迟发性囊袋阻滞综合征临床特征、治疗方法及其疗效的临床研究

doi:10.3877/cma.j.issn.2095-2007.2023.02.002

中华眼科医学杂志(电子版) ›› 2023, Vol. 13 ›› Issue (02) : 70 -75. doi: 10.3877/cma.j.issn.2095-2007.2023.02.002

论著

迟发性囊袋阻滞综合征临床特征、治疗方法及其疗效的临床研究

郝壮, 马济远, 何梦梅, 李兴育, 陆新婷, 武静, 周健^†(

)

710032　西安，空军军医大学西京医院眼科　全军眼科研究所；130000　长春，空军航空大学门诊部
710032　西安，空军军医大学西京医院眼科　全军眼科研究所
710032　西安，空军军医大学西京医院眼科　全军眼科研究所；710004　西安，西安市人民医院　陕西省眼科医院白内障与人工晶状体中心

收稿日期:2023-02-11 出版日期:2023-04-28
通信作者: 周健
基金资助:
陕西省重点研发计划基金项目(2022SF－067)

Clinical features, surgical treatment and its effectiveness of late-onset capsular block syndrome

Zhuang Hao, Jiyuan Ma, Mengmei He, Xingyu Li, Xinting Lu, Jing Wu, Jian Zhou^†()

Department of Ophthalmology, Xijing Hospital, Air Force Medical University, Eye Institute of PLA, Xi′an 710032, China; Department of Clinics, Aviation University of Air Force, Changchun 130000, China
Department of Ophthalmology, Xijing Hospital, Air Force Medical University, Eye Institute of PLA, Xi′an 710032, China
Department of Ophthalmology, Xijing Hospital, Air Force Medical University, Eye Institute of PLA, Xi′an 710032, China; Center of Cataract and Intraocular Lens, Xi′an People′s Hospital, Shaanxi Ophthalmic Hospital, Xi′an 710004, China

Received:2023-02-11 Published:2023-04-28
Corresponding author: Jian Zhou

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引用本文：

郝壮, 马济远, 何梦梅, 李兴育, 陆新婷, 武静, 周健. 迟发性囊袋阻滞综合征临床特征、治疗方法及其疗效的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2023, 13(02): 70-75.

Zhuang Hao, Jiyuan Ma, Mengmei He, Xingyu Li, Xinting Lu, Jing Wu, Jian Zhou. Clinical features, surgical treatment and its effectiveness of late-onset capsular block syndrome[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2023, 13(02): 70-75.

目的

探讨迟发性囊袋阻滞综合征(LCBS)的临床特征及手术治疗效果。

方法

选取2007年1月至2022年6月空军军医大学西京医院眼科诊为LCBS的住院患者12例(12只眼)。其中，男性3例(3只眼)，女性9例(9只眼)。年龄44~87岁，平均年龄(66.5±11.42)岁。全部患者散瞳后均行裂隙灯显微镜检查；其中，8例(8只眼)再采用超声生物显微镜检查囊袋与人工晶状体(IOL)的位置关系。所有患者均行前囊环松解联合囊袋内液体吸除术。收集并记录患者的性别、年龄、眼别、术后发病时间、症状特点、植入IOL的类型及其他眼病史；检测并记录术前与术后患眼的视力、眼压、屈光度、最佳矫正视力(BCVA)和术中及术后并发症，采用频数和百分比描述；与合并症相关的年龄、眼轴长度、术后发生囊袋阻滞综合征的时间、术前前房深度及后囊与IOL距离，经Shapiro－Wilk检验符合正态分布，采用(±s)描述。

