双眼亲水性丙烯酸酯人工晶状体混浊房水检测和超微结构分析

Aqueous humor and ultramicrostructure analysis of bilateral hydrophilic acrylate intraocular lens opacification

研究背景人工晶状体混浊在临床上相对少见,而亲水性丙烯酸酯人工晶状体混浊的发生率相对较高,多为沉积性混浊,其发病机制复杂,房水高钙磷是可能的机制之一。病例报告69岁男性,双眼行超声乳化白内障吸除并植入亲水性丙烯酸酯人工晶状体(IOL),术后1年逐渐出现视力下降,就诊时查见双眼IOL混浊。既往高血压、糖尿病、冠状动脉粥样硬化性心脏病、脑梗死、风湿免疫性疾病病史。予双眼人工晶状体置换术。术前查血动态红细胞沉降率为17 mm/h,高于正常范围(0~15 mm/h),类风湿因子20 IU/m L,为正常范围(0~20 IU/m L)高限。血清免疫球蛋白、补体均在正常范围,各种抗体检查均为阴性。血液和房水中钙和磷水平在正常范围内。血管内皮生长因子(VEGF)32.7 pg/m L,接近正常范围(0~40 pg/m L)高限。手术取出的混浊亲水性丙烯酸酯IOL表现为乳白色雾状均质混浊,经透射电子显微镜和能量色散X射线光谱仪检测,其表面为致密含钙结晶物沉积,可溶解于1%氯化氢溶液。混浊IOL前表面结晶小体附着密集,而后表面几乎没有。结论该患者人工晶状体混浊为含钙物质沉积于人工晶状体表面,且前表面多于后表面,内部不存在结晶物。混浊的出现可能与人工晶状体材料或患者自身的糖尿病、风湿免疫性疾病有关。

BACKGROUND Intraocular lens opacification is relatively rare in clinical case. The incidence of opacity of hydrophilic acrylic intraocular lens is relatively high. Most of them are sedimentary turbidity. Its patho-genesis is complex, and high phosphorus and calcium in aqueous humor is one of the possible mechanisms. CASE REPORT A 69 year old man presented with phacoemulsification and implantation of hydrophilic acrylic intraocular lens（IOL）. 1 years later, visual acuity decreased and IOL opacity was seen. He had hypertension, diabetes, coronary atherosclerotic heart disease, cerebral infarction, and rheumatic immune disease. Intraocular lens replacement was performed. Preoperative blood dynamic erythrocyte sedimentation rate was 17 mm/h, higher than the normal range（0 ~ 15 mm/h）, rheumatoid factor 20 IU/m L, normal range is 0 ~ 20 IU/m L. The serum immunoglobulin and comple-ment were all in the normal range, and all kinds of antibodies were negative. The level of calcium and phosphorus in the blood and aqueous humor was within the normal range. Vascular endothelial growth factor（VEGF） was 32.7 pg/m L, close to the high limit of normal range（0~40 pg/m L）. The opacity of hydrophilic acrylic IOL showed milky white mist and homogeneous turbidity. The surface was calcium crystal by transmission electron microscope and energy dispersive X ray spectrometer, and dissolved in 1% hydrogen chloride solution. The crystal was densely attached to the front surface of the IOL, and the posterior surface was almost not. CONCLUSIONS The opacities of the intraocular lens were deposited on the surface of IOL with calcium containing material, and the front surface was more than the posterior surface, and there was no crystallization in the internal lens. The occurrence of opacity may be related to the intraocular lens material or the patient＇s own diabetes and rheumatic immune disease.