后发性白内障对视功能的影响
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摘要
目的探讨后发性白内障(posterior capsular opacification,PCO)对视功能的影响,比较不同程度不同类型的PCO引起的最佳矫正视力(best correct distant visualacuity,BCDVA)、对比敏感度(contrast sensitivity function,CS)、眩光敏感度(glare sensitivity,GS)的改变。寻求临床量化PCO准确实用的诊断标准,探讨Nd:YAG激光晶状体囊膜切开术的手术时机。
方法老年性白内障行超声乳化白内障吸除合并人工晶体植入术后患者151例(190眼),40眼无PCO,150眼有各种程度PCO,其中Nd:YAG激光囊膜切开术治疗的患者58例(67眼)。所有患者检查裂隙灯、眼底、眼压、BCDVA、CS、GS;PCO的150眼散瞳至瞳孔直径达6mm以上拍摄晶状体后囊膜裂隙灯直接照明和后部发射照明数码照片。Nd:YAG激光囊膜切开术治疗的67眼,于治疗后一周复查裂隙灯、眼底、眼压、BCDVA、CS、GS。
标准对数视力表检查BCDVA,为便于统计结果转换成LOGMAR记录。
CGT-1000(contrast glare tester,CGT-1000 Takagi Seiko,日本)检查对比敏感度阈值、眩光敏感度阈值,阈值取倒数即为CS、GS,统计时取LOG计算。
TOPCON SL-8Z裂隙灯连接的SONY DXC-990D 3CCD彩色数码照相机和IMAGEnet 2000软件观察、拍摄、选择、存储晶体后囊膜直接照明和后部反射照明照片。
根据裂隙灯、眼底检查按Odrich法对PCO主观分级,并使用EPCO软件(Evaluation of Posterior Capsule Opacification,EPCO;海德堡大学德国)分析后部反射照明数码照片,半客观量化PCO程度。选择23眼,有两张不同角度拍摄的高度清晰的后部反射照明数码照片,由OSCA软件(objective system capsuleanalysis,OSCA;爱丁堡大学英国)分析,完全客观的量化PCO程度。
ZEISS VISULAS YAGⅡ激光机行Nd:YAG激光囊膜切开术,随机选择3mm或4mm切开直径。
1后囊膜混浊测量方法比较:
比较主观临床分级、半客观EPCO值、完全客观OSCA值与BCDVA、CS、GS的关系,并比较EPCO值在不同检查者间的差异。
2后囊膜混浊与BCDVA、CS及GS下降的关系:
分别比较不同程度不同类型的PCO对BCDVA、CS及GS的影响。
3 Nd:YAG激光治疗前后视功能的改变:
不同程度PCO在Nd:YAG激光治疗前后BCDVA、CS、GS的改变,并比较3mm和4mm不同切开直径患者治疗后的BCDVA、CS及GS。
结果
1后囊膜混浊测量方法比较:
1.1 23眼PCO EPCO值、OSCA值和临床分级比较,EPCO与OSCA相关性佳(r=0.508,P＜0.05),EPCO与临床分级、log MAR相关性(r=0.711、r=0.669,P＜0.01)高于OSCA(r=0.415、r=0.512,P＜0.05)。LOGCS、LOGGS(除高频区0.7°视角)与EPCO值的相关性最明显(P＜0.01),高于临床分级、OSCA值(P＜0.05)。
1.2 30张后部反射照明数码照片,轻、中、重各10张,3位检查者之间的PCO面积相关性明显(r分别为0.864、0.878、0.832,P＜.001);检查者之间EPCO值的相关性更加明显(r分别为0.977、0.977、0.965,P＜.001)。
2后囊膜混浊与BCDVA、CS及GS下降的关系:
无PCO的40眼作为对照组,不同程度PCO的150眼按Odrich法分1级:轻度62眼,2级:中度66眼,3级:重度22眼。
2.1轻度PCO按形态分云雾状(6眼)、纤维状(21眼)、薄层状(35眼),只有薄层状PCO组视力下降,术后发生时间较迟(P＜0.01)。云雾状、薄层状组在高频区CS,纤维状组在中频区GS下降,差异明显(P＜0.05)。
2.2中度PCO按形态分纤维状(6眼)、厚层状(27眼)、珍珠状(26眼),各组间CS、GS有明显差异。珍珠状组各频区CS、GS均低于纤维状组,差异明显(P＜0.05);厚层状界于两组间,与珍珠状组无明显差异。
2.3不同类型PCO的EPCO值与CS、GS关系:
珍珠状PCO对CS、GS曲线影响最大,EPCO值与CS、GS呈明显负相关,中频区(2.5°视角)最明显,对GS的影响更大于CS(r=-0.676、-0.632,p＜0.01)。回归方程为loggs2.5°=2.04—0.60 epco、loges2.5°=1.94—0.48epco
层状EPCO值与CS、GS(除高频区)也呈明显负相关,低中频(4.0°视角)相关性最大(r分别为-0.453、-0.473,p＜0.01)。
纤维状、云雾状PCO的EPCO值与各频区CS、GS无明显相关性。
3 Nd:YAG激光治疗前后视功能的改变:
Nd:YAG激光晶体囊膜切开术治疗PCO 58例(67H艮)
3.1按EPCO值分四组EPCO＜1、1≤EPCO＜2、2≤EPCO＜3、EPCO≥3。各组间后囊膜切开前EPCO、LOGMAR、各频区CS、GS(除0.7°视角)有显著差别(p＜0.01),切开后无差别。
各组内后囊膜切开前、后比较,EPCO＜1组后囊膜切开前、后无差别,其他三组LOGMAR均降低(p＜0.01),1≤EPCO＜2组除高频区(p＜0.05)、2≤EPCO＜3组全频区、EPCO≥3组除高频区(p＜0.01)CS、GS都提高,差异明显。
3.2 Nd:YAG激光囊膜切开随机分3mm、4mm切开直径两组,分别为24眼、43眼,后囊膜切开后的LOGMAR、CS、GS无差异;与对照组比较LOGMAR无差异,中低频区CS(p＜0.05)、各频区GS(除0.7°视角)降低(p＜0.01)。
结论
1 EPCO是准确实用的PCO评估方法与完全客观的OSCA相关性明显,比后者与临床分级、视功能的相关性更高;而且EPCO评估方法简便,检查者之间的个体差异轻微,可重复性佳。
2 CS、GS比视力更早更敏感的反映视功能。轻度的PCO只有薄层状视力下降,云雾状、纤维状视力正常,但CS、GS已有下降。
珍珠状PCO对CS、GS的影响最大,中频区最明显;其次为层状,低、中频区明显;纤维状、云雾状影响较小。
3 EPCO值可作为Nd:YAG激光晶体囊膜切开术的时机选择的指标,轻度PCO如EPCO＜1不宜治疗,EPCO≥1进行治疗能取得较好作用。
选择3mm或4mm后囊膜切开直径对视功能的改善无明显差异。但后囊膜周边的混浊对视功能存在影响,尤其是引起GS降低。
PURPOSE:
To investigate the correlation between visual acuity,contrast sensitivity,glare sensitivity,and the degree of posterior capsule opacification(PCO)in different morphology.Ascertain accurate and practical quantification system of PCO assessment and to be able to predict outcomes following Nd:YAG laser capsulotomy.
