人工晶状体植入术后早期囊袋阻滞综合征的临床处理

目的探讨人工晶状体术后早期囊袋阻滞综合征(capsularblock syndrome,CBS)的临床表现、发生机制、治疗和预防方法。方法收集超声乳化、人工晶状体囊袋内植入术后早期出现CBS者13例(13眼)。首先尝试Nd:YAG激光周边前囊切开术;其中1例瞳孔不能散大无法暴露周边前囊,则改行激光后囊切开术。结果13例CBS均表现出明显的撕囊口阻滞、囊袋高度扩张、人工晶状体前移位、浅前房和近视性漂移。除1例未经干预自行消失外,其余12例经Nd:YAG激光囊切开后CBS消失,前房深度平均加深(1.52±0.67)mm。结论囊袋内黏弹剂残存是造成术后早期CBS的重要因素。激光周边前囊切开术、后囊切开术可安全、有效地治疗CBS。     

白内障术后囊袋阻滞综合征病因分析及临床处理

目的 探讨白内障超声乳化联合人工晶状体植入术后囊袋阻滞综合征(capsular block syndrome,CBS)的临床表现、发生机制、治疗和预防方法.方法 采用回顾性分析法,对2009年7月至2011年5月施行白内障超声乳化联合人工晶体植入术3287例(3854只眼),术后共发生15例(15只眼)CBS,分析其临床特点并随访了不同处理方法的效果.结果 11例诊断为术后早期CBS,4例为术后晚期CBS,前囊连续环形撕囊口直径均小于5 mm.除3例早期CBS未经干预症状自行消失,其中7例行Nd:YAG激光治疗,5例行前房及囊袋内冲洗后均恢复较好视力.讨论 前囊撕囊口直径过小,术中黏弹剂残留是术后早期CBS的两个易发因素,术后前房及囊袋内冲洗以及择期Nd:YAG激光前囊口或后囊切开均可以有效治疗术后CBS.     

Nd：YAG激光治疗白内障术后囊袋阻滞综合征疗效分析

目的:探讨白内障超声乳化吸出联合人工晶状体植入术后晶状体囊袋阻滞综合征临床特征及Nd:YAG激光治疗方法选择.方法:回顾性分析7例术后晶状体囊袋阻滞综合征临床特征及Nd:YAG激光治疗方法.其中2例术后早期晶状体囊袋阻滞综合征采用Nd:YAG激光前囊膜周边造孔术;4例术后晚期晶状体囊袋阻滞综合征仅晶状体后囊膜混浊、增厚,采用Nd:YAG激光后囊膜切除术;1例术后晚期晶状体囊袋阻滞综合征伴有人工晶状体前、后表面光学部纤维增殖膜,采用Nd:YAG激光人工晶状体前后囊膜切除术后再行晶状体后囊膜切除术.结果:患者7例经Nd:YAG激光治疗后均恢复较好视力,未见严重并发症.结论:根据术后囊袋阻滞综合征临床特征采取相应的Nd:YAG激光治疗安全有效.     

Nd:YAG激光治疗对早期晶状体囊袋阻滞综合征的疗效

目的：：探讨Nd：YAG激光治疗对早期晶状体囊袋阻滞综合征的临床疗效。方法：选取2010-01/2015-07在安阳市眼科医院诊断为术后早期晶状体囊袋阻滞综合征的患者18例21眼,使用Nd：YAG激光行单纯晶状体前囊膜打孔,或联合后囊膜打孔,观察术前和术后第2 wk裸眼远视力、眼压、屈光度、前房深度等的变化。结果：所有患者中,17眼单纯采用Nd：YAG激光行前囊膜打孔,4眼采用了前囊膜打孔联合后囊膜打孔。患者术后2 wk较术前相比,裸眼远视力提高、眼压恢复正常、近视屈光度降低、前房深度加深。结论：Nd：YAG激光治疗术后早期晶状体囊袋阻滞综合征是一种安全、有效的临床治疗方法。     

Nd:YAG激光治疗囊袋收缩综合征的临床效果分析

目的观察Nd:YAG激光治疗囊袋收缩综合征的疗效。方法 15例(15只眼)经专科检查确定为囊袋收缩综合征的患者接受Nd:YAG激光囊袋切开治疗,对比观察治疗前后的视力、人工晶状体位置的变化。结果 86.7%的患者治疗取得了成功,变现为视力的提高、人工晶状体位置的改善,囊袋收缩过程结束。结论 Nd:YAG激光囊袋切开是治疗囊袋收缩综合征的有效方法。     