结果

全部LCBS患者12例(12只眼)，均为单眼发病，发病时间在白内障术后2~10年，平均(5.00±2.37)年；视力下降是主要症状，术前BCVA为指数/眼前~0.8，中位数为0.2(0.05，0.55)；屈光度－5.00 D~+2.75 D，中位数为－2.31(－3.50，0.125)D。眼压9~22 mmHg(1 mmHg＝0.133 kPa)，平均(15.3±3.98)mmHg；眼轴长度20.80~32.63 mm，平均(25.45±3.87)mm；前房深度2.90~4.86 mm，平均(3.36±0.69)mm；其中，合并高度近视眼者6例(6只眼)，占50%(6/12)。植入三片式折叠C形袢疏水型IOL者9例(9只眼)，占75%(9/12)，植入无后倾角2袢或4袢亲水型IOL者3例(3只眼)，占25%(3/12)。术后第1天，视力较术前提高者有10例(10只眼)，占83%(10/12)；术后视力较术前下降者2例(2只眼)，占17%(2/12)。术后眼压8~19 mmHg，平均(15.00±3.03)mmHg。患眼术后屈光度改变－4.25 D~+2.00 D，中位数为－1.00(－2.13，0.56)D。术中及术后均未见严重并发症发生。

结论

LCBS起病隐匿，其主要临床表现为轻度视力下降，无明显的眼压升高和近视漂移；白内障合并高度近视眼的患者术后易发生LCBS；各种设计和材料的IOL都可能发生LCBS。前囊环松解联合囊袋内液体吸除术是治疗严重LCBS有效且安全的治疗方法。

关键词: 囊袋阻滞综合征, 手术治疗, 高度近视, 白内障手术, 并发症

Objective

To investigate the clinical features, surgical treatment and its effectiveness and of late-onset capsular block syndrome (LCBS).

Methods

A total of 12 patients (12 eyes) diagnosed with LCBS were enrolled from January 2007 to June 2022 at Department of Ophthalmology of Xijing Hospital, Air Force Medical University. All 12 cases (12 eyes) were detected and diagnosed by slit-lamp microscope after dilating pupils. In order to clarify the location of the capsular bag and intraocular lens (IOL), 8 cases (8/12) were performed by the ultrasound biomicroscopy. All the enrolled patients underwent releasing the adhesion of the anterior capsular ring combined with fluid aspiration in the capsular bag. The complete data of the patients were collected, including gender, age, laterality, onset time, clinical features, IOL type, and other ocular medical histories. The visual acuity, intraocular pressure (IOP) and refraction before and after surgery were examined and documented, and intraoperative and postoperative complications were recorded. All of the above clinical measurement data were described using frequencies and percentages. Age, axial length, postoperative time to capsular bag block syndrome, preoperative anterior chamber depth and distance between the posterior capsule and the IOL conformed to normal distribution through Shapiro-Wilk test, and were described by±s.

Results

The onset of LCBS ranged from 2 to 10 years after cataract surgery, with an average period of (5.00±2.37) years. The visual acuity loss was the main symptom, with preoperative best corrected visual acuity (BCVA) ranging from countfigures to 0.8, with a median value of 0.2 (0.05, 0.55); the diopter of all patients was -5.00 D to + 2.75 D with a median value of -2.31(-3.50, 0.125)D. IOP of all patients ranged from 9 to 22 mmHg (1 mmHg=0.133 kPa), with an average value of (15.3±3.98) mmHg. Axial length was 20.8 to 32.63 mmwith an average value of (25.45±3.87) mm; and the anterior chamber depth ranged from 2.90 to 4.86 mm, with an average value of (3.36±0.69) mm. A total of 6 cases (6 eyes) were combined with high myopia before surgery, accounting for 50% (6/12). Nine cases (9 eyes) had three-piece foldable C-loop hydrophobic IOL and 3 cases (3 eyes) had two-loop or four-loop hydrophilic IOL without the angle to the posterior capsule, accounting for 75% (9/12) and 25% (3/12), respectively. There were 10 cases (10 eyes) with visual acuity improved on the 1^st postoperative day compared with the preoperative, and 2 cases (2 eyes) decreased after surgery, accounting for 83% (10/12) and 17% (2/12), respectively. Postoperative IOP ranged from 8 to 19 mmHg, with an average value of (15.0±3.03) mmHg. The changes of postoperative refraction were from -4.25 D to + 2.00 D, with a median value of -1.00 (-2.13, 0.563) D. There were not observed serious intraoperative or postoperative complications.