METHODS:
One hundred and ninety pseudophakic eyes of 151 patients were recruited in this study,40 eyes without PCO as control,150 eyes with PCO of varying intensity and morphologic.The eyes were examined with a slit-lamp and direct ophthalmoscope. Intraocular pressure,visual acuity,contrast sensitivity and glare sensitivity were measured,Reflected-light and retroillumination digital images of the PCO was acquired after mydriasis.Sixty-seven eyes of 58 patients were re-examined 1 week after Nd:YAG laser capsulotomy.
As main outcome measures,best corrected distant visual acuity was examined using logarithmic charts and and converted to a logarithm of minimal angle of resolution(log MAR)scale.Contrast thresholds with or without glare were measured using contrast glare tester(CGT-1000;Takagi Seiko,Japan).Contrast sensitivity as well as glare sensitivity was calculated as inverse value of the contrast threshold.
Reflected-light and retroillumination digital images of the PCO were taken using a SONY DXC-990D 3CCD colour digital camera system based on TOPCON SL-8Z slit-lamp and saving into IMAGEnet 2000 software
PCO was grade according Odrich's method based on slit-lamp and direct ophthalmoscopic evaluation,density value was measured using Evaluation of Posterior Capsule Opacification(EPCO,M.R.Tetz,Ch.Nimsgern,Humboldt-niversity, Germany)and 23 eyes using Objective System Capsule Analysis(OSCA,T.M.Aslam Edinburgh-University,UK)with retroillumination digital images.
After full mydriasis,67 eyes underwent Nd:YAG laser posterior capsulotomy with a Q-switched ZEISS VISULAS YAGⅡlaser.An approximately 3-mm or 4-mm diameter area of the central posterior capsule was then cleared by emitting laser energy on the capsule.
1.Comparison of 3 methods for analysis of posterior capsule opacification:
To compare the results of PCO severity and correlation between the measurement of PCO severity and visual function testing in 23 eyes.
2.The effect of Posterior Capsule Opacification on visual function:
Compare the correlation between visual acuity,contrast sensitivity,glare sensitivity,and the degree of posterior capsule opacification(PCO)in different morphologic.
3.The improvement in visual function after Nd:YAG laser posterior capsulotomy:
Compare the improvement in visual function before and after Nd:YAG laser posterior capsulotomy in different extents and the influence of two different diameter of posterior capsulotomy:
RESULTS:
1 Comparison of 3 methods for analysis of posterior capsule opacification:
1.1 To compare the EPCO scores,OSCA scores and clinical PCO severity,EPCO scores and OSCA score showed a significant correlation(r=0.508,P＜0.05),and EPCO scores showed a better correlation with clinical PCO severity and IogMAR (r=0.711、r=0.669,P＜0.01)than OSCA score(r=0.415、r=0.512,P＜0.05),also logCS、logGS showed a best orrelation with EPCO scores.
1.2 Correlation between the EPCO area and total scores measured by 3 independent observers using a library of 30 retroillumination images ranging from clear posterior capsules to very severe PCO.Correlations between EPCO area of 3 clinicians are significant(r=0.864,0.878,0.832 P＜.001),between EPCO scores are more significant (r=0.977,0.977,0.965 P＜.001).
2 The effect of Posterior Capsule Opacification on visual function:
2.1 Mild PCO is classified into 3 morphologys as clouding(or trace)6 eyes,fibrosis 21 eyes,thin layer 35 eyes.The visual acuity impaired in patients with thin layer and preserved in the others,but it is impaired in high frequency contrast sensitivity of clouding and intermediate frequency glare sensitivity of fibrosis.
2.2 Moderate PCO is classified into 3 morphologys as fibrosis 6 eyes,thick layer 27 eyes,pearl 26 eyes.No difference on visual acuity each other,but it is significant different on contrast sensitivity and glare sensitivity.Patients with pearl-type PCO had lower contrast sensitivity and glare sensitivity than those with fibrosis-type PCO, thick layer was in the middle of the two types and approach to pearl-type.
2.3 A strong correlation existed between the EPCO scores and visual function with pearl-type PCO,logcs2.5°= 1.94—0.48epco(r:0.-632、p＜0.01)loggs2.5°= 2.04—0.60 epco(r:-0.676、p＜0.01),a weak and significant correlation with layer-type PCO,no significant correlation with clouding and fibrosis types.
3 The improvement in visual function after Nd:YAG laser posterior capsulotomy
3.1 Classified 67 eyes underwent Nd:YAG laser posterior capsulotomy into 4 groups according EPCO scores,EPCO＜1,1≤EPCO＜2,2＜EPCO＜3,EPCO≥3.There is no difference on visual function between groups after Nd:YAG laser posterior capsulotomy.No improvement on visual function after capsulotomy in group EPCO＜1,but significant improvement in the other 3groups.
3.2 Nd:YAG laser posterior capsulotomy in different diameter of capsulotomy 3-mm 24 eyes and 4-mm 43 eyes,no difference on visual function between groups after capsulotomy,but compared to no PCO patients,it was impaired at low to intermediate frequencies contrast sensitivity and all spatial frequencies glare sensitivity.