连续环形撕囊术后囊袋收缩症的成因和防治

目的 探讨白内障连续环形撕囊术（CCC）后囊袋收缩症的成因、临床特点、对视力的影响和防治方法。方法 对23例23眼CCC术后晶状体前囊口纤维增生、收缩情况进行观察，对其影响进行了分析。YAG激光晶状体前囊放射状切开术或后囊截开术前术后进行检验。结果 23眼有不同程度的前囊口纤维增生、收缩，可伴有后囊浑浊、皱褶。23眼中有13眼不同程度的视力下降，3眼人工晶状体偏位，眩光6例，前房加深3眼。3眼行YAG激光前囊口放射状切开，2眼行手术剥离。YAG激光后囊截开术可提高视力。结论 囊袋收缩综合症是撕囊区面积缩小、残留的晶状体前囊浑浊、后囊皱褶、人工晶状体位置改变为特点，导致视力障碍，眩光，人工晶状体偏位。YAG激光前囊口放射状切开术和后囊截开术可松解囊袋、改善症状、提高视力。     

YAG激光治疗晶状体囊袋阻滞综合征

晶状体囊袋阻滞综合征(capsular block syndrome，CBS)见于白内障摘除行连续环形撕囊并囊袋内后房型人工晶状体植入的患者。最早由Davison在1989年描述。我院自1999年至今发生白内障术后晶状体CBS 3例，采用YAG激光切除后囊获得良好效果，报告如下。     

囊袋收缩综合征31例疗效分析

目的总结囊袋收缩综合征（CCS）的临床处理方法及其效果。方法回顾性病例研究。对31例（31眼）囊袋收缩综合征患者行Nd∶YAG激光治疗和手术治疗。行Nd∶YAG激光治疗22眼,其中行前囊三切口法17眼;先行二切口法后效果不理想即时或二期改做四切口法5眼。行手术治疗9眼。术后观察术眼视力,裂隙灯观察撕囊口透明区大小,前后囊膜情况及人工晶状体（IOL）位置等。观察术后并发症及主观症状。术后随访3～6个月。结果所有术眼术后裸眼视力及最佳矫正视力均有不同程度提高。术前主诉伴眩光或单眼复视者,术后上述主观症状消失。术眼囊袋收缩缓解,撕囊口透明区较术前扩大,IOL位置居中稳定。术后并发症主要为高眼压和轻度的虹膜炎症反应。结论Nd∶YAG激光和手术治疗CCS疗效可靠,简便安全。     

白内障超声乳化术三种人工晶状体植入疗效分析

目的 观察PMMA晶状体及三片式、单片式Acrysof晶状体植入后视力恢复、散光度、角膜内皮细胞密度变化、术后后囊膜混浊发生率及Nd：YAG激光切开率。方法 对PMMA晶状体组55只眼、三片式、单片式Acrysof晶状体各52只眼进行回顾性研究，将术后各期视力、散光度、角膜内皮细胞密度变化和后囊膜混浊发生率及激光切开率进行对比研究。结果 折叠式人工晶状体组比PMMA晶状体组视力恢复快。1月后三者间没有差异。角膜散光PMMA晶状体组6个月与术前无差异，折叠式人工晶状体组1个月与术前比较即无差异。术后角膜内皮细胞密度三组之间无差异。术后6月后囊膜混浊发生率及Nd：YAG激光后囊膜切开率，折叠式人工晶状体组与PMMA晶状体差异有显著意义。结论 三种不同人工晶状体植入后均可获得满意的效果，Acrysof晶状体术后后发障明显低于PMMA晶状体。     

