液性后发性白内障的临床特点及激光治疗

Clinical character and laser treatment of liquefied after-cataract

目的报告一种罕见的液性后发性白内障（1iquefied after—cataract，LAC）的临床特点及治疗方式，分析其并发症及治疗结果。方法回顾性分析2011年1月至2015年3月在天津市眼科医院就诊的7例（8只眼）液性后发性白内障，所有病例均行常规裂隙灯显微镜、检眼镜、B超等检查，诊断验光、裂隙灯显微镜照相检查，非接触眼压计测眼压。详细询问眼病史及全身病病史。以0．1％氟美龙及双氯芬酸钠4次／d滴眼1周无缓解后行Nd—YAG激光后囊切开术治疗。结果7例8只眼为顺利的晶状体超声乳化术后3～10年，发生液性后发性白内障，无前房炎症反应。1例有关节炎病史，1例有视网膜色素变性，3例4只眼为高度近视，1例有糖尿病视网膜病变，1例有青光眼手术史和色素膜炎病史。所有病例药物治疗均无效，后经激光后囊切开治愈。激光前后屈光状态无明显改变，人工晶状体位置无改变。1例术后2h发生一过性高眼压，1例术后发生全葡萄膜炎，2周内恢复，无其他并发症。结论LAC表现为在人工晶状体和囊膜间乳白色液体集聚从而影响视力。Nd—YAG激光后囊切开术是其有效的治疗方法。激光术后并发症为一过性高眼压，色素膜炎。青光眼，葡萄膜炎，高度近视，视网膜色素变性．糖尿病视网膜病变等为其可能危险因素。

Objective To introduce a rare liquefied after-cataract （LAC） and study its clinical characters, treatment and complications after laser capsulectomy. Methods Seven patients （8 eyes） with LAC were retrospectively analyzed. All patients were examined by slit-lamp microscopy, funduscopy, B-ultrasound, optometry and tonometry. 0.1% fluorometholone and diclofenac sodium eye drops were used for all patients 4 times daily for a week. Then Nd-YAG laser capsulectomy was performed. Results Phacoemulsification was performed successfully in 8 eyes of 7 cases. Three to ten years after surgery, LAC happened and no signs of aqueous inflammation were found. One patient had arthritis and one had retinitis pigmentosa. 4 eyes of three patients had high myopia and the axial length was 26.03-28.74mm, 1 had diabetic retinopathy, 1 had PACG and anti-glaucoma surgery and uveitis history. Eye drops had no effect, and all patients were cured by laser posterior capsulectomy. The refraction did not change and no IOL forward displacement were found after laser capsulectomy. The intraocular pressure was elevated in one eye 2 hours after laser capsulectomy, and recovered soon by medication, 1 had uveitis and was cured within 2 weeks. Conclusions LAC is characterized by milky white liquid accumulate between intraocular lens and capsulular bag, which can cause blurred vision. Nd-YAG laser capsulectomy is an effective treatment. Transit elevated intraocular pressure and uveitis are its complications. Glaucoma, uveitis, high myopia, retinitis pigmentosa and diabetic retinopathy may be its risk factors.