium-YAG laser to open the posterior capsule after lens implant surgery: a preliminary report. J Am Intraocul Implant Soc, 1980, 6(4): 352-354.
[7]
Khanzada MA, Jatoi SM, Narsani AK, et al. Is the Nd:YAG laser a safe procedure for posterior capsulotomy? Pak J Ophthalmol,2008, 24(2): 73-78.
[8]
Kara N, Evcimen Y, Kirik F, et al. Comparison of two laser capsulotomy techniques: cruciate versus circular. Semin Ophthalmol, 2014, 29(3): 151-155. DOI: 10.3109/08820538.2013.874467.
[9]
Cetinkaya S, Cetinkaya YF, Yener HI, et al. The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction. Arq Bras Oftalmol, 2015, 78(4): 220-223. DOI:10.5935/0004-2749.20150057.
[10]
Gomaa A, Liu C. Nd:YAG laser capsulotomy: a survey of UK practice and recommendations. Eur J Ophthalmol, 2011, 21(4):385-390. DOI: 10.5301/EJO.2010.6085.
Patton N, Aslam TM, Bennett HG, et al. Does a small central Nd:YAG posterior capsulotomy improve peripheral fundal visualisation for the vitreoretinal surgeon? BMC Ophthalmol,2004, 4: 8. DOI: 10.1186/1471-2415-4-8.
[4]
Chua CN, Gibson A, Kazakos DC. Refractive changes following Nd:YAG capsulotomy. Eye (Lond), 2001, 15(Pt 3): 304-305.DOI: 10.1038/eye.2001.99.
[5]
Bhargava R, Kumar P, Phogat H, et al. Neodymium-yttrium aluminium garnet laser capsulotomy energy levels for posterior capsule opacification. J Ophthalmic Vis Res, 2015, 10(1): 37-42.DOI: 10.4103/2008-322X.156101.
[6]
Keates RH, Steinert RF, Puliafito CA, et al. Long-term follow-up of Nd:YAG laser posterior capsulotomy. J Am Intraocul Implant Soc, 1984, 10(2): 164-168. DOI: 10.1016/S0146-2776(84)80101-9.
Khanzada MA, Jatoi SM, Narsani AK, et al. Is the Nd:YAG laser a safe procedure for posterior capsulotomy? Pak J Ophthalmol,2008, 24(2): 73-78.
[8]
Kara N, Evcimen Y, Kirik F, et al. Comparison of two laser capsulotomy techniques: cruciate versus circular. Semin Ophthalmol, 2014, 29(3): 151-155. DOI: 10.3109/08820538.2013.874467.
[9]
Cetinkaya S, Cetinkaya YF, Yener HI, et al. The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction. Arq Bras Oftalmol, 2015, 78(4): 220-223. DOI:10.5935/0004-2749.20150057.
[10]
Gomaa A, Liu C. Nd:YAG laser capsulotomy: a survey of UK practice and recommendations. Eur J Ophthalmol, 2011, 21(4):385-390. DOI: 10.5301/EJO.2010.6085.
Rastegar A, Mahdavi M, Hashemian Z. 白内障摘除术后不同后囊膜混浊的发生率和分布. 国际眼科杂志, 2010, 10(1): 12-14. DOI: 10.3969/j.issn.1672-5123.2010.01.004.
[18]
Bhargava R, Kumar P, Prakash A, et al. Estimation of mean ND:Yag laser capsulotomy energy levels for membranous and fibrous posterior capsular opacification. Nepal J Ophthalmol,2012, 4(1): 108-113. DOI: 10.3126/nepjoph.v4i1.5861.
Magno BV, Datiles MB, Lasa MS, et al. Evaluation of visual function following neodymium: YAG laser posterior capsulotomy.Ophthalmology, 1997, 104(8):1287-1293.
[20]
Hayashi K, Nakao F, Hayashi H. Influence of size of neodymium:yttrium-aluminium-garnet laser posterior capsulotomy on visual function. Eye (Lond), 2010, 24(1): 101-106. DOI: 10.1038/eye.2009.41.
Rastegar A, Mahdavi M, Hashemian Z. 白内障摘除术后不同后囊膜混浊的发生率和分布. 国际眼科杂志, 2010, 10(1): 12-14. DOI: 10.3969/j.issn.1672-5123.2010.01.004.