钕-钇铝石榴石激光玻璃体松解术治疗人工晶状体植入术后前部玻璃体混浊

目的 观察钕-钇铝石榴石(neodymium-yttrium aluminum garnet,Nd:YAG)激光玻璃体松解术对人工晶状体植入手术后前部玻璃体混浊的治疗效果。 方法 对裂隙灯显微镜联合光相干断层扫描（optical coherence tomography, OCT）和B型超声检查确诊的人工晶状体植入手术后前部玻璃体混浊患者47例49只眼，采用Nd:YAG激光行晶状体后囊切开的同时进行前部玻璃体切开及松解，观察激光治疗前后的视力变化、前部玻璃体混浊的改善情况以及治疗后的并发症。 结果 49只眼中，前部玻璃体混浊伴有晶状体后囊混浊46 只眼，晶状体后囊无明显混浊3只眼。Nd:YAG激光玻璃体松解术后视力均有改善,与术前比较差异有显著性的意义(t=3 2.50，P=0.007)。激光松解术后15 min前部混浊的玻璃体形成透明区者21只眼，占42.86% ；24 h内形成透明区者47只眼，占95.92%；2只眼在术后7 d透明区小于瞳孔接受了第2次激光治疗。全部患眼术中和术后无并发症发生。 结论 人工晶状体植入手术后视力缓慢下降的患者，除考虑有后发障外，还应注意是否有前部玻璃体混浊的存在。Nd:YAG激光晶状体后囊切开联合前部玻璃体松解是治疗人工晶状体植入手术后前部玻璃体混浊的有效方法。 （中华眼底病杂志，2003，19：99-101）     

Effect of Nd∶YAG laser treatment for correlative capsular syndrome

ObjectiveTo study the clinical effect of Nd∶YAG laser treatment for correlative capsular syndrome after cataract phacoemulsification with foldable intraocular lenses （IOL） implants. MethodsThis was a retrospective case-controlled study. Thirty-three patients （33 eyes） diagnosed with correlative capsular syndrome who underwent cataract phacoemulsification with foldable IOL implantation were treated with Nd∶YAG laser. Twelve eyes were in the capsular contraction syndrome （CCS） group and 21 eyes were in the capsular block syndrome （CBS） group. In the CCS group, radial cuts were made in 10 eyes for anterior capsular fibrillar contraction rings and posterior capsulotomy with Nd∶YAG laser was used in 2 eyes. Seven eyes with early postoperative CBS underwent peripheral anterior capsulotomy with Nd∶YAG laser and fluid from the capsular bag was drained into the anterior chamber. Two of them had procedures that were combined with posterior capsulotomy. Fourteen eyes in the CBS group with late postoperative CBS underwent posterior capsulotomy with Nd∶YAG laser to liberate fluid from the capsular bag into the vitreous cavity. All cases were followed up for 6 months. ResultsIn the CCS group postoperatively, the anterior capsular fibrillar contraction rings were relaxed, capsular bag contraction disappeared, the anterior capsular transparent zones were enlarged, IOLs were in the central position, the lenses were stretched and there was no deviation in IOL tilt or capsular bag capture. In the CBS group postoperatively, IOLs were in good position, the posterior capsules were attached to the posterior surface of the lenses without spaces, and capsular bag block was relieved effectively. Pupillary block had disappeared, the depth of the anterior chamber had deepened and IOP was normal in all 7 eyes with early CBS. Uncorrected visual acuity （UCVA） improved at different degrees postoperatively in the CBS and CCS groups. ConclusionNd∶YAG laser is a good choice for correlative capsular syndrome after cataract phacoemulsification with foldable IOL implantation. It has a definite clinical effect and is a simple and safe procedure.     

Nd:YAG激光治疗晶体囊阻滞综合征的临床观察

目的：总结晶体囊袋阻滞综合征的临床特点并评价Nd:YAG激光的治疗效果。方法：对6例晶体囊袋阻滞综合征的临床特点进行回顾性分析,其中4例使用科以人7970Nd:YAG激光机行Nd:YAG激光前后囊膜切开术,平均能量4．7mJ,平均击发69次。结果：6例晶体囊袋阻滞综合征共同表现为连续环形撕囊术后人工晶体光学面被连续环行撕囊口阻塞,晶体囊袋形成密闭的液性腔,后囊膜向后膨隆。4例Nd:YAG激光前后囊膜切开成功,视力明显提高,后囊膜复位。结论：晶体囊袋阻滞综合征是白内障手术并发症之一,对术后迟发膨胀型者,Nd:YAG激光前后囊膜切开术是安全、有效的治疗方法。     

Capsular block syndrome associated with horizontal jerk nystagmus

A 78-year-old cataract patient with horizontal jerk nystagmus had phacoemulsification and intraocular lens (IOL) implantation in the capsular bag with continuous curvilinear capsulorhexis. One week postoperatively, the posterior capsule ballooned posteriorly, the anterior capsule opening was sealed to the IOL optic, and a transparent liquefied substance accumulated between the lens optic and the posterior capsule. The best corrected visual acuity was 0.6 with a myopic shift compared with the refraction after the first day. A neodymium:YAG laser posterior capsulotomy was performed, and the capsular block syndrome (CBS) resolved. The results confirm the experimental model proposed by Zacharias suggesting that saccadic eye movements contribute to CBS under certain anatomic conditions.     

