【摘要】 目的：探讨白内障术后继发的后囊膜混浊（posterior capsule opacification，PCO）对患者视功能的影响及YAG激光治疗前后视功能的变化。方法：对57例（59眼）的患者于激光治疗前后进行视力检查，并主觉验光矫正视力；采用对比敏感度检测卡分别测试患眼和对侧眼的对比敏感度曲线；采用颜氏《立体视觉检查图》和Titmus立体视觉检查图检测患者的近距立体视锐度；采用王克长《色觉检查图》检测患者的色觉辨认功能。采用SPSS 12.0统计软件进行统计分析比较。结果：激光治疗前患眼的平均视力为0.56±0.25，治疗后患眼平均视力为0.86±0.21。采取最小角度对数视力统计比较患眼治疗前LogMAR视力0.3103，较对侧眼LogMAR视力0.0707低下，差异有极显著性（t=7.63， P=0.000）；治疗后患眼LogMAR视力0.0811较治疗前提高差异有显著性（t=7.076，P=0.000）。治疗前患眼各频区的对比敏感度值均较对侧眼显著低下，治疗后敏感度值明显提升较治疗前差异有非常显著性。治疗前44眼（75%)出现色觉异常，仅15眼（25%)辨色完全正常；治疗后31眼（53%）辨色完全正常，治疗前后的辨色能力差异有显著性。采用颜少明《立体视觉检查图》和Titmus立体视觉检查图检测显示，治疗前立体视缺失者分别为39例（68%）和19例（33%），具有正常立体视锐度者分别为3例（5%）和6例（11%）；治疗后立体视缺失者降至11例（19%）和2例（4%），具有正常立体视锐度者达到22例（39%）和36例（63%），立体视的改善较之前差异有显著性。结论：白内障术后的后囊膜混浊不仅影响患眼的最佳矫正视力，还影响其对比敏感度值和色觉辨认，并可损伤患者的立体视功能。YAG激光后囊膜切开术是治疗PCO，恢复患者多项视功能的有效手段。
【关键词】 白内障术后继发后囊膜混浊；激光治疗；视功能
Clinical effect for visual function of postphacoemulcification patients before and after Nd∶YAG laser posterior capsulotomy
Guang Lu, Qun Xia, Yan Gao
Department of Ophthalmology, Beijing Hospital, Beijing 100730, China
AbstractAIM: To investigate the influence of the development of secondary posterior capsule opacification (PCO) postphacoemulcification on visual function, and to evaluate the improvement of visual function after treated by postNd∶YAG laser posterior capsulotomy.METHODS: Fiftyseven patients (59 eyes) who had postoperative PCO with Nd∶YAG laser posterior capsulotomy were followed. Pre and postlaser evaluation included best corrected visual acuity (BCVA), objective refraction, FACT contrast sensitivity, near stereoscopic vision with Yan Shaoming stereoscopic chart and Titmus stereoscopic chart, color vision with Wang Kechang color vision chart.All data were analyzed with SPSS 12.0 software. RESULTS: The average prelaser visual acuity were 0.56±0.25 and the postlaser visual acuity were 0.86±0.21. The prelaser LogMAR was 0.3103 and postlaser was 0.0811. There were significant differences with LogMAR (t=7.076, P=0.000). The contrast sensitivity for spatial frequencies of postlaser was significantly improved. The number of eyes with normal color vision increased from 15 eyes (25%) to 31 eyes (53%) after laser therapy in all 44 eyes with abnormal color vision. The results from Yan Shaoming stereoscopic chart and Titmus stereoscopic chart showed that patients without stereoscopic vision were 39 cases(68%) and 19 cases (33%) before treatment and after treatment, 3 cases (5%) and 6 cases (11%) reobtained it. The postlaser central stereo function improved from 11 cases (19%), 2 cases (4%) to 22 patients(39%), 36 patients(63%) with significant differences.CONCLUSION: PCO affects not only BCVA, but also contrasts sensitivity, color vision and stereo function. Nd∶YAG laser posterior capsulotomy is a valuable clinical method for PCO to improve the visual functions.
KEYWORDS:cataract surgery/posterior capsule opacification; laser therapy; visual function
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