CONCLUSION:
1 EPCO is a accurate and practical quantification system of PCO assessment,it is good correlation with completely objective OSCA,and showed a better correlation with clinical PCO severity and visual function.It was successfully used to calculate the severity of PCO.And the assessment is simple,the individual difference of the Examiner is slight and reproductive well.
2 Contrast sensitivity and glare sensitivity has a strong association with PCO than does visual acuity and therefor should be considered to reflect most accurately the degree of PCO.
The effect of PCO on visual function is different in varing morphology.Pearl -type PCO impaired visual function severely,clouding and fibrosis types PCO effect slight,thick layer-type PCO approach to pearl-type.
3 The EPCO will be able to predict outcomes following Nd:YAG laser capsulotomy.If EPCO＜1,the patient is not proper to be treatment,and EPCO≥1 the patient underwent capsulotomy can improve visual function significant.
No significant difference in 3mm or 4mm diameter capsulotomy on visual function.But the opacification at periphery of posterior capsule considered impaired contrast sensitivity and glare sensitivity particularly.
方法老年性白内障行超声乳化白内障吸除合并人工晶体植入术后患者151例(190眼),40眼无PCO,150眼有各种程度PCO,其中Nd:YAG激光囊膜切开术治疗的患者58例(67眼)。所有患者检查裂隙灯、眼底、眼压、BCDVA、CS、GS;PCO的150眼散瞳至瞳孔直径达6mm以上拍摄晶状体后囊膜裂隙灯直接照明和后部发射照明数码照片。Nd:YAG激光囊膜切开术治疗的67眼,于治疗后一周复查裂隙灯、眼底、眼压、BCDVA、CS、GS。
标准对数视力表检查BCDVA,为便于统计结果转换成LOGMAR记录。
CGT-1000(contrast glare tester,CGT-1000 Takagi Seiko,日本)检查对比敏感度阈值、眩光敏感度阈值,阈值取倒数即为CS、GS,统计时取LOG计算。
TOPCON SL-8Z裂隙灯连接的SONY DXC-990D 3CCD彩色数码照相机和IMAGEnet 2000软件观察、拍摄、选择、存储晶体后囊膜直接照明和后部反射照明照片。
根据裂隙灯、眼底检查按Odrich法对PCO主观分级,并使用EPCO软件(Evaluation of Posterior Capsule Opacification,EPCO;海德堡大学德国)分析后部反射照明数码照片,半客观量化PCO程度。选择23眼,有两张不同角度拍摄的高度清晰的后部反射照明数码照片,由OSCA软件(objective system capsuleanalysis,OSCA;爱丁堡大学英国)分析,完全客观的量化PCO程度。
ZEISS VISULAS YAGⅡ激光机行Nd:YAG激光囊膜切开术,随机选择3mm或4mm切开直径。
1后囊膜混浊测量方法比较:
比较主观临床分级、半客观EPCO值、完全客观OSCA值与BCDVA、CS、GS的关系,并比较EPCO值在不同检查者间的差异。
2后囊膜混浊与BCDVA、CS及GS下降的关系:
分别比较不同程度不同类型的PCO对BCDVA、CS及GS的影响。
3 Nd:YAG激光治疗前后视功能的改变:
不同程度PCO在Nd:YAG激光治疗前后BCDVA、CS、GS的改变,并比较3mm和4mm不同切开直径患者治疗后的BCDVA、CS及GS。
结果
1后囊膜混浊测量方法比较:
1.1 23眼PCO EPCO值、OSCA值和临床分级比较,EPCO与OSCA相关性佳(r=0.508,P＜0.05),EPCO与临床分级、log MAR相关性(r=0.711、r=0.669,P＜0.01)高于OSCA(r=0.415、r=0.512,P＜0.05)。LOGCS、LOGGS(除高频区0.7°视角)与EPCO值的相关性最明显(P＜0.01),高于临床分级、OSCA值(P＜0.05)。
1.2 30张后部反射照明数码照片,轻、中、重各10张,3位检查者之间的PCO面积相关性明显(r分别为0.864、0.878、0.832,P＜.001);检查者之间EPCO值的相关性更加明显(r分别为0.977、0.977、0.965,P＜.001)。
2后囊膜混浊与BCDVA、CS及GS下降的关系:
无PCO的40眼作为对照组,不同程度PCO的150眼按Odrich法分1级:轻度62眼,2级:中度66眼,3级:重度22眼。
2.1轻度PCO按形态分云雾状(6眼)、纤维状(21眼)、薄层状(35眼),只有薄层状PCO组视力下降,术后发生时间较迟(P＜0.01)。云雾状、薄层状组在高频区CS,纤维状组在中频区GS下降,差异明显(P＜0.05)。
2.2中度PCO按形态分纤维状(6眼)、厚层状(27眼)、珍珠状(26眼),各组间CS、GS有明显差异。珍珠状组各频区CS、GS均低于纤维状组,差异明显(P＜0.05);厚层状界于两组间,与珍珠状组无明显差异。
2.3不同类型PCO的EPCO值与CS、GS关系:
珍珠状PCO对CS、GS曲线影响最大,EPCO值与CS、GS呈明显负相关,中频区(2.5°视角)最明显,对GS的影响更大于CS(r=-0.676、-0.632,p＜0.01)。回归方程为loggs2.5°=2.04—0.60 epco、loges2.5°=1.94—0.48epco
层状EPCO值与CS、GS(除高频区)也呈明显负相关,低中频(4.0°视角)相关性最大(r分别为-0.453、-0.473,p＜0.01)。
纤维状、云雾状PCO的EPCO值与各频区CS、GS无明显相关性。
3 Nd:YAG激光治疗前后视功能的改变:
Nd:YAG激光晶体囊膜切开术治疗PCO 58例(67H艮)
3.1按EPCO值分四组EPCO＜1、1≤EPCO＜2、2≤EPCO＜3、EPCO≥3。各组间后囊膜切开前EPCO、LOGMAR、各频区CS、GS(除0.7°视角)有显著差别(p＜0.01),切开后无差别。
各组内后囊膜切开前、后比较,EPCO＜1组后囊膜切开前、后无差别,其他三组LOGMAR均降低(p＜0.01),1≤EPCO＜2组除高频区(p＜0.05)、2≤EPCO＜3组全频区、EPCO≥3组除高频区(p＜0.01)CS、GS都提高,差异明显。
3.2 Nd:YAG激光囊膜切开随机分3mm、4mm切开直径两组,分别为24眼、43眼,后囊膜切开后的LOGMAR、CS、GS无差异;与对照组比较LOGMAR无差异,中低频区CS(p＜0.05)、各频区GS(除0.7°视角)降低(p＜0.01)。
结论
1 EPCO是准确实用的PCO评估方法与完全客观的OSCA相关性明显,比后者与临床分级、视功能的相关性更高;而且EPCO评估方法简便,检查者之间的个体差异轻微,可重复性佳。
2 CS、GS比视力更早更敏感的反映视功能。轻度的PCO只有薄层状视力下降,云雾状、纤维状视力正常,但CS、GS已有下降。
珍珠状PCO对CS、GS的影响最大,中频区最明显;其次为层状,低、中频区明显;纤维状、云雾状影响较小。
3 EPCO值可作为Nd:YAG激光晶体囊膜切开术的时机选择的指标,轻度PCO如EPCO＜1不宜治疗,EPCO≥1进行治疗能取得较好作用。
选择3mm或4mm后囊膜切开直径对视功能的改善无明显差异。但后囊膜周边的混浊对视功能存在影响,尤其是引起GS降低。
PURPOSE:
To investigate the correlation between visual acuity,contrast sensitivity,glare sensitivity,and the degree of posterior capsule opacification(PCO)in different morphology.Ascertain accurate and practical quantification system of PCO assessment and to be able to predict outcomes following Nd:YAG laser capsulotomy.