Capsular bag distention after implantation of foldable acrylic lenses

BACKGROUND: Incomplete removal of the viscoelastic material during cataract surgery may lead to the early postoperative capsular block syndrome. In this retrospective case series, postoperative capsular bag distention after implantation of a foldable acrylic lens is reported and the sequelae are analyzed. PATIENTS AND METHOD: In a retrospective case series, 10 eyes of altogether 1674 eyes that underwent cataract surgery in the years 2001 and 2002 were identified with early postoperative capsular block syndrome. All 10 eyes had cataract removal with continuous curvilinear capsulorhexis, phacoemulsification and a foldable acrylic lens was placed in the capsular bag. In 4 of 10 eyes cataract extraction was combined with trabeculectomy. All patients had posterior Nd:YAG capsulotomy. Refraction was performed before and after capsulotomy. RESULTS: Postoperative examination showed capsular bag distention in all eyes. The mean postoperative spherical equivalent was -3.9 +/- 1.6 Dpt. As the target refraction was -1.2 +/- 1.0 Dpt there was an average of -2.7 +/- 1.4 Dpt of induced myopia. A mild increase in postoperative anterior chamber inflammation was noted only in 1 patient and shallowing of the anterior chamber was observed in another patient. Posterior Nd:YAG capsulotomy was performed 4.5 +/- 4.3 months after surgery. The mean refractive shift after Nd:YAG capsulotomy was 1.9 +/- 1.9 Dpt. CONCLUSIONS: Unexpected postoperative myopic correction was the main manifestation of capsular block syndrome in this series. Intraoperative use of miotics prohibiting optical control of complete viscoelastic removal may explain the high proportion of combined procedures. In the case of unexpected postoperative myopia the position of the intraocular lens within the bag should be checked and attention should be paid to possibly incompletely removed viscoelastic material.     

Neodymium:YAG laser damage threshold of foldable intraocular lenses

PURPOSE: To determine the energy level of the neodymium:YAG (Nd:YAG) laser that induced a 50% incidence of intraocular lens (IOL) damage in 5 foldable IOL materials. SETTING: Department of Ophthalmology, Siriraj Hospital Mahidol University, Bangkok, Thailand. METHODS: To simulate the condition within the capsular bag, an IOL was sandwiched between 2 rubber membranes. The front membrane had a central opening mimicking the anterior capsulotomy; the back membrane acted as the posterior capsule. The model was submerged in a water-filled chamber. The Nd:YAG laser with an automatic focus 150 microm beyond the focus of the aiming beam was used to perform a posterior capsulotomy. Three IOLs of each of 5 foldable IOL materials were tested. One type of poly(methyl methacrylate) (PMMA) was studied as a reference. The incidence of IOL damage at various energy levels was recorded. Linear regression analysis was used to determine the 50% incidence damage threshold. RESULTS: The 6 materials tested included 1 silicone lens (SI-40NB, AMO), 1 hydrophobic acrylic lens (MA60BM, Alcon), 3 hydrophilic acrylic lenses (Haptibag Ang, IOLtech; ACR6D, Corneal; H60M, Bausch & Lomb), and 1 PMMA lens (LX10BD, Alcon). The 50% incidence damage threshold values were 0.37 mJ, 0.54 mJ, 0.58 mJ, 0.52 mJ, 0.66 mJ, and 0.68 mJ, respectively. CONCLUSIONS: The 50% incidence damage threshold in all the IOLs was below the energy level normally used to perform a posterior capsulotomy in clinical practice. However, setting the laser at the lowest possible energy, focusing the laser beam beyond the posterior capsule, and performing the capsulotomy early should minimize the risk of IOL damage.     

Scheimpflug imaging in late Capsular Bag Distention syndrome after phacoemulsification

PURPOSE: To describe two cases of late Capsular Bag Distention syndrome (CBDS) and posterior capsular opacification (PCO) as documented on Pentacam. DESIGN: Case series. METHODS: A 55-year-old male and a 72-year-old female presented three years after phacoemulsification and intraocular lens (IOL) implantation with a complaint of decreased vision. Scheimpflug imaging was done using Pentacam. Patients underwent Nd:YAG capsulotomy for PCO, and postcapsulotomy capsular bag dynamics were imaged on Pentacam. RESULTS: Three years after phacoemulsification, patients presented with blurred vision and posterior bowing of opacified posterior capsule. Anterior capsular opening was apparently sealed by lens optic, and space between IOL and opacified posterior capsule was filled with turbid fluid. Nd:YAG laser capsulotomy was done. All findings, including collapse of distended bag, were precisely documented on Scheimpflug images. CONCLUSIONS: Pentacam Scheimpflug imaging is a useful technique to diagnose and document the presence and progress of CBDS and PCO.     