Conclusions

The onset of LCBS is insidious, and its primary clinical manifestation is mild visual acuity loss, with no apparent IOP increase and myopia shift. Patients with high myopia are prone to LCBS after cataract surgery, and LCBS can occur with IOLs of various designs and materials. Adhesion of anterior capsular ring releasing combined with fluid aspiration in the capsular bag is an effective and safe surgical treatment for severe LCBS.

Key words: Capsular bag block syndrome, Surgical treatment, High myopia, Cataract surgery, Complications

表1 纳入本研究囊袋阻滞综合征患者的基本情况

患者编号	性别	年龄(岁)	眼别	眼轴长度(mm)	术后时间(年)	其他相关眼病	人工晶状体的特点(型号)
1	女	58	左	32.63	4	高度近视眼合并黄斑板层裂孔	三片式折叠，C形袢，疏水型(AR40M)
2	女	70	右	31.49	8	高度近视眼	三片式折叠，C形袢，疏水型(AR40e)
3	女	57	右	30.79	5	高度近视眼	三片式折叠，C形袢，疏水型(AR40e)
4	女	66	左	22.80	4	无	一片式折叠，2袢，亲水型(RAYNER)
5	女	61	右	25.27	7	高度近视眼合并黄斑裂孔	三片式折叠，C形袢，疏水型(PY－60AD)
6	女	72	左	22.30	10	无	三片式折叠，C形袢，疏水型(ZA9003)
7	男	61	左	25.90	2	高度近视眼	一片式折叠，4袢，亲水型(AKREOS－ADAPT)
8	男	71	右	22.40	5	无	三片式折叠，C形袢，疏水型(ZA9003)
9	女	44	右	22.50	3	无	三片式折叠，C形袢，疏水型
10	男	70	右	22.77	2	糖尿病视网膜病变	三片式折叠，C形袢，疏水型
11	女	81	右	20.80	5	无	三片式折叠，C形袢，疏水型
12	女	87	右	25.75	5	高度近视眼	一片式折叠，2袢，亲水型(RAYNER)

表1 纳入本研究囊袋阻滞综合征患者的基本情况

患者编号	性别	年龄(岁)	眼别	眼轴长度(mm)	术后时间(年)	其他相关眼病	人工晶状体的特点(型号)
1	女	58	左	32.63	4	高度近视眼合并黄斑板层裂孔	三片式折叠，C形袢，疏水型(AR40M)
2	女	70	右	31.49	8	高度近视眼	三片式折叠，C形袢，疏水型(AR40e)
3	女	57	右	30.79	5	高度近视眼	三片式折叠，C形袢，疏水型(AR40e)
4	女	66	左	22.80	4	无	一片式折叠，2袢，亲水型(RAYNER)
5	女	61	右	25.27	7	高度近视眼合并黄斑裂孔	三片式折叠，C形袢，疏水型(PY－60AD)
6	女	72	左	22.30	10	无	三片式折叠，C形袢，疏水型(ZA9003)
7	男	61	左	25.90	2	高度近视眼	一片式折叠，4袢，亲水型(AKREOS－ADAPT)
8	男	71	右	22.40	5	无	三片式折叠，C形袢，疏水型(ZA9003)
9	女	44	右	22.50	3	无	三片式折叠，C形袢，疏水型
10	男	70	右	22.77	2	糖尿病视网膜病变	三片式折叠，C形袢，疏水型
11	女	81	右	20.80	5	无	三片式折叠，C形袢，疏水型
12	女	87	右	25.75	5	高度近视眼	一片式折叠，2袢，亲水型(RAYNER)