[18]
Bhargava R, Kumar P, Prakash A, et al. Estimation of mean ND:Yag laser capsulotomy energy levels for membranous and fibrous posterior capsular opacification. Nepal J Ophthalmol,2012, 4(1): 108-113. DOI: 10.3126/nepjoph.v4i1.5861.
[21]
Yilmaz S, Ozdil MA, Bozkir N, et al. The effect of Nd:YAG laser capsulotomy size on refraction and visual acuity. J Refract Surg, 2006, 22(7): 719-721.
Oztas Z, Palamar M, Afrashi F, et al. The effects of Nd:YAG laser capsulotomy on anterior segment parameters in patients with posterior capsular opacification. Clin Exp Optom, 2015,98(2): 168-171. DOI: 10.1111/cxo.12205.
Goble RR, O'Brart DP, Lohmann CP, et al. The role of light scatter in the degradation of visual performance before and after Nd:YAG capsulotomy. Eye (Lond), 1994, 8(Pt 5): 530-534.DOI: 10.1038/eye.1994.131.
[27]
Ozkurt YB, Sengör T, Evciman T, et al. Refraction, intraocular pressure and anterior chamber depth changes after Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes. Clin Exp Optom, 2009, 92(5): 412-415. DOI: 10.1111/j.1444-0938.2009.00401.x.
[19]
Magno BV, Datiles MB, Lasa MS, et al. Evaluation of visual function following neodymium: YAG laser posterior capsulotomy.Ophthalmology, 1997, 104(8):1287-1293.
[20]
Hayashi K, Nakao F, Hayashi H. Influence of size of neodymium:yttrium-aluminium-garnet laser posterior capsulotomy on visual function. Eye (Lond), 2010, 24(1): 101-106. DOI: 10.1038/eye.2009.41.
[28]
Hu CY, Woung LC, Wang MC, et al. Influence of laser posterior capsulotomy on anterior chamber depth, refraction, and intraocular pressure. J Cataract Refract Surg, 2000, 26(8): 1183-1189.
[29]
Findl O, Drexler W, Menapace R, et al. Changes in intraocular lens position after neodymium: YAG capsulotomy. J Cataract Refract Surg, 1999, 25(5): 659-662. DOI: 10.1177/1078087407311393.
Yilmaz S, Ozdil MA, Bozkir N, et al. The effect of Nd:YAG laser capsulotomy size on refraction and visual acuity. J Refract Surg, 2006, 22(7): 719-721.
Oztas Z, Palamar M, Afrashi F, et al. The effects of Nd:YAG laser capsulotomy on anterior segment parameters in patients with posterior capsular opacification. Clin Exp Optom, 2015,98(2): 168-171. DOI: 10.1111/cxo.12205.
Goble RR, O'Brart DP, Lohmann CP, et al. The role of light scatter in the degradation of visual performance before and after Nd:YAG capsulotomy. Eye (Lond), 1994, 8(Pt 5): 530-534.DOI: 10.1038/eye.1994.131.
[27]
Ozkurt YB, Sengör T, Evciman T, et al. Refraction, intraocular pressure and anterior chamber depth changes after Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes. Clin Exp Optom, 2009, 92(5): 412-415. DOI: 10.1111/j.1444-0938.2009.00401.x.
[32]
Barman SA, Hollick EJ, Boyce JF, et al. Quantification of posterior capsular opacification in digital images after cataract surgery. Invest Ophthalmol Vis Sci, 2000, 41(12): 3882-3892.
[28]
Hu CY, Woung LC, Wang MC, et al. Influence of laser posterior capsulotomy on anterior chamber depth, refraction, and intraocular pressure. J Cataract Refract Surg, 2000, 26(8): 1183-1189.
[29]
Findl O, Drexler W, Menapace R, et al. Changes in intraocular lens position after neodymium: YAG capsulotomy. J Cataract Refract Surg, 1999, 25(5): 659-662. DOI: 10.1177/1078087407311393.
Barman SA, Hollick EJ, Boyce JF, et al. Quantification of posterior capsular opacification in digital images after cataract surgery. Invest Ophthalmol Vis Sci, 2000, 41(12): 3882-3892.