Postoperative Capsular Bag Distension Syndrome – Risk Factors and Treatment

Introduction:Postoperative capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery which might occur in the early postoperative period, as well as several years after uncomplicated surgery. The aim of this study was to review the current evidence on postoperative capsular bag distension syndrome. Material and Methods: PubMed and Web of Science were used for literature search. Results: The typical presentation involves deterioration in visual acuity, unexpected myopic shift or less frequently hyperopia. In eyes with clear capsular fluid and no posterior capsule opacification, usually in the late postoperative period, CBDS can be asymptomatic. Risk factors for developing CBDS include retained ophthalmic viscoelastic device, inadequate subincisional cortex cleaning, apposition between the intraocular lens (IOL) and the capsular bag, postoperative inflammation and IOL sequestration with Propionibacterium acnes. Visualization of the CBDS can be aided with Scheimpflug imaging, ultrasound biomicroscopy, and particularly anterior-segment optical coherence tomography. Conclusion:Nd:YAG posterior capsulotomy, and in some cases anterior capsulotomy, is accepted as a standard and effective CBDS treatment. Surgical approach could be beneficial in cases suspected of Propionibacterium acnes presence or when it is impossible to perform Nd:YAG posterior capsulotomy.     

Implantation of the modified endocapsular bending ring in pediatric cataract surgery using a viscoadaptive viscoelastic agent

Cataract surgery and intraocular lens (IOL) implantation in pediatric eyes remain controversial. Using a viscoadaptive viscoelastic agent, we implanted a modified capsular bending ring (CBR) as well as an acrylic IOL with a sharp-optic-edge design in the capsular bag. All operated eyes demonstrated a low postoperative inflammatory reaction and a clinically well-centered IOL. The band-shaped, sharp-edged CBR facilitates the creation of a sharp, discontinuous bend in the equatorial capsule, which prevents anterior and posterior capsule opacification. Combining the viscoadaptive viscoelastic agent and the CBR enhances the safety of primary and secondary posterior chamber IOL implantation in pediatric cataract surgery, reduces capsule opacification, and may facilitate IOL exchange.     

Incomplete capsular bag distension syndrome after neodymium:YAG capsulotomy

We report a 60-year-old man with incomplete capsular bag distension syndrome 2 years after neodymium:YAG (Nd:YAG) laser capsulotomy for capsule opacification, which developed from extracapsular cataract extraction with intraocular lens (IOL) implantation performed 4 years before presentation to our clinic. The patient reported floaters of 15 days duration. Slitlamp examination showed shallowing of the inferior and medial anterior chamber. Dilated pupil examination showed a peripheral capsular bag inferiorly and medially behind the IOL. The bag was distended and filled with turbid fluid. The central and superior capsule was absent as a result of the previous Nd:YAG treatment. The IOL lie over the anterior capsule, and peripheral capsule leaves' edges were adhered. An Nd:YAG laser puncture of the incomplete capsular bag resolved the condition.     

两种Nd:YAG激光后囊切开方式对不同材料人工晶状体损伤的观察

目的观察Nd:YAG激光后囊膜切开方式对不同材料的人工晶体(IOL)损伤的情况。方法对86例(124只眼)IOL眼晶状体后囊膜混浊(posterior capsule opacity,PCO)患者随机分为两组行Nd:YAG激光后囊膜切开术。A组64眼采用环行切开后推膜瓣法,人工晶体包括:PMMA23眼、疏水性丙烯酸26眼、硅凝胶15眼。B组60眼行十字形切开法,人工晶体包括:PMMA21眼、疏水性丙烯酸25眼、硅凝胶14眼。术前术后常规眼前段检查、测视力、眼压。结果截囊成功率100%。发生IOL损伤16眼,其中A组6眼(9.38%),B组10眼(16.67%),两种方式对相同材料的人工晶体损伤的机率相似(均p>0.05),不同材料的耐受强弱依次为PMMA、疏水性丙烯酸、硅凝胶,均为轻度损伤。结论两种方式对不同材料损伤的机率依次为硅凝胶、疏水性丙烯酸、PMMA,但环行切开后推膜瓣法可以减少Nd:YAG激光后囊膜切开术IOL损伤机率。