Nd:YAG激光治疗后发性白内障对角膜内皮影响的研究

发布时间：2018-03-25 06:14

本文选题：YAG激光　切入点：后发性白内障　出处：《山东大学》2014年硕士论文

【摘要】：[背景及目的]后发性白内障是白内障摘除术后引起患者视力再次下降的最常见原因,同时也是白内障术后最常见的并发症。术后晶状体囊残留的晶状体上皮细胞的增殖、迁移、纤维化生是形成后发性白内障的主要原因。随着现代白内障囊外摘除术的普及和超声乳化术的开展,这种并发症的发生越来越常见。成年人后发性白内障的发生率约为10%-40%,儿童几乎高达100%。目前临床上主要采用手术及Nd:YAG激光治疗后发性白内障,而后者被广泛应用。Nd:YAG激光后囊膜切开术是目前国内外治疗后发性白内障安全而有效的方法。Nd:YAG激光治疗后发性白内障操作简单,可在门诊开展。Nd:YAG激光治疗后发性白内障术后视力提高明显,并发症少。Nd:YAG激光术后最主要的并发症是一过性眼压升高和人工晶体损伤。Nd:YAG激光治疗后囊混浊的原理是等离子体效应,等离子体的微小爆破可形成冲击波,其以声波形式扩散可导致靶组织破解碎裂,击穿后囊膜等组织。等离子体的这种爆破其形成的冲击波的作用范围为球面,所以,在应用激光治疗眼部病变时应充分考虑到激光对靶组织以外的组织的影响,如对角膜内皮细胞等。本研究的目的在于探讨Nd:YAG激光治疗后发性白内障对角膜内皮影响的情况。 [方法]本研究为回顾性研究,病例均选自山东大学附属济南市中心医院,分为两组,实验组：对32例(32眼)后发性白内障患者行YAG激光后囊切开术,激光瞄准光准确聚焦于后囊膜表面,激光能量应从最小能量开始,环形切开后囊膜,切开直径约为4.5mm。全部患者后囊膜均成功切开,未出现并发症。激光后定期复查,分别于术前0.5h、术后1d、1周、1个月与3个月测定术眼角膜内皮细胞密度及六边形细胞比例；同时选取32例、32眼(Phaco+IOL后,后囊混浊未行YAG激光后囊切开术)作为对照组。记录并分析两组内皮细胞变化趋势。 [结果]两组随访期内角膜内皮细胞密度变化差异无统计学意义,但六边形细胞的比例下降程度实验组大于对照组。 [结论]一定能量范围的YAG激光对角膜内皮细胞的密度无明显影响,而对内皮细胞的正常形态产生影响。
[Abstract]:[background and objective] posterior cataract is the most common cause of vision loss after cataract extraction, and the most common complication after cataract surgery. Migration and fibrosis are the main causes of post-cataract. With the popularization of modern extracapsular cataract extraction and phacoemulsification, This complication is becoming more and more common. The incidence of adult posterior cataract is about 10 to 40 percent, and that of children is almost 100. At present, surgery and Nd:YAG laser are mainly used in the treatment of post-cataract. However, the latter is widely used. ND: YAG laser posterior capsulectomy is a safe and effective method for the treatment of post-cataract at home and abroad. ND: YAG laser is a simple procedure for the treatment of post-cataract. The visual acuity can be significantly improved after the treatment of post-cataract with. ND: YAG laser. The most important complications after. ND: YAG laser surgery are transient intraocular pressure elevation and intraocular lens injury. The principle of treating capsular opacification after ND: YAG laser treatment is plasma effect. The tiny blasting of a plasma can form a shock wave, and its diffusion in the form of sound waves can cause the target tissue to crack and break through the posterior capsule and other tissues. The effect of laser on the corneal endothelium, such as corneal endothelial cells, should be taken into account in the treatment of ocular lesions by laser. The purpose of this study was to investigate the effect of Nd:YAG laser on corneal endothelium after cataract treatment. [methods] this study was a retrospective study. All the patients were selected from Jinan Central Hospital affiliated to Shandong University and divided into two groups: the experimental group: 32 cases (32 eyes) with posterior cataract were treated with YAG laser posterior capsulectomy. The laser aiming light should focus on the surface of the posterior capsule accurately. The laser energy should start from the minimum energy, the posterior capsule should be cut in a circular way, and the diameter of the incision should be about 4.5 mm. all the patients had successfully incision of the posterior capsule without complications. The density of corneal endothelial cells and the ratio of hexagonal cells were measured at 0.5 h before operation, 1 week, 1 month and 3 months after operation, and 32 eyes of 32 eyes were treated with Phaco IOL. The posterior capsule opacification was not performed by YAG laser posterior capsulectomy) as control group. The changes of endothelial cells in both groups were recorded and analyzed. [results] there was no significant difference in the density of corneal endothelial cells between the two groups during the follow-up period, but the percentage of hexagonal cells in the experimental group was higher than that in the control group. [conclusion] YAG laser has no effect on the density of corneal endothelial cells, but on the normal morphology of corneal endothelial cells.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R779.6

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