Hutcheson K A, Drack A V, Ellish N J, Lambert S R
Department of Ophthalmology, University of Maryland School of Medicine, Baltimore MD 21201, USA.
J AAPOS. 1999 Oct;3(5):303-7. doi: 10.1016/s1091-8531(99)70027-3.
The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population.
A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure.
Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment.
In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.
本研究旨在探讨小儿白内障摘除及一期人工晶状体植入术后钕:钇铝石榴石激光晶状体后囊切开术后视轴的清晰度。
对5年内所有白内障摘除及一期人工晶状体植入病例进行回顾性研究。一组接受一期手术性后囊切开及前部玻璃体切除术治疗的儿童（第1组）作为“金标准”，与接受钕:钇铝石榴石激光晶状体后囊切开术治疗的儿童（第2组）进行比较。研究两组在一期手术后视轴浑浊的发生率。
回顾了78只眼的数据，56只眼符合纳入标准。其中，33只眼接受一期后囊切开及前部玻璃体切除术治疗（第1组），23只眼接受钕:钇铝石榴石激光晶状体后囊切开术治疗（第2组）。第1组有1只眼（3%）术后视轴再次浑浊。第2组23只眼中有13只眼（57%）出现再次浑浊，需要再次治疗。4只接受钕:钇铝石榴石激光治疗的眼（17%）需要第三次治疗。
在我们的系列研究中，57%接受钕:钇铝石榴石激光晶状体后囊切开术治疗的患者在前部玻璃体前表面出现再次浑浊。白内障摘除时切除前部玻璃体，可去除细胞迁移的支架，视轴再次浑浊少见。对于无法进行裂隙灯晶状体后囊切开术的患者，尤其是手术室没有钕:钇铝石榴石激光可用或可能出现失访问题时，应强烈考虑一期后囊切开及前部玻璃体切除术。
