白内障术后早期囊袋阻滞综合征

The clinical study of early post-cataract surgery capsular block syndrome

目的探讨白内障行超声乳化联合人工晶状体植入术后因早期囊袋阻滞综合征（CBS）引起持续性高眼压的发病原因、预防及治疗方法。方法分析54例（54眼）白内障术后早期CBS病例的临床特点，22眼行微创前段玻璃体切除＋前房注气术，19眼行YAG激光周边前囊切开或后囊切开术，13眼行降眼压药物治疗。应用SPSS13．0软件包行单因素方差分析，比较三组处理方式的疗效。结果3组治疗后1周矫正视力提高，差异无统计学意义（P=0．594），眼压下降，差异有统计学意义（P=0．048）。3组随访3个月矫正视力差异无统计学意义（P=0．240），眼压差异有统计学意义（P=0．030），两两组间比较：玻切组和激光组间眼压差异无统计学意义（P=0．725），但分别显著优于药物组（P=0．004，P=0．033）。结论白内障术后早期CBS可以通过扩大撕囊口、选择合适的人工晶状体及提高手术技巧，彻底清除黏弹剂等途径有效预防。在保守治疗无效的情况下，及早行微创前段玻璃体切除＋前房注气术，可与激光治疗取得相同疗效，有效降低眼压，提高视力。

Objective To discuss the causes, prevention and treatment of persistent high intraocu- lar pressure caused by early capsular block syndrome （CBS） after phacoemulsification and intraocular lens （IOL） implantation. Methods 54 patients who developed early postoperative CBS were included in this study. 22 cases received anterior vitrectomy and anterior chamber gas injection, 19 cases received YAG laser anterior or posterior capsulotomy, 13 cases only received medication to drop intraocular pressure. Statistical data was analysed by SPSS 13.0 software package to compare the efficacy of treatment. Results The cor- rected visual acuity improved after one week of treatment, there was no significant difference between the three groups （P = 0. 594 ）. The high intraocular pressure relieved, there was significant difference （P = 0. 048 ）. After three months of follow-up, there was no significant difference between the three groups of cor- rected visual acuity （ P = 0. 240 ） , but there was significant difference of IOP （ P = 0. 030 ）. Furthermore, there was no significant difference of IOP between the vitrectomy group and laser group （ P = 0. 725 ）, but the IOP of the vitrectomy group and laser group was significantly better than that of medication group （ P = 0. 004, P = 0.033 ）. Conclusion The early postoperative CBS can be prevented by expansion of eapsulo- rhexis diameter, selecting appropriate intraocular lens, and improving surgical skills to complete removal of the viscoelastic material. When the medication fails, early operation of anterior vitrectomy and anterior chamber gas injection can effectively reduce intraocular pressure and improve corrected visual acuity, which may achieve the same effect of laser treatment.