不同之眼科黏彈劑(OVD)對飛秒雷射輔助白內障手術影響: 病例報告

Effects of Different Ocular Viscoelastic Devices on Femtosecond Laser-Assisted Cataract Surgery: A Case Report

本論文報告一病例，因使用不同之眼科黏彈劑(OVD) ，對飛秒雷射輔助白內障手術所造成之影響。病患為65歲華裔女性，因急性隅角閉鎖性青光眼發作，高眼壓導致水晶體的蛋白質變性腫大，使原本的白內障更為嚴重，並造成前房嚴重狹窄，以藥物治療效果不彰，故建議接受飛秒雷射輔助白內障手術。雷射手術前因瞳孔無法充分散瞳而先行以眼科黏彈劑(Viscoat®, Alcon Laboratories, Inc.)注入眼前房輔助，但發現後續雷射手術失效，直至將眼前房中之眼科黏彈劑更換為Protectalon 1.6% (VSY Biotechnology) ，順利完成飛秒雷射輔助白內障手術。本文推測為眼科黏彈劑間之類型與成分差異所致，望此經驗能對遭遇類似問題之醫師有所助益。

 

A 65-year-old woman with a previous history of acute angle-closure glaucoma received femtosecond laser-assisted cataract surgery (FLACS) at our hospital. The patient’s pupil diameter was about 4mm and could not be dilated preceding the operation. We performed corneal microincision following pupil dilation with OVDs (Viscoat, Alcon Laboratories, Inc.). Lens fragmentation and capsulotomy were not able to be performed by FEMTO LDV Z8. We replaced the dispersive OVD--Viscoat, with an alternative cohesive OVD--Protectalon. After replacement, lens fragmentation and capsulotomy were performed smoothly under the same femtosecond laser settings. We propose the componential difference of the two OVDs, as well as lower laser pulse energy of FEMTO LDV Z8, might contribute to our reported complication. Our hypotheses require further studies with better study designs to validate. We hope this experience might reveal effects of different OVDs on FLACS and also help solve possible difficulties during FLACS on a very smaller pupil and shallow ACD cataract.