METHODS:
One hundred and ninety pseudophakic eyes of 151 patients were recruited in this study,40 eyes without PCO as control,150 eyes with PCO of varying intensity and morphologic.The eyes were examined with a slit-lamp and direct ophthalmoscope. Intraocular pressure,visual acuity,contrast sensitivity and glare sensitivity were measured,Reflected-light and retroillumination digital images of the PCO was acquired after mydriasis.Sixty-seven eyes of 58 patients were re-examined 1 week after Nd:YAG laser capsulotomy.
As main outcome measures,best corrected distant visual acuity was examined using logarithmic charts and and converted to a logarithm of minimal angle of resolution(log MAR)scale.Contrast thresholds with or without glare were measured using contrast glare tester(CGT-1000;Takagi Seiko,Japan).Contrast sensitivity as well as glare sensitivity was calculated as inverse value of the contrast threshold.
Reflected-light and retroillumination digital images of the PCO were taken using a SONY DXC-990D 3CCD colour digital camera system based on TOPCON SL-8Z slit-lamp and saving into IMAGEnet 2000 software
PCO was grade according Odrich's method based on slit-lamp and direct ophthalmoscopic evaluation,density value was measured using Evaluation of Posterior Capsule Opacification(EPCO,M.R.Tetz,Ch.Nimsgern,Humboldt-niversity, Germany)and 23 eyes using Objective System Capsule Analysis(OSCA,T.M.Aslam Edinburgh-University,UK)with retroillumination digital images.
After full mydriasis,67 eyes underwent Nd:YAG laser posterior capsulotomy with a Q-switched ZEISS VISULAS YAGⅡlaser.An approximately 3-mm or 4-mm diameter area of the central posterior capsule was then cleared by emitting laser energy on the capsule.
1.Comparison of 3 methods for analysis of posterior capsule opacification:
To compare the results of PCO severity and correlation between the measurement of PCO severity and visual function testing in 23 eyes.
2.The effect of Posterior Capsule Opacification on visual function:
Compare the correlation between visual acuity,contrast sensitivity,glare sensitivity,and the degree of posterior capsule opacification(PCO)in different morphologic.
3.The improvement in visual function after Nd:YAG laser posterior capsulotomy:
Compare the improvement in visual function before and after Nd:YAG laser posterior capsulotomy in different extents and the influence of two different diameter of posterior capsulotomy:
RESULTS:
1 Comparison of 3 methods for analysis of posterior capsule opacification:
1.1 To compare the EPCO scores,OSCA scores and clinical PCO severity,EPCO scores and OSCA score showed a significant correlation(r=0.508,P＜0.05),and EPCO scores showed a better correlation with clinical PCO severity and IogMAR (r=0.711、r=0.669,P＜0.01)than OSCA score(r=0.415、r=0.512,P＜0.05),also logCS、logGS showed a best orrelation with EPCO scores.
1.2 Correlation between the EPCO area and total scores measured by 3 independent observers using a library of 30 retroillumination images ranging from clear posterior capsules to very severe PCO.Correlations between EPCO area of 3 clinicians are significant(r=0.864,0.878,0.832 P＜.001),between EPCO scores are more significant (r=0.977,0.977,0.965 P＜.001).
2 The effect of Posterior Capsule Opacification on visual function:
2.1 Mild PCO is classified into 3 morphologys as clouding(or trace)6 eyes,fibrosis 21 eyes,thin layer 35 eyes.The visual acuity impaired in patients with thin layer and preserved in the others,but it is impaired in high frequency contrast sensitivity of clouding and intermediate frequency glare sensitivity of fibrosis.
2.2 Moderate PCO is classified into 3 morphologys as fibrosis 6 eyes,thick layer 27 eyes,pearl 26 eyes.No difference on visual acuity each other,but it is significant different on contrast sensitivity and glare sensitivity.Patients with pearl-type PCO had lower contrast sensitivity and glare sensitivity than those with fibrosis-type PCO, thick layer was in the middle of the two types and approach to pearl-type.
2.3 A strong correlation existed between the EPCO scores and visual function with pearl-type PCO,logcs2.5°= 1.94—0.48epco(r:0.-632、p＜0.01)loggs2.5°= 2.04—0.60 epco(r:-0.676、p＜0.01),a weak and significant correlation with layer-type PCO,no significant correlation with clouding and fibrosis types.
