PDF(Pubmed)
Abstract：
BACKGROUND: Late-onset capsule block syndrome (CBS) is a rare complication of cataract phacoemulsification and the implantation of a posterior chamber intraocular lens (PCIOL), which manifests six months to years after surgery. The hallmark of CBS is the formation of an opaque liquid substance between the implanted intraocular lens (IOL) and the posterior capsule. However, its pathogenesis remains unclear.
METHODS: A 64-year-old female patient with chronic angle-closure glaucoma (axis length < 21 mm) underwent trabeculectomy surgery combined with phacoemulsification and PCIOL. After a 4-year follow-up, a decline in visual acuity occurred in her right eye due to the location of opaque fluid in the visual axis and distension of the capsular bag. The initial course of action was to release the trapped fluid. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy could not be employed due to her non-dilating pupil and high extension of the posterior capsule. Subsequently, anterior capsule peeling and anterior segment vitrectomy surgery were performed. The depth of the anterior chamber (ACD), the distance between the face of the retro-IOL and the posterior capsule, the best-corrected visual acuity (BCVA), and the visual quality (VQ) were measured both before and after surgery. Inflammatory cytokine levels in the opaque substances (OS) trapped between the PCIOL and the posterior capsule were assessed using a flow cytometer and compared to normal statistical data in aqueous humor. After surgery, the patient experienced a significant improvement in BCVA and VQ. The distance between the face of the retro-IOL and the posterior capsule was on the verge of disappearing. However, ACD did not differ between pre- and post-operatively. Interleukin-8 (IL-8) and basic fibroblast growth factor (BFGF) concentrations were higher in the OS than in aqueous humor, especially in the former. However, the concentration of vascular cell adhesion molecule (VCAM) in the OS was lower than in aqueous humor.
CONCLUSIONS: Anterior segment vitrectomy surgery proved to be a successful treatment for late-onset CBS, presenting a challenging case. In the human lens, inflammatory cytokines originating from the opaque substances may contribute to abnormal metabolism in the sealed area, a consequence of late-onset CBS.
METHODS: A 64-year-old female patient with chronic angle-closure glaucoma (axis length < 21 mm) underwent trabeculectomy surgery combined with phacoemulsification and PCIOL. After a 4-year follow-up, a decline in visual acuity occurred in her right eye due to the location of opaque fluid in the visual axis and distension of the capsular bag. The initial course of action was to release the trapped fluid. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy could not be employed due to her non-dilating pupil and high extension of the posterior capsule. Subsequently, anterior capsule peeling and anterior segment vitrectomy surgery were performed. The depth of the anterior chamber (ACD), the distance between the face of the retro-IOL and the posterior capsule, the best-corrected visual acuity (BCVA), and the visual quality (VQ) were measured both before and after surgery. Inflammatory cytokine levels in the opaque substances (OS) trapped between the PCIOL and the posterior capsule were assessed using a flow cytometer and compared to normal statistical data in aqueous humor. After surgery, the patient experienced a significant improvement in BCVA and VQ. The distance between the face of the retro-IOL and the posterior capsule was on the verge of disappearing. However, ACD did not differ between pre- and post-operatively. Interleukin-8 (IL-8) and basic fibroblast growth factor (BFGF) concentrations were higher in the OS than in aqueous humor, especially in the former. However, the concentration of vascular cell adhesion molecule (VCAM) in the OS was lower than in aqueous humor.
CONCLUSIONS: Anterior segment vitrectomy surgery proved to be a successful treatment for late-onset CBS, presenting a challenging case. In the human lens, inflammatory cytokines originating from the opaque substances may contribute to abnormal metabolism in the sealed area, a consequence of late-onset CBS.
摘要：
背景：迟发性囊阻滞综合征（CBS）是白内障超声乳化术和后房型人工晶状体（PCIOL）植入的一种罕见并发症，手术后六个月到几年。CBS的标志是在植入的人工晶状体(IOL)和后囊之间形成不透明的液体物质。然而,其发病机制尚不清楚。
方法：1例64岁女性慢性闭角型青光眼（轴长<21mm）患者，行小梁切除术联合超声乳化和PCIOL。经过4年的随访,由于视轴中不透明液体的位置和囊袋的扩张，她的右眼视力下降。最初的行动过程是释放捕获的流体。由于她的瞳孔不扩张和后囊的高度延伸，无法采用钕：钇铝石榴石（Nd：YAG）激光囊切开术。随后，进行前囊剥离和前节玻璃体切除术。前房深度（ACD），后IOL表面和后囊之间的距离，最佳矫正视力（BCVA），手术前后测量视觉质量（VQ）。使用流式细胞仪评估PCIOL和后囊之间捕获的不透明物质（OS）中的炎性细胞因子水平，并与房水中的正常统计数据进行比较。手术后,患者经历了BCVA和VQ的显著改善.后IOL表面与后囊之间的距离濒临消失。然而,ACD在术前和术后之间没有差异。白细胞介素-8(IL-8)和碱性成纤维细胞生长因子(BFGF)在OS中的浓度高于房水,尤其是前者。然而,OS中血管细胞粘附分子（VCAM）的浓度低于房水。
结论：前节段玻璃体切除术被证明是治疗迟发性CBS的成功方法，提出一个具有挑战性的案例。在人类的镜头中，来自不透明物质的炎性细胞因子可能导致密封区域的异常代谢，迟发性CBS的结果。
方法：1例64岁女性慢性闭角型青光眼（轴长<21mm）患者，行小梁切除术联合超声乳化和PCIOL。经过4年的随访,由于视轴中不透明液体的位置和囊袋的扩张，她的右眼视力下降。最初的行动过程是释放捕获的流体。由于她的瞳孔不扩张和后囊的高度延伸，无法采用钕：钇铝石榴石（Nd：YAG）激光囊切开术。随后，进行前囊剥离和前节玻璃体切除术。前房深度（ACD），后IOL表面和后囊之间的距离，最佳矫正视力（BCVA），手术前后测量视觉质量（VQ）。使用流式细胞仪评估PCIOL和后囊之间捕获的不透明物质（OS）中的炎性细胞因子水平，并与房水中的正常统计数据进行比较。手术后,患者经历了BCVA和VQ的显著改善.后IOL表面与后囊之间的距离濒临消失。然而,ACD在术前和术后之间没有差异。白细胞介素-8(IL-8)和碱性成纤维细胞生长因子(BFGF)在OS中的浓度高于房水,尤其是前者。然而,OS中血管细胞粘附分子（VCAM）的浓度低于房水。
结论：前节段玻璃体切除术被证明是治疗迟发性CBS的成功方法，提出一个具有挑战性的案例。在人类的镜头中，来自不透明物质的炎性细胞因子可能导致密封区域的异常代谢，迟发性CBS的结果。
