【摘要】 目的 分析后发性白内障行Nd∶YAG激光后囊切开术后出现急性眼压升高的临床处理及预后。方法 回顾性系列病例研究。收集2012年1月-2013年11月我院眼科门诊因后发性白内障行Nd∶YAG激光后囊切开术后出现急性眼压升高（≥40 mmHg，1 mmHg=0.133 kPa）的16例患者病例资料，并对其年龄、性别、白内障类型、治疗前后视力和眼压、激光治疗参数、高眼压处理经过及预后进行总结。结果 16例患者平均年龄（22.5±11.8）岁，其中男10例，女性6例。激光治疗前眼压11~22 mmHg，平均（17.3±3.5）mmHg，有2例患者在接受抗青光眼药物治疗；激光治疗后（3.6±1.3）h患者眼压升高至40~57mmHg，平均（44.1±4.5）mmHg。12例患者药物降眼压处理后眼压下降， 4例患者在药物降眼压后眼压仍高于40 mmHg，行前房穿刺放液术控制眼压。术后第2天，除1例患者眼压31 mmHg，其余均在21 mmHg以内。术后第2天平均眼压（14.7±4.1）mmHg，恢复至治疗前水平。随访6个月，末次随访眼压12~20 mmHg，平均（16.3±2.8）mmHg，与激光治疗前眼压差异无统计学意义（t=1.240，P>0.05）。结论 后发性白内障行Nd∶YAG激光后囊切开术后急性眼压升高患者可以通过药物和（或）前房穿刺放液术降眼压，效果和预后良好。
【关键词】 白内障，后发性； 激光，固体； 高眼压； 预后
DOI：10.3760/cma.j.issn.1674-845X.2014.12.011
作者单位：100005 北京眼科中心北京学与视觉科学重点实验室（卿国平、王怀洲、熊瑛、王晓贞、万修华）；100005 北京研究所（万修华）
通信作者：万修华，Email：xiuhuawan@126.com
Management and prognosis of an acuteintraocular pressure spike posterior to Nd∶YAG laser capsulotomy in patients with posterior capsularopacification
Qing Guoping*， Wang Huaizhou， Xiong Ying， Wang Xiaozhen， Wan Xiuhua. * Beijing Tongren EyeCenter， BeijingTongren Hospital， CapitalMedical University； Beijing Ophthalmology & Visual Sciences Key Lab， Beijing 100730， China
Corresponding author： Wan Xiuhua， Email： xiuhuawan@126.com
【Abstract】 Objective To analyze the clinicalcharacteristics and prognosis of an acute intraocular pressure （IOP） spike posterior to the Nd∶YAG laser capsulotomy in patients with posterior capsularopacification. Methods Medical charts of16 patients who underwent Nd∶YAG laser capsulotomy and presented with an IOP spike （≥40 mmHg， 1 mmHg=0.133 kPa） after treatment in Beijing TongrenEye Center from January 2012 to November 2013 were reviewed retrospectively.Main investigative aspects included age， gender， cataract subtypes， pre- and post-treatment visual acuity and IOP， Nd∶YAG laser parameters used in the treatment， the management of the acute IOPelevation and the clinical outcomes. Results Sixteen patients （10 males and 6 females） were enrolled in this retrospective study， with an average age of 22.5±11.8 years. Mean IOP level was 17.3±3.5（11-22）mmHg beforelaser capsulotomy. Two of the patients were receiving anti-glaucoma medicationbefore the laser treatment. IOP increased immensely 3.6±1.3（2-6） hours afterposterior laser capsulotomy， with an average of 44.1±4.5（40-57）mmHg. IOP was controlled in 12patients after intensive anti-glaucoma medication. Nevertheless， the other four patients still hadhigh IOP above 40 mmHg after medical intervention， and paracentisis was performed to reduce ocular hypertension.Except for one patient who still had an IOP of 31 mmHg， IOP was under control （≤21 mmHg） in all other patients by thesecond day. On follow-up day 3， IOP was 14.7±4.1（11-19）mmHg. IOP remained stable and was16.3±2.8（12-20）mmHg on the last follow-up visit， which was not statistically different from baseline （t=1.240， P>0.05）. Conclusion Intensive anti-glaucoma medication and/orparacentisis is safe and effective to reverse the IOP spike in patients withposterior capsular opacification posterior to Nd∶YAG laser capsulotomy. And the prognosis is excellent.
【Key words】 Cataract，posteriorcapsular； Laser，solid； Ocular hypertension； Prognosis