3 The improvement in visual function after Nd:YAG laser posterior capsulotomy
3.1 Classified 67 eyes underwent Nd:YAG laser posterior capsulotomy into 4 groups according EPCO scores,EPCO＜1,1≤EPCO＜2,2＜EPCO＜3,EPCO≥3.There is no difference on visual function between groups after Nd:YAG laser posterior capsulotomy.No improvement on visual function after capsulotomy in group EPCO＜1,but significant improvement in the other 3groups.
3.2 Nd:YAG laser posterior capsulotomy in different diameter of capsulotomy 3-mm 24 eyes and 4-mm 43 eyes,no difference on visual function between groups after capsulotomy,but compared to no PCO patients,it was impaired at low to intermediate frequencies contrast sensitivity and all spatial frequencies glare sensitivity.
CONCLUSION:
1 EPCO is a accurate and practical quantification system of PCO assessment,it is good correlation with completely objective OSCA,and showed a better correlation with clinical PCO severity and visual function.It was successfully used to calculate the severity of PCO.And the assessment is simple,the individual difference of the Examiner is slight and reproductive well.
2 Contrast sensitivity and glare sensitivity has a strong association with PCO than does visual acuity and therefor should be considered to reflect most accurately the degree of PCO.
The effect of PCO on visual function is different in varing morphology.Pearl -type PCO impaired visual function severely,clouding and fibrosis types PCO effect slight,thick layer-type PCO approach to pearl-type.
3 The EPCO will be able to predict outcomes following Nd:YAG laser capsulotomy.If EPCO＜1,the patient is not proper to be treatment,and EPCO≥1 the patient underwent capsulotomy can improve visual function significant.
No significant difference in 3mm or 4mm diameter capsulotomy on visual function.But the opacification at periphery of posterior capsule considered impaired contrast sensitivity and glare sensitivity particularly.
引文
1.葛坚.眼科学 人民卫生出版社 2002:119-129.
2.Pandey SK,Apple D J,Werner L,et al.Posterior Capsule Opacification:A Review of the Aetiopathogenesis,Experimental and Clinical Studies and Factors for Prevention.Indian Journal of Ophthalmic,2004,52:99-112.
3.Neumayer T,Findl O,Buehl W,et al.Long-term changes in the morphology of posterior capsule opacification.J Cataract Refract Surg,2005,31:2120-2128.
4.Apple D J,Solomon KD,Tetz MR,et al.Posterior capsule opacification Surv Ophthalmo,1992,37:73-116.
5.Friedman DS,Duncan DD,Munoz B,et al.Digital Image Capture and Automated Analysis of Posterior Capsular Opacification.Invest Ophthalmol Vis Sci,1999,40:1715-1726.
6.Javitt JC,Tielsch JM,Canner JK,et al.National outcomes of cataract extraction Increased risk of retinal complications associated with Nd:YAG laser capsulotomy.Ophthalmology,1999:1487-1498.
7.Aslam TM,Dhillon B,Werghi N,et al.Systems of analysis of posterior capsule opacification.Br J Ophthalmol,2002,86:1181-1186.
8.郭未艾,王晓黎,吴文捷.后发性白内障相关因素的临床研究.眼视光学杂志,2005,7:92-96.
9.Sundelin K,Lundstrom M,Stenevi U.Posterior capsular opacification:comparisons between morphology,visual acuity and self-assessed visual function.Acta Ophthalmol Scand,2006,84:667-673.
10.Aslam TM.Posterior capsular morphology determinants of visual funtion.Graefes Arch Clin Exp Ophthalmol,2003:208-212.
11.Aslam TM,Patton N,Rose CJ.OSCA:a comprehensive open-access system of analysis of posterior capsular opacification.BMC Ophthalmol,2006,6:30.
12.王光霁.不同对比度视力表及其临床应用.Chin J Ophthalmol,1999,1:10-12.
13.姚克,汤霞靖,陈佩卿,等.非球面人工晶状体与球面人工晶状体临床应用的对比研究.中华眼科杂志,2007,43:709-712.
14.Perez-Carrasco MJ,Puell MC,Sanchez-Ramos C,Effect of a yellow filter on contrast sensitivity and disability glare after lase in situ keratomileusis under mesopic and photopic conditions. Journal of Refractive Surgery,2005,21:151-158.
15.Nadler DJ,Jaffe NS,Clayman HM,et al,Glare disability in eyes with intraocular lenses.Am J Ophthalmol,1984,97:43-47.
16.Buehl W,Sacu S,Findl O,Association between intensity of posterior capsule opacification and contrast sensitivity.Am J Ophthalmol,2005,140:927-930.
17.王军,孙葆忱,杨晓慧,等.掺钕钇铝石榴石激光治疗人工晶状体眼晶状体后囊膜混浊的视功能评价方法.中华眼科杂志,2002,38:556-561.
18.Hayashi K,Hayashi H,Nakao F,et al.Correlation between posterior capsule opacification and visual function before and after Neodymium:YAG laser posterior capsulotomy.Am J Ophthalmoi,2003,136:720-726.
19.Cheng CY,Yen MY,Chen SJ,et al.Visual acuity and contrast sensitivity in different types of posterior capsule opacification.J Cataract Refract Surg 2001,27:1055-1060.
20.Kruger AJ,Schauersberger J,Abela C,et al.Two year results:Sharp versus rounded optic edges on silicone lenses.J Cataract Refract Surg,2000,26:566-570.
21.Prajna NV,Ellwein LB,Selvaraj S,et al.The madurai intraocular lens study Ⅳ:posterior capsule opacification.Am J Ophthalmol,2000,130:304-309.
22.王峰,崔国义,丁相奇.先天性白内障手术两种抽吸方法对后发障形成的影响.中国斜视与小儿眼科杂志,2003,11:121-122.
23.Mamalis N,Crandall AS,Linebarger E,et al.Effect of intraocular lens size on posterior capsule opacification after phacoemulsification.J Cataract Refract Surg,1995,21:99-102.
24.Sundelin K,Sjostrand J.Posterior capsule opacification 5 years after extracapsular cataract extraction.J Cataract Refract Surg,1999,25:246-250.
25.Moreno-Montanes J,Alvarez A,Maldonado MJ.Objective Quantification of Posterior Capsule Opacification after Cataract Surgery,with Optical Coherence Tomography.Invest Ophthalmol Vis Sci,2005,46:3999-4006.
