發(fā)布時間：2018-03-25 06:14

  本文選題：YAG激光　切入點：后發(fā)性白內(nèi)障　出處：《山東大學》2014年碩士論文

【摘要】：[背景及目的]后發(fā)性白內(nèi)障是白內(nèi)障摘除術(shù)后引起患者視力再次下降的最常見原因,同時也是白內(nèi)障術(shù)后最常見的并發(fā)癥。術(shù)后晶狀體囊殘留的晶狀體上皮細胞的增殖、遷移、纖維化生是形成后發(fā)性白內(nèi)障的主要原因。隨著現(xiàn)代白內(nèi)障囊外摘除術(shù)的普及和超聲乳化術(shù)的開展,這種并發(fā)癥的發(fā)生越來越常見。成年人后發(fā)性白內(nèi)障的發(fā)生率約為10%-40%,兒童幾乎高達100%。目前臨床上主要采用手術(shù)及Nd:YAG激光治療后發(fā)性白內(nèi)障,而后者被廣泛應用。Nd:YAG激光后囊膜切開術(shù)是目前國內(nèi)外治療后發(fā)性白內(nèi)障安全而有效的方法。Nd:YAG激光治療后發(fā)性白內(nèi)障操作簡單,可在門診開展。Nd:YAG激光治療后發(fā)性白內(nèi)障術(shù)后視力提高明顯,并發(fā)癥少。Nd:YAG激光術(shù)后最主要的并發(fā)癥是一過性眼壓升高和人工晶體損傷。Nd:YAG激光治療后囊混濁的原理是等離子體效應,等離子體的微小爆破可形成沖擊波,其以聲波形式擴散可導致靶組織破解碎裂,擊穿后囊膜等組織。等離子體的這種爆破其形成的沖擊波的作用范圍為球面,所以,在應用激光治療眼部病變時應充分考慮到激光對靶組織以外的組織的影響,如對角膜內(nèi)皮細胞等。本研究的目的在于探討Nd:YAG激光治療后發(fā)性白內(nèi)障對角膜內(nèi)皮影響的情況。 [方法]本研究為回顧性研究,病例均選自山東大學附屬濟南市中心醫(yī)院,分為兩組,實驗組：對32例(32眼)后發(fā)性白內(nèi)障患者行YAG激光后囊切開術(shù),激光瞄準光準確聚焦于后囊膜表面,激光能量應從最小能量開始,環(huán)形切開后囊膜,切開直徑約為4.5mm。全部患者后囊膜均成功切開,未出現(xiàn)并發(fā)癥。激光后定期復查,分別于術(shù)前0.5h、術(shù)后1d、1周、1個月與3個月測定術(shù)眼角膜內(nèi)皮細胞密度及六邊形細胞比例；同時選取32例、32眼(Phaco+IOL后,后囊混濁未行YAG激光后囊切開術(shù))作為對照組。記錄并分析兩組內(nèi)皮細胞變化趨勢。 [結(jié)果]兩組隨訪期內(nèi)角膜內(nèi)皮細胞密度變化差異無統(tǒng)計學意義,但六邊形細胞的比例下降程度實驗組大于對照組。 [結(jié)論]一定能量范圍的YAG激光對角膜內(nèi)皮細胞的密度無明顯影響,而對內(nèi)皮細胞的正常形態(tài)產(chǎn)生影響。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R779.6

【參考文獻】

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本文編號：1661890