Department of Ophthalmology, Ünye State Hospital, Ordu, Turkey,
Graefes Arch Clin Exp Ophthalmol. 2014 Jan;252(1):71-5. doi: 10.1007/s00417-013-2526-x. Epub 2013 Nov 21.
This study evaluated anterior hyaloid damage (AHD), AHD-related Nd:YAG laser parameters, and retinal complications in subjects that underwent Nd:YAG laser posterior capsulotomy for cataracts.
In this prospective, cross-sectional study, 277 pseudophakic eyes of 216 patients treated with Nd:YAG laser capsulotomy for posterior capsule opacification were enrolled. Pulse number, pulse energy, and total energy were noted for each eye. All procedures were performed with a sense of anterior hyaloid protection. Anterior hyaloid faces were assessed during procedure and 1 day after the procedure. Eyes with biomicroscopically invisible anterior hyaloid face were excluded from statistical analysis. Eyes with and without AHD were compared according to Nd:YAG laser parameters. Retinal complications were evaluated at day 1, week 1, month 1, and month 3.
In 22 eyes (7.9 % of 277 eyes), the anterior hyaloid face couldn't be assessed biomicroscopically. Anterior hyaloid damage was observed in 49 eyes (19.2 % of 255 eyes). The pulse number, pulse energy, and total energy were observed to be higher in eyes with AHD (P < .001, P = .024, P < .001, respectively). Cystoid macular edema was detected in five eyes (three with AHD) at 1-week examination. Localized retinal detachment occurred in one eye with AHD. Occurrence of retinal complication in the AHD(+) group was 12.7 times higher than in the AHD(-) group, adjusted for total energy used (P < 0.001).
The risk of AHD may increase with high pulse number, pulse energy, and total energy. Anterior hyaloid face integrity should be considered for YAG laser-related retinal complications.
本研究评估了行 Nd:YAG 激光后囊切开术治疗白内障患者的前玻璃体膜损伤（AHD）、AHD 相关 Nd:YAG 激光参数和视网膜并发症。
在这项前瞻性、横断面研究中，纳入了 216 例 277 只接受 Nd:YAG 激光后囊切开术治疗后囊混浊的白内障患者。记录每只眼的脉冲数、脉冲能量和总能量。所有操作均在保护前玻璃体膜的意识下进行。在手术过程中和术后 1 天评估前玻璃体膜表面。在生物显微镜下无法评估前玻璃体膜表面的眼睛被排除在统计分析之外。根据 Nd:YAG 激光参数比较有和无前玻璃体膜损伤的眼睛。术后 1 天、1 周、1 个月和 3 个月评估视网膜并发症。
在 22 只眼（277 只眼中的 7.9%）中，无法在生物显微镜下评估前玻璃体膜表面。在 49 只眼中（255 只眼中的 19.2%）观察到前玻璃体膜损伤。有 AHD 的眼睛的脉冲数、脉冲能量和总能量较高（P<0.001、P=0.024、P<0.001）。在 5 只眼中（3 只眼有 AHD）的 1 周检查时发现了囊样黄斑水肿。1 只眼有 AHD 发生局限性视网膜脱离。考虑到使用的总能量，AHD（+）组视网膜并发症的发生率是 AHD（-）组的 12.7 倍，差异有统计学意义（P<0.001）。
AHD 的风险可能随高脉冲数、脉冲能量和总能量增加而增加。在与 YAG 激光相关的视网膜并发症中，应考虑前玻璃体膜完整性。