26.Findl O,Buehl W,Menapace R,et al.Comparison of 4 methods for quantifying posterior capsule opacification.J Cataract Refract Surg,2003,29:106-11.
27.Jose RM,Bender LE,Boyce JF,et al.Correlation between the measurement of posterior capsular opacification severity and visual function testing.J Cataract Refract Surg,2005,31:534-542.
28.Buehl W,Sacu S,Findl O.Association between intensity of posterior capsule opacification and visual acuity.J Cataract Refract Surg,2005,31:543-547.
29.Tetz MR,Auffarth GU,Sperker M,et al.Photographic image analysis system of posterior capsule opacification.J Cataract Refract Surg,1997,23:1515-1520.
30.Tetz MR,Nimsgern Ch.Posterior capsule opacification Part 2:Clinical findings.J Cataract Refract Surg,1999;,25:1662-1674.
31.Barman S,Hollick,EJ,Boyce J,et al.Quantification of Posterior Capsular Opacification in Digital Images after Cataract Surgery.Invest Ophthalmol Vis Sci,2000,41:3882-3892.
32.Vassilev A,et al.Spatial - frequency specific contrast gain and flicker masking of human transient VEP.Vision Res,1994,34:863.
33.阎洪禄.眼生理学 人民卫生出版社2001:385-393.
34.Jim Schwiegerling.Recent developments in pseudophakic dysphotopsia.Current Opinion in Ophthalmology,2006,17:27-30.
35.Tariq Mehmood Aslam,Baljean Dhillon Principles of Pseudophakic Photic Phenomena.Ophthalmologica,2004,218:4-13.
36.黄小明,李乐平,金成鹏.近视眼屈光系统CSF的初步研究.眼视光学杂志,2003,5:95-96.
37.Tan JC,Spalton D J,Arden GB.Comparison of methods to assess visual impairment from glare and light scattering with posterior capsule opacification.J Cataract Refract Surg,1998,24:1626-31.
38.郭晓萍,夏群,王铮.人工晶状体后囊膜混浊激光治疗前后视功能的变化.眼科,2006,15:38-41.
39.Superstein R,Byaner D,Overbury O,et al.Glare disability and contrast sensitivity before and after cataract surgery.J Cataract Refract Surg,1997,23:2482-2531.
40.Meacock WR,Spalton DJ,Boyce J,The effect of posterior capsule opacification on visual function.Invest Ophthalmol Vis Sci.2003,44:4665-9.
41.Nakashima Y,Yoshitomi F,Oshika T.Regression of Elschnig pearls on the posterior capsule in a pseudophakic eye.Arch Ophthalmol,2002,120:397-398.
42.Mcleod SD.Risk factors for posterior capsule opacification.Br J Ophthalmol,2005,89:1389-90.
43.Pollack IP,Brown RH,Crandall AS,et al.Effectiveness of apraclonidine in preventing the rise in intraocular pressure after Neodymium:YAG posterior capsulotomy.Tr Am Ophth Soc.1988:462-469.
44.Javitt JC,Tielsch TM,Canner JK,et al.National outcomes of cataract extraction.Ophthalmology,1992,99:1487-1498.
45.陈锋,李润春,王竞.后发性白内障切开孔径大小对视野的影响.中华眼科杂志,2003,39:294-297.
46.Khandwala MA,Marjanovic B,Kotagiri AK,Rate of posterior capsule opacification in eyes with the Akreos intraocular lens.J Cataract Refract Surg,2007,33:1409-1413.
46.Thompson A M,Sachdev N,Wong T The Auckland Cataract Study:2 year postoperative assessment of aspects of clinical,visual,corneal topographic and satisfaction outcomes.Br J Ophthalmol,2004,88:1042-1048.
48.Masker S.Postoperative complications of capsulorhexis.J Cat Refract Surg,1993,19:721-24.
49.Chatterjee S,Garg P."String of pearls" following Nd:YAG laser posterior capsulotomy.Indian J Ophthalmol,2002,50:140-142.
50.Johnson SH,Kratz RP,Olson PF.Clinical experience with the Nd:YAG laser.J Am Intraocular Implant Soc,1984,10:452-60.
51.Holladay JT,Bishop JE,Lewis JW,et al.The optimal size of a posterior capsulotomy.J Am Intraocular Implant Soc,1985,11:218-20.
52.Georgopoulos M,Findl O,Menapace R,et al.Influence of intraocular lens material on regeneratory posterior capsule opacification after neodymium:YAG laser capsulotomy.J Cataract Refract Surg,2003,29:1560-1565.
1 Aslam TM,Devlin H,Dhilion B.Use of Nd:YAG laser capsulotomy.Surv Ophthalmol,2003,48:594-612.
2 Apple D J,Solomon KD,Tetz MR,et al.Posterior capsule opacification.Surv Ophthalmol,1992,37:73-115.
3 Goodman DF,Stark WJ,Gottsch JD.Complications of cataract extraction with traocular lens implantation.Ophthalmic Surg,1989,20:132-133.
4 Aslam TM,Dhillon B,Werghi N,et al.Systems of analysis of posterior capsule opacification.Br J Ophthalmol,2002,86:1181-1186.
5 Tetz MR,Auffarth GU,Sperker M,et al.Photographic image analysis system of posterior capsule opacification.J Cataract Refract Surg,1997,23:1515-1520.
6 Nadler D J,Jaffe NS,Clayman HM,et al.Glare disability in eyes with intraocular lenses.Am J Ophthalmol,1984,97:43-47.
7 Abela-Formanek C,Amon M,Schild G,et al.Uveal and capsular biocompatibility of hydrophilic acrylic,hydrophobic acrylic,and silicone intraocular lenses.J Cataract Refract Surg,2002,28:1160-1172.
8 Cheng CY,Yen MY,Chen SJ,et al.Visual acuity and contrast sensitivity in different types of Posterior capsule opacification.J Cataract Refract Surg,2001,27:1056-1060.
9 Aslam TM,Patton N.Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement.BMC Ophthalmol,2004,4:13.
10 Prajna NV,Ellwein LB,Selvaraj S,Manjula K,Kupfer C.The madurai intraocular lens study Ⅳ:posterior capsule opacification.Am J Ophthalmol,2000,130:304-309.
