Analysis Of Related Factors Of PCO And Study Of Visual Quality After Nd:YAG

PURPOSE: 1.To compare the correlation between posterior capsule opacification(PCO)clinical grade,EPCO2000 value and best corrected visual acuity(BCVA),and to quantitatively analyze the related factors of PCO after phacoemulsification and foldable intraocular lens(IOL)implantation using EPCO2000 software.2.To investigate the changes of refractive status after Nd: YAG laser posterior capsulotomy,and to evaluate the changes of visual quality after Nd:YAG laser posterior capsulotomy using Catquest-9SF questionnaire and KR-1W Visual Function Analyzer.METHODS: Methods: In the first part,a retrospective study of one year after phacoemulsification combined with intraocular lens implantation for age-related cataract in March 2016 to November 2016 in the Department of Ophthalmology,Shanghai Jiao Tong University Affiliated Sixth People's Hospital.The first part included 600 cases of 971 IOL eyes.After pupil dilation with tropicamide phenylephrine eye drops,the PCO clinical grading under the slit lamp was performed and the retroillumination slit-lamp photographs were obtained,using EPCO2000 software for PCO quantification.And then analyze the relevant factors of PCO.In the second part,73 eyes of 57 PCO consecutive patients having Nd: YAG laser capsulotomy from in the Department of Ophthalmology,Shanghai Jiao Tong University Affiliated Sixth People's Hospital betweenSeptember 2017 and November 2017 for this prospective study.The diameter of the posterior capsular incision was 3-4mm.The subjective refraction,KR-1W Visual Function Analyzer,scores of Catquest-SF questionnaire was performed before and after surgery.Results: 1.In the first part,EPCO total score and central 3mm value showed a significant correlation with clinical PCO severity(r = 0.851,r =0.599,P <0.05),EPCO total score and central 3mm value showed a significant correlation with LogMAR visual acuity(r = 0.366,R = 0.466,P<0.05),clinical PCO severity also showed a significant correlation with LogMAR visual acuity(r = 0.406,P <0.05).2.There were 153 eyes(15.76%)without PCO,818 eyes(84.24%)with PCO,and 167 eyes(17.20%)with PCO involving the central 3 mm of the pupil,significant PCO that was due to PCO caused a BCVA ? 0.5 or had been performed Nd: YAG laser capsulotomy in 78 eyes(8.03%);In the high myopia group(AL?26mm),there were 34 eyes(15.18%)without PCO,190 eyes(84.82%)with PCO,and 51 eyes(22.78%)with PCO involving the central 3 mm of the pupil,Significant PCO that was due to PCO caused a BCVA ? 0.5 or had been performed Nd: YAG laser capsulotomy in 36eyes(16.07%).The differences in the PCO scores of grade 1 and the total scores for the hydrophobic acrylic group and hydrophilic group were significant.According to IOL optical surface heparin modification or not,the corresponding PCO values were compared,grade 2,grade 3,total andcentral 3mm values were significant differences.According to one-piece and three-piece IOL design,the two groups corresponding PCO values were compared,grade 1 and the total score differences were significant;According to the haptic angulation,the two groups corresponding PCO values were compared,grade 1 and the total scores differences were significant.According to the optical diameter,the corresponding PCO values of three groups were compared,there was no significant difference in the PCO values.According to the total length of the IOL,the PCO values of the three groups were compared,except for grade 4,there was a significant difference among three groups.The differences in the PCO scores of grade 2,grade 3,total and central 3mm values between 11.0mm and 12.5mm were significant.The differences in the PCO scores of grade3,total and central 3mm values between 11.0mm and 13.0mm were significant.The differences in the PCO scores of grade 1,grade 2,grade 3,total and central 3mm values between 12.5mm and 13.0 mm were significant.The differences in the PCO scores for the with or without DM group were not significant.According to the AL group,the PCO scores among the three groups were not significantty different.Logistic regression analysis of the occurrence of Nd: YAG showed that the IOL type and AL were independent risk factors for Nd: YAG(OR = 1.683,P =0.010,OR = 1.180,P = 0.033).3).The postoperative LogMAR visual acuity(0.095 ± 0.020)was significantly higher than thatpreoperative(0.550 ± 0.039)(P <0.001).The postoperative spherical and spherical equivalent were increased compared with preoperative(P <0.05),howeve,there was no significant difference between one week and one month after surgery(P = 0.858).With 4mm pupil diameter ocular Total HOA(high-order aberrations),3rd-order,4th-order,Trefoil,Coma,Tetrafoil and 2nd-Astig were significantly lower than those before surgery(P <0.05).With 4mm pupil diameter,intraocular Astigmatism,Total HOA,3rd-order,4th-order,Trefoil,Coma and 2nd-Astig were significantly lower than those before surgery(P <0.05).With 6mm pupil diameter,ocular and intraocular Astigmatism,Total HOA,3rd-order,4th-order,Trefoil,Coma,Tetrafoil and 2nd-Astig were significantly lower than those before surgery(P <0.05).The postoperative total scores of Catquest-9SF and scores of each question were significantly higher than those before surgery(P <0.05).CONCLUSION:1.The total score of EPCO measured by EPCO2000 is the strongest correlation with clinical PCO severity,the correlation between central 3mm value and visual acuity is good,however the correlation between EPCO total score and visual acuity is not good.2.PCO has no correlation with optical diamete and DM.hydrophilic and heparin IOL more prone to PCO,one-piece design,the IOL with a 0degree haptic anguiation and a total length of 13 mm can reduce the PCO.The AL value has a certain effect on the occurrence of PCO,the rate ofNd: YAG laser posterior capsulotomy is increased with the prolongation of AL.3.The equivalent spherical increases after Nd: YAG laser posterior capsulotomy,and the refractive status shifts to hyperopia.4.The visual quality of life of patient's self reporting outcome with the Catquest-9SF questionnaire after Nd: YAG laser posterior capsulotomy is significantly improved,and the postoperative best corrected visual acuity is also significantly improved.5.Using the KR-1W Visual Function Analyzer finds that after Nd: YAG laser posterior capsulotomy,with 4mm,6mm pupil diameter the ocular and intraocular Total HOA,Coma,Trefoil aberration significantly reduce,the patient's visual quality improves significantly.