摘要目的 评估比较YAG激光不同方式切开后囊膜术后主观、客观视觉质量的差异.方法 采用系列病例观察研究方法,对2015-2016年在温州医科大学附属眼视光医院行Nd:YAG激光晶状体后囊膜切开术患者28例38眼临床资料进行回顾性分析,按照手术方式的不同分为圆形切开组20例23眼和十字形切开组12例15眼,分别采用圆形切开后囊膜法和十字形切开后囊膜推瓣法切开后囊膜.术前、术后2周检查裸眼视力(UCVA)、最佳矫正视力(BCVA),术前、术后1h、术后2周测眼压,采用双通道视觉质量分析系统OQASⅡ测量术后1h、术后2周斯特尔比率(SR)、调制传递函数截止频率(MTF cut off)、客观散射指数(OSI)、OQAS对比度视力(OVs)(包括OV100％、OV20％和OV9％),比较并分析不同后囊膜切开方式术后1h、术后2周眼内散射和视觉质量变化. 结果 Nd:YAG激光后囊膜切开术后2周,圆形切开组和十字形切开组患眼的UCVA分别为0.18±0.15和0.16±0.14,BCVA分别为0.10±0.10和0.10±0.11,均较术前明显提高,差异均有统计学意义(均P＜0.01),但2个组间UCVA及BCVA比较差异均无统计学意义(均P＞0.05),术后1h、2周,2个组眼压比较差异均无统计学意义(均P＞0.05).术后1h、术后2周圆形切开组患者眼前黑影飘动的发生率分别为39.1％和30.4％,均高于同时间点十字形切开组的6.7％和6.7％,但差异均无统计学意义(P=0.065、0.177).2个组OSI、MTF、SR、OV100％、OV20％、OV9％比较差异均无统计学意义(均P＞0.05).结论 与圆形切开后囊膜推瓣法相比,Nd∶YAG激光后囊膜切开术后十字形切开术后患者眼前黑影飘动的发生率相对较低,但2种切开方式对术后患者视力、眼压、眼内散射及视觉质量参数的影响均无明显差异.

abstractsObjective To evaluate and compare the subjective and objective visual quality of YAG laser posterior capsulotomy.Methods A series of case observation study was designed.Twenty-eight patients (38 eyes)underwent Nd:YAG laser posterior capsulotomy in the Eye Hospital of Wenzhou Medical University were retrospectively collected from 2015 to 2016.Patients were divided into circular capsulotomy group (20 patients 23 eyes) and cruciate capsulotomy group (12 patients 15 eyes) based on the capsulotomy technique (round incision of posterior capsule or cross incision of posterior capsule).The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were examined before and 2 weeks after operation,the intraocular pressure was also measured before operation,1 hour after operation and 2 weeks after operation.The Strehl ratio (SR),modulation transfer function (MTF) cut-off,objective scatter index (OSI),OQAS values (OVs) were analyzed by Two-channel visual quality analysis system OQAS Ⅱ at 1 h and 2 weeks after operation.The changes of intraocular scattering and visual quality at 1 h and 2 weeks after operation with different posterior capsulotomy methods were compared and analyzed.Results At 2 weeks after operation,the UCVA was 0.18±0.15 and 0.16±0.14,and the BCVA was 0.10±0.10 and 0.10±0.11,respectively in the circular capsulotomy group and cruciate capsulotomy group,which was higher than those before operation (all at P＜0.05),but there was no significant difference in UCVA and BCVA between the two groups (all at P＞0.05).There was no significant difference in intraocular pressure between the two groups at 1 hour and 2 weeks after operation (both at P＞0.05).In the circular capsulotomy group,the incidence of black shadow drift was 39.1％ and 30.4％ respectively at 1 hour and 2 weeks after operation,which was higher than that in the cruciate capsulotomy group (6.7％ and 6.7 ％),with no significant differences between the two groups (P =0.065,0.177).No significant difference were found in the incidence of black shadow drift before eyes between the two groups (P＞0.05),and there was no significant differences in the OQAS parameters OSI,MTF,SR,OV100％,OV20％ and OV9％ between the two groups (all at P＞0.05).Conclusions After Nd:YAG laser capsulotomy,the incidence of black shadow drift in the cruciate capsulotomy group is lower than that in the circular capsulotomy group.There is no significant difference in the visual acuity,intraocular pressure,intraocular scattering and visual quality parameters between circular posterior capsulotomy and cross posterior capsulotomy.