11 Camparini M,Macaluso C,Reggiani L,et al.Retroillumination versus Reflected-Light Images in the Photographic Assessment of Posterior Capsule Opacification.Invest Ophthalmol Vis Sci.,2000,41:3074-3079.
12 Sundelin K,Sjostrand J.Posterior capsule opacification 5 years after extracapsular cataract extraction.J Cataract Refract Surg,1999,25:246-250.
13 Mamalis N,Crandall AS,Linebarger E,et al.Effect of intraocular lens size on posterior capsule opacification after phacoemulsification.J Cataract Refract Surg,1995,21:99-102.
14 Meacock WR,Spalton DJ,Boyce J,et al.The Effect of Posterior Capsule Opacification on Visual Function.Invest Ophthalmol Vis Sci,2003,44:4665-4669.
15 Hayashi K,Hayashi H,Nakao F,et al.Correlation between posterior capsule opacification and visual function before and after Neodymium:YAG laser posterior capsulotomy.Am J Ophthalmol,2003,136:720-726.
16 王军,孙葆忱,杨晓慧,等.掺钕钇铝石榴石激光治疗人工晶状体眼晶状体后囊膜混浊的视功能评价方法.中华眼科杂志,2002,38:556-561.
17 Kaneda E,Negishi K,Kobayashi K,et al.Evaluation of Visual Function Using a New Point Spread Function Analysis System in Pseudophakic Eyes with Aftercataract.Invest Ophthalmol Vis Sci,2002,43:2019.
18 Hayashi K, Hayashi H. Posterior capsule opacification in the presence of an intraocular lens with a sharp versus rounded optic edge. Ophthalmology, 2005,112:1550-1556.
19 Hayashi K,Hayashi H. Posterior capsule opacification after implantation of a hydrogel intraocular lens. Br J Ophthalmol ,2004,88:182-185.
20 Nejima R, Miyata K, Honbou M et al. A prospective, randomised comparison of single and three piece acrylic foldable intraocular lenses. Br J Ophthalmol ,2004,88:746-749.
21 Moreno-Montanes J, Alvarez A, Maldonado MJ. Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography. Invest Ophthalmol Vis Sci ,2005,46:3999-4006.
22 Barman S,Hollick, EJ, Boyce J,et al .Quantification of Posterior Capsular Opacification in Digital Images after Cataract Surgery. Invest Ophthalmol Vis Sci,2000, 41:3882-3892.
23 Reda Z, Vytautas J,Valerijus B,et al. Prevention of posterior capsule Opacification using different intraocular lenses. Medicina(Kaunas), 2004,40:721-730.
24 郭未艾,千晓梨,吴文捷,等．后发性白内障相关因素的临床研究．眼视光学杂志,2005,7：92-99．
25 Bender L, Spalton DJ, Uyanonvara B,et al. POCOman:New system for quantifying Posterior Capsular Opacification. J Cataract Refract Surg,2004,30:2058-2064.
26 Friedman DS, Duncan DD, Munoz B ,et al. Digital Image Capture and Automated Analysis of Posterior Capsular Opacification . Invest Ophthalmol Vis Sci, 1999,40:1715-1726.
27Jose RM, Bender LE, Boyce JF,et al. Correlation between the measurement of posterior capsular opacification severity and visual function testing. J Cataract Refract Surg, 2005, 31: 534-542.
28 Findl O, Buehl W, Siegl H, et al. Removal of Reflections in the Photographic Assessment of PCO by Fusion of Digital Retroillumination Images. Invest Ophthalmol Vis Sci, 2003 ,44: 275-280.
29 Findl O, Buehl W, Menapace R,et al .Comparison of 4 methods for quantifying posterior capsule opacification. J Cataract Refract Surg,2003,29:106-11.
30 Aslam TM, Patton N, Graham J. A freely accessible, evidence based, objective system of analysis of posterior capsular opacification ; Evidence for its validity and reliability. BMC Ophthalmol, 2005,5: 9.
31 Aslam TM, Patton N, Rose CJ. OSCA: a comprehensive open-access system of analysis of posterior capsular opacification. BMC Ophthalmol, 2006, 6: 30.
2.Pandey SK,Apple D J,Werner L,et al.Posterior Capsule Opacification:A Review of the Aetiopathogenesis,Experimental and Clinical Studies and Factors for Prevention.Indian Journal of Ophthalmic,2004,52:99-112.
3.Neumayer T,Findl O,Buehl W,et al.Long-term changes in the morphology of posterior capsule opacification.J Cataract Refract Surg,2005,31:2120-2128.
4.Apple D J,Solomon KD,Tetz MR,et al.Posterior capsule opacification Surv Ophthalmo,1992,37:73-116.
5.Friedman DS,Duncan DD,Munoz B,et al.Digital Image Capture and Automated Analysis of Posterior Capsular Opacification.Invest Ophthalmol Vis Sci,1999,40:1715-1726.
6.Javitt JC,Tielsch JM,Canner JK,et al.National outcomes of cataract extraction Increased risk of retinal complications associated with Nd:YAG laser capsulotomy.Ophthalmology,1999:1487-1498.
7.Aslam TM,Dhillon B,Werghi N,et al.Systems of analysis of posterior capsule opacification.Br J Ophthalmol,2002,86:1181-1186.
8.郭未艾,王晓黎,吴文捷.后发性白内障相关因素的临床研究.眼视光学杂志,2005,7:92-96.
9.Sundelin K,Lundstrom M,Stenevi U.Posterior capsular opacification:comparisons between morphology,visual acuity and self-assessed visual function.Acta Ophthalmol Scand,2006,84:667-673.
10.Aslam TM.Posterior capsular morphology determinants of visual funtion.Graefes Arch Clin Exp Ophthalmol,2003:208-212.
11.Aslam TM,Patton N,Rose CJ.OSCA:a comprehensive open-access system of analysis of posterior capsular opacification.BMC Ophthalmol,2006,6:30.
12.王光霁.不同对比度视力表及其临床应用.Chin J Ophthalmol,1999,1:10-12.
