白内障超声乳化术后囊袋皱缩综合征病因分析

Pathogeny analysis of capsular contraction syndrome following cataract phacoemulsification

目的探讨白内障超声乳化术后囊袋皱缩综合征的影响因素和危险因素、临床表现,为减少白内障术后囊袋皱缩综合征提供可靠有效的预防方法。方法回顾性分析2014年10月至2015年6月在我院收治的行白内障超声乳化联合人工晶状体植入术的白内障患者1028例(1242眼),术后1周、1个月、3个月、6个月、12个月复诊,观察患者视力、前囊口形态及直径、IOL位置及形态。结果 1242眼中19眼发生囊袋皱缩综合征,发生率1.53%。19眼中发生时间在术后3个月内者15眼(78.95%),术中未行前囊膜抛光16眼(84.21%),撕囊口直径过小(≤5 mm)16眼(84.21%),植入亲水性丙烯酸酯人工晶状体15眼(78.95%),合并全身或眼部疾病10眼(52.63%),术后炎症反应重8眼(42.11%)。囊袋皱缩综合征可引起视力下降、远视漂移。结论白内障术中撕囊口直径过小、前囊膜下晶状体上皮细胞残留是术后发生囊袋皱缩综合征的重要因素。人工晶状体的选择、合并全身或眼部疾病、术后炎症反应均是发生囊袋皱缩综合征的影响因素。术中大小适宜的环形撕囊、前囊膜下环周晶状体上皮细胞清除抛光可有效预防囊袋皱缩综合征的发生。

Objective To investigate the effective and risk factors of capsular contraction syndrome after phacoemulsification and intraocular lens implant, and offer a method to prevent patients from capsular contraction syndrome. Methods Retrospective analysis of hospital operative records was analyzed from October 2014 to June 2015. During this time period, 1028 cases （ 1242 eyes） of phacoemulsification and intraocular tens （IOL） implantation were performed. Capsular contraction syndrome was observed and analyzed at 1 week, 1 month, 3 months, 6 months and 12 months postoperatively, and the visual acuity, shape and diameter of anterior capsule opening, IOL position and shape were reviewed. Results In the 1028 cases （1242 eyes） patients, the occurrence of capsular contraction syndrome were in 19 eyes, the incidence of capsular contraction syndrome accounted for 1. 53%. Case with manifestation time less than 3 months occurred for 19 eyes （78.95%）, performed anterior capsule without polishing during the surgery accounted for 16 eyes （ 84.21% ）. Capsulorhexis opening diameter which was too small accounted for 16 eyes （ 84.21% ）. Implantation of hydrophilic acrylic IOL accounted for 15 eyes （78.95%）. Combining with systemic or ocular diseases accounted for 10 eyes （52.63%）. Postoperative inflammatory reaction accounted for 8 eyes （42. 11% ）. Capsular contraction syndrome could decrease the visual acuity and caused hyperopic shift. Conclusion Too small anterior capsule opening diameter in cataract surgery and the residual of lens epithelial cells under anterior capsule are important factors of capsular contraction syndrome in postoperative. Intraoperative appropriate size of circular capsulorhexis, under the anterior capsule lens epithelial cells circumferential clear polishing and choosing the right IOL can be effective in preventing the occurrence of capsular contraction syndrome.