表2 术前与术后囊袋阻滞综合征患眼的视力、眼压及屈光度情况

患者编号	术前BCVA	术后BCVA	术前眼压(mmHg)	术后眼压(mmHg)	术前屈光度(D)	术后屈光度(D)
1	0.02	0.05	13.0	8.0	未获得	未获得
2	0.08	0.8	15.0	18.0	－3.75	－2.00
3	0.6	0.2	16.0	19.0	－5.00	－4.25
4	0.5	0.6	10.0	15.0	+2.75	+1.25
5	0.15	0.2	17.0	16.0	－3.25	－2.25
6	0.5	0.8	13.0	12.0	+1.00	－1.25
7	0.25	0.05	15.0	13.0	－1.25	+3.00
8	0.8	1	21.0	17.7	－1.38	－0.50
9	指数/眼前	0.6	19.0	15.0	未获得	－1.50
10	指数/30 cm	0.8	9.0	17.3	未获得	－0.75
11	0.4	0.6	22.0	14.0	未获得	+2.25
12	0.1	0.6	14.0	15.0	－3.25	－1.25

表2 术前与术后囊袋阻滞综合征患眼的视力、眼压及屈光度情况

患者编号	术前BCVA	术后BCVA	术前眼压(mmHg)	术后眼压(mmHg)	术前屈光度(D)	术后屈光度(D)
1	0.02	0.05	13.0	8.0	未获得	未获得
2	0.08	0.8	15.0	18.0	－3.75	－2.00
3	0.6	0.2	16.0	19.0	－5.00	－4.25
4	0.5	0.6	10.0	15.0	+2.75	+1.25
5	0.15	0.2	17.0	16.0	－3.25	－2.25
6	0.5	0.8	13.0	12.0	+1.00	－1.25
7	0.25	0.05	15.0	13.0	－1.25	+3.00
8	0.8	1	21.0	17.7	－1.38	－0.50
9	指数/眼前	0.6	19.0	15.0	未获得	－1.50
10	指数/30 cm	0.8	9.0	17.3	未获得	－0.75
11	0.4	0.6	22.0	14.0	未获得	+2.25
12	0.1	0.6	14.0	15.0	－3.25	－1.25

表3 囊袋阻滞综合征患眼合并高度近视眼与非高度近视眼临床特征的比较

是否合并高度近视	年龄(岁)	眼轴长度(mm)	术后患囊袋阻滞综合征时间(年)	术前前房深度(mm)	后囊与人工晶状体距离(mm)	术后视力提高(只眼)	术后视力不提高(只眼)	术后近视(只眼)	术后非近视(只眼)	三片式疏水人工晶状体(只眼)	一片式亲水人工晶状体(只眼)
高度近视	65.67±11.41^*	28.64±3.34^*	5.17±2.13^*	3.64±0.93^*	1.57±0.88^**	4	2	4	1	4	4
非高度近视	67.33±12.45^*	22.26±0.74^*	4.83±2.78^*	3.08±1.37^*	0.89±0.48^**	6	0	3	3	5	2

表3 囊袋阻滞综合征患眼合并高度近视眼与非高度近视眼临床特征的比较

是否合并高度近视	年龄(岁)	眼轴长度(mm)	术后患囊袋阻滞综合征时间(年)	术前前房深度(mm)	后囊与人工晶状体距离(mm)	术后视力提高(只眼)	术后视力不提高(只眼)	术后近视(只眼)	术后非近视(只眼)	三片式疏水人工晶状体(只眼)	一片式亲水人工晶状体(只眼)
高度近视	65.67±11.41^*	28.64±3.34^*	5.17±2.13^*	3.64±0.93^*	1.57±0.88^**	4	2	4	1	4	4
非高度近视	67.33±12.45^*	22.26±0.74^*	4.83±2.78^*	3.08±1.37^*	0.89±0.48^**	6	0	3	3	5	2

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Clinical features, surgical treatment and its effectiveness of late-onset capsular block syndrome

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Clinical features, surgical treatment and its effectiveness of late-onset capsular block syndrome