| Objective:To investigate the incidence of posterior capsular opacification after intraocular lenses implantation with different materials;to compare the efficacy and safety of different laser pattern for early posterior capsular opacification.Methods:587 patients(603 eyes)with cataract phacoemulsification combined with intraocular lens implantation were followed up for 1 year.296 patients(301 eyes)were implanted with acrylic intraocular lens,while 291 patients(302 eyes)were implanted with polymethylmethacrylate intraocular lens.The incidence of posterior capsular opacification after implantation of two kinds of intraocular lens was evaluated 1 year later.46 eyes of posterior capsular opacification in grade I were randomly divided into two groups,A and B,with 23 eyes in each group.40 eyes of grade II posterior capsular opacification were randomly divided into two groups,C and D,with 20 eyes in each group.Patients in group A and group C were treated with ND:YAG laser cruciate posterior capsulotomy,while patients in group B and D were treated with circular posterior capsulotomy.The success rates and complications were compared between groups A and C,B and D.Results:1、33 eyes(11%)of 296 patients(301 eyes)developed posterior capsular opacification after 1 year with acrylic intraocular lens implantation.Among them,18 eyes(6.0%)were with grade I posterior capsule opacification and 15 eyes(5.0%)were with grade II posterior capsular opacification.No patient developd grade III posterior capsular opacification.53 eyes(17.5%)of 291 patients(302 eyes)developed posterior capsular opacification after 1 year with polymethylmethacrylate intraocular lens implantation.Among them,28 eyes(9.3%)were with grade I posterior capsule opacification and 25 eyes(8.3%)were with grade II posterior capsular opacification.No patient developd grade III posterior capsular opacification.The incidence of posterior capsular opacification 1 year after implantation in acrylic intraocular lens group were lower than polymethacrylate intraocular lens group(P < 0.05).2、The patients in group A,B,C and D were treated with ND:YAG laser posterior capsulotomy and the results of intraoperative laser parameters were obtained.(1)Pulse number: group A,50.3±2.8;group B,54.6±4.3;group C,47.8±3.3;group D,54.2±5.1.The difference between group A and B,group C and group D was statistically significant(P < 0.05).(2)The total energy: group A,40.30±4.75(mJ);group B,45.63±9.24(mJ);group C,41.80±4.85(mJ);group D,49.09±8.72(mJ).Compared with group A and B,group C and group D,P < 0.05,the difference was statistically significant.3、The complications after ND:YAG laser posterior capsulotomy were observed in group A,B,C and D.In group A,1 eye(4.35%)with anterior uveitis occurred.In group B,complications occurred in 8 eyes(34.78%): 1 eye with intraocular lens injury,2 eyes with temporarily high intraocular pressure,1 eye with break up of anteriorvitreous membrane and 4 eyes with anterior uveitis.In group C,complications occurred in 2 eyes(10%): 1 eye with intraocular lens injury,1 eye with anterior uveitis.In group D,complications occurred in 8 eyes 40%: 1 eye with intraocular lens injury,2 eyes with temporarily high intraocular pressure,1 eye with Breakup of anteriorvitreous membrane and 4 eyes with anterior uveitis.Compared with group A and B,group C and group D,P < 0.05,the difference was statistically significant.4.After laser treatment,the patients in group A,B,C,and D could form a posterior capsule hole of about 4 mm in size,and the effectiveness was 100%(P>0.05).In group A,preoperative vision :0.32±0.15,postoperative vision,0.56±0.12;In group B patients,preoperative vision 0.31±0.14,postoperative vision,0.55±0.12;In group C patients,preoperative vision 0.21±0.12,postoperative vision,0.55±0.14;In group D patients,preoperative vision 0.22±0.13,postoperative vision,0.54±0.15;Postoperative visual acuity in four groups was significantly improved compared with that before operation(P < 0.05).Conclusions:1、1 year after cataract phacoemulsification combined with intraocular lens implantation,the acrylic intraocular lens biocompatibility was better than the polymethylmethacrylate intraocular lens,the incidence of posterior capsule opacification is lower.2 、 ND:YAG laser posterior capsulotomy for early posterior capsular opacification is simple,safe and successful.After laser treatment,the glare symptoms were improved in varying degrees and the visual acuity was improved significantly.Compared with circular posterior capsulotomy,cruciate posterior capsulotomy needed fewer laser pulses,less energy and lower incidence of complications.Cruciate posterior capsulotomy is safer and more practical than circular posterior capsulotomy. |
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