术后早期晶状体囊袋阻滞综合征分析

目的探讨白内障超声乳化联合人工晶状体植入术后早期晶状体囊袋阻滞综合征（capsular block syndrome，CBS）的易发因素、处理方法及效果。方法分析我院2006年1月至2007年1月所发生的9例白内障术后早期CBS病例的临床特点，并随访了不同处理方法的效果。结果9例患者均发生在术后早期（术后1天-1周）。其中8例裸眼视力低于0.4，且具有明显的近视漂移平均等效球镜（-2.50＋0.71）D]，另1例裸眼视力0.9（1.0＊＋0.25／-0.75×95）。6例患者使用了四襻式亲水性丙烯酸酯人工晶状体，2例患者使用了一片式亲水性丙烯酸酯人工晶状体，1例患者植入了三片式丙烯酸酯人工晶状体。前囊撕囊直径5-5.5mm，人工晶状体与后囊之间留有明显的间隙。对其中6例患者施行了前房灌洗术，术中吸除囊袋内部分黏弹剂样物质，术后第1天裸眼视力均恢复至0.7以上，平均等效球镜减少-1.60 D；1例施行了Nd：YAG激光前囊周边部打孔术，裸眼视力恢复至0.8；1例患者因瞳孔不能充分散大，后囊已有轻微混浊，我们施行了Nd：YAG激光后囊切开，裸眼视力恢复至0.6；另1例因裸眼视力0.9，没有明显近视，未作处理，2周后囊袋内液体吸收，后囊贴附；随访5个月8例患者后囊均未发生混浊（8例后囊未切开，其中1例已行后囊切开）。结论前囊撕囊直径过小，术中黏弹剂残留是术后早期CBS的两个易发因素，术后早期前房灌洗以及择期Nd：YAG激光前囊或后囊切开均可以有效治疗术后早期CBS。

Early postoperative capsular block syndrome

Objective To discuss the risk factors, treatment and the effects of early postoperative capsular block syndrome （CBS） after phacoemulsification and intraocular lens （IOL） implantation. Methods Nine patients who developed early postoperative CBS from January 2006 to January 2007 in our hospital were included in this study. The clinical characteristics and follow-up results of different treatments were analyzed. Results The postoperative CBS of all 9 patients occurred in the early postoperative period （postop- erative 1 day-1 week）; visual acuity （VA） for 8 of the 9 patients was below 0.4, with a distinct myopic drift （mean spherical equiva-lent -2.50±0.71 D）, and the VA of the remaining patient was 0.9 （1.0＊＋0.25/-0.75×95）. Six patients used a four-loop hydrophilic acrylic intraocular lens, 2 patients used a one-piece hydrophilic acrylic intraocular lens and the remaining patient used a three- piece hydrophilic acrylic intraocular lens. The capsulorhexis diameter of the anterior capsule was less than 5.5 mm, and there was a significant gap between the posterior capsule and the IOL. Anterior chamber lavage was performed on the eyes of 6 of the 9 patients, and some viscoelastic material was aspirated from the capsular bag with VA recovering to 0.7 or better on the first postoperative day and mean postoperative spherical equivalent was reduced by -1.60 D. One patient underwent a YAG laser anterior capsulotomy with 0.8 VA. The pupil was not casual in one patient and there was a slight posterior capsule opacity, so YAG laser capsulotomy was performed with 0.6 VA. No special treatment was necessary in another case due to good VA （0.9） and no apparent myopia. However, the patient was followed up for two weeks after the operation. The liquid in the bag had dissipated and the posterior capsule was touching the IOL. There was no posterior capsule opacification during the 5-month follow-up period. Conclusion Incomplete removal of the viscoelastic material during cataract surgery and a capsul