13.姚克,汤霞靖,陈佩卿,等.非球面人工晶状体与球面人工晶状体临床应用的对比研究.中华眼科杂志,2007,43:709-712.
14.Perez-Carrasco MJ,Puell MC,Sanchez-Ramos C,Effect of a yellow filter on contrast sensitivity and disability glare after lase in situ keratomileusis under mesopic and photopic conditions. Journal of Refractive Surgery,2005,21:151-158.
15.Nadler DJ,Jaffe NS,Clayman HM,et al,Glare disability in eyes with intraocular lenses.Am J Ophthalmol,1984,97:43-47.
16.Buehl W,Sacu S,Findl O,Association between intensity of posterior capsule opacification and contrast sensitivity.Am J Ophthalmol,2005,140:927-930.
17.王军,孙葆忱,杨晓慧,等.掺钕钇铝石榴石激光治疗人工晶状体眼晶状体后囊膜混浊的视功能评价方法.中华眼科杂志,2002,38:556-561.
18.Hayashi K,Hayashi H,Nakao F,et al.Correlation between posterior capsule opacification and visual function before and after Neodymium:YAG laser posterior capsulotomy.Am J Ophthalmoi,2003,136:720-726.
19.Cheng CY,Yen MY,Chen SJ,et al.Visual acuity and contrast sensitivity in different types of posterior capsule opacification.J Cataract Refract Surg 2001,27:1055-1060.
20.Kruger AJ,Schauersberger J,Abela C,et al.Two year results:Sharp versus rounded optic edges on silicone lenses.J Cataract Refract Surg,2000,26:566-570.
21.Prajna NV,Ellwein LB,Selvaraj S,et al.The madurai intraocular lens study Ⅳ:posterior capsule opacification.Am J Ophthalmol,2000,130:304-309.
22.王峰,崔国义,丁相奇.先天性白内障手术两种抽吸方法对后发障形成的影响.中国斜视与小儿眼科杂志,2003,11:121-122.
23.Mamalis N,Crandall AS,Linebarger E,et al.Effect of intraocular lens size on posterior capsule opacification after phacoemulsification.J Cataract Refract Surg,1995,21:99-102.
24.Sundelin K,Sjostrand J.Posterior capsule opacification 5 years after extracapsular cataract extraction.J Cataract Refract Surg,1999,25:246-250.
25.Moreno-Montanes J,Alvarez A,Maldonado MJ.Objective Quantification of Posterior Capsule Opacification after Cataract Surgery,with Optical Coherence Tomography.Invest Ophthalmol Vis Sci,2005,46:3999-4006.
26.Findl O,Buehl W,Menapace R,et al.Comparison of 4 methods for quantifying posterior capsule opacification.J Cataract Refract Surg,2003,29:106-11.
27.Jose RM,Bender LE,Boyce JF,et al.Correlation between the measurement of posterior capsular opacification severity and visual function testing.J Cataract Refract Surg,2005,31:534-542.
28.Buehl W,Sacu S,Findl O.Association between intensity of posterior capsule opacification and visual acuity.J Cataract Refract Surg,2005,31:543-547.
29.Tetz MR,Auffarth GU,Sperker M,et al.Photographic image analysis system of posterior capsule opacification.J Cataract Refract Surg,1997,23:1515-1520.
30.Tetz MR,Nimsgern Ch.Posterior capsule opacification Part 2:Clinical findings.J Cataract Refract Surg,1999;,25:1662-1674.
31.Barman S,Hollick,EJ,Boyce J,et al.Quantification of Posterior Capsular Opacification in Digital Images after Cataract Surgery.Invest Ophthalmol Vis Sci,2000,41:3882-3892.
32.Vassilev A,et al.Spatial - frequency specific contrast gain and flicker masking of human transient VEP.Vision Res,1994,34:863.
33.阎洪禄.眼生理学 人民卫生出版社2001:385-393.
34.Jim Schwiegerling.Recent developments in pseudophakic dysphotopsia.Current Opinion in Ophthalmology,2006,17:27-30.
35.Tariq Mehmood Aslam,Baljean Dhillon Principles of Pseudophakic Photic Phenomena.Ophthalmologica,2004,218:4-13.
36.黄小明,李乐平,金成鹏.近视眼屈光系统CSF的初步研究.眼视光学杂志,2003,5:95-96.
37.Tan JC,Spalton D J,Arden GB.Comparison of methods to assess visual impairment from glare and light scattering with posterior capsule opacification.J Cataract Refract Surg,1998,24:1626-31.
38.郭晓萍,夏群,王铮.人工晶状体后囊膜混浊激光治疗前后视功能的变化.眼科,2006,15:38-41.
39.Superstein R,Byaner D,Overbury O,et al.Glare disability and contrast sensitivity before and after cataract surgery.J Cataract Refract Surg,1997,23:2482-2531.
40.Meacock WR,Spalton DJ,Boyce J,The effect of posterior capsule opacification on visual function.Invest Ophthalmol Vis Sci.2003,44:4665-9.
41.Nakashima Y,Yoshitomi F,Oshika T.Regression of Elschnig pearls on the posterior capsule in a pseudophakic eye.Arch Ophthalmol,2002,120:397-398.
42.Mcleod SD.Risk factors for posterior capsule opacification.Br J Ophthalmol,2005,89:1389-90.
43.Pollack IP,Brown RH,Crandall AS,et al.Effectiveness of apraclonidine in preventing the rise in intraocular pressure after Neodymium:YAG posterior capsulotomy.Tr Am Ophth Soc.1988:462-469.
44.Javitt JC,Tielsch TM,Canner JK,et al.National outcomes of cataract extraction.Ophthalmology,1992,99:1487-1498.
45.陈锋,李润春,王竞.后发性白内障切开孔径大小对视野的影响.中华眼科杂志,2003,39:294-297.
46.Khandwala MA,Marjanovic B,Kotagiri AK,Rate of posterior capsule opacification in eyes with the Akreos intraocular lens.J Cataract Refract Surg,2007,33:1409-1413.
46.Thompson A M,Sachdev N,Wong T The Auckland Cataract Study:2 year postoperative assessment of aspects of clinical,visual,corneal topographic and satisfaction outcomes.Br J Ophthalmol,2004,88:1042-1048.
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