Center for Research on Ocular Therapeutic and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina.
Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
Ophthalmology. 2020 Apr;127(4S):S29-S42. doi: 10.1016/j.ophtha.2020.01.026.
(1) To report the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy rate (%) of eight rigid and foldable intraocular lens (IOL) designs in a series of 5416 pseudophakic human eyes obtained postmortem, accessioned in our center between January 1988 and January 2000. (2) To identify factors that are instrumental in reducing the incidence of posterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy.
Comparative autopsy tissue analysis.
A total of 5416 globes with posterior chamber intraocular lens (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000.
Miyake-Apple posterior photographic technique. Special reference was given to the presence or absence of Nd:YAG laser posterior capsulotomy orifice on the posterior capsule of each eye.
The Nd:YAG laser posterior capsulotomy rate (%) as of January 2000 was documented. In addition, the Nd:YAG laser posterior capsulotomy rate for each lens was plotted on a monthly basis for the same period, creating a computerized trend or "timeline" for each IOL style.
Relatively high Nd:YAG laser posterior capsulotomy rates ranging from 20.3% to 33.4% were noted with four relatively older designs (high incidence of implantation between 1988 and the early 1990s). Four modern foldable lOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acrysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant (P < 0.0001, chi-square test). Comparing foldable versus rigid designs, the foldable IOLs were associated with a much lower Nd:YAG laser posterior capsulotomy rate (14.1% vs. 31.1%).
By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons can genuinely lead in the direction of virtual eradication of secondary cataract, the second most common cause of visual loss worldwide.
(1)报告在我们中心于 1988 年 1 月至 2000 年 1 月期间获得的 5416 例死后人类眼球系列中，8 种刚性和折叠式人工晶状体（IOL）设计的钕：钇铝石榴石（Nd：YAG）激光后囊切开率（%）。(2)确定有助于降低后囊混浊（PCO，继发性白内障）发生率的因素，从而降低 Nd：YAG 激光后囊切开术的必要性。
比较尸体组织分析。
1988 年至 2000 年期间，从狮子眼库获得的共 5416 个具有后房人工晶状体（PC-IOL）的眼球。
Miyake-Apple 后摄影技术。特别注意每只眼睛后囊上是否存在 Nd：YAG 激光后囊切开孔。
截至 2000 年 1 月 Nd：YAG 激光后囊切开术的发生率（%）。此外，为每个晶状体绘制了同一时期的每月 Nd：YAG 激光后囊切开术率，为每个 IOL 样式创建了一个计算机化的趋势或“时间线”。
与四个相对较老的设计（1988 年至 90 年代早期植入率较高）相比，四个相对较新的折叠式 IOL 设计（硅酮和丙烯酸材料制造）的 Nd：YAG 激光后囊切开术率较高，范围为 20.3%至 33.4%。四个现代折叠式 IOL 的 Nd：YAG 激光后囊切开术率从 0.9%（Alcon Acrysof）到 17.1%显著降低。8 种 IOL 设计之间的 Nd：YAG 率差异具有统计学意义（P<0.0001，卡方检验）。与刚性设计相比，折叠式 IOL 与较低的 Nd：YAG 激光后囊切开术率相关（14.1% vs. 31.1%）。
通过使用本文中描述的关于手术技术和 IOL 选择的六个因素，我们坚信，PCO 的总体发生率，因此 Nd：YAG 激光后囊切开术的发生率，现在正在从 80 年代和 90 年代早期的高达 50%迅速下降。现在有手术工具和 IOL 可将这些比率降低到个位数。外科医生谨慎地应用和使用这些工具确实可以真正朝着消除继发性白内障（全球第二大常见视力丧失原因）的方向发展。
