Nishi Okihiro, Nishi Kayo, Akura Junsuke
Nishi Eye Hospital, Osaka, Japan.
J Cataract Refract Surg. 2002 Mar;28(3):431-7. doi: 10.1016/s0886-3350(01)01094-x.
To evaluate how and how fast a capsular bend is created clinically at the optic edge of an intraocular lens (IOL) after cataract surgery.
Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan.
Capsular bend formation was observed by slitlamp after maximum pupil dilation in 45 eyes of 45 patients with senile cataract. Fifteen eyes each received an AcrySof MA60BM acrylic (Alcon), PhacoFlex II SI-40NB silicone (Allergan), or UV26T poly(methyl methacrylate) (PMMA) (Menicon) IOL. Patients were evaluated prospectively at 1 day and 1, 2, and 4 weeks and retrospectively (15 eyes per IOL) 1 year after cataract surgery. A capsular bend index was developed to document and categorize the capsular bend formation process at the IOL optic edge.
The anterior and posterior capsules adhered, with the latter attracted to the former. The adhesion always progressed from the periphery to the optic edge so that the posterior capsule eventually wrapped around the posterior optic edge, although not fully circumferentially in all cases. The process took place in 4 stages. Capsular bend formation was complete 1 month after surgery with the foldable IOLs (AcrySof, PhacoFlex II) but was significantly delayed with the PMMA IOL. After 1 year, the capsular wrapping was firm and fully circumferential at the optic edge with all IOL types in all cases.
Capsular bend formation progressed in the same fashion but at significantly different speeds among the IOLs, suggesting that the process depends on IOL material and design. Fast, early capsular bend formation may be 1 reason AcrySof and PhacoFlex II IOLs prevent PCO statistically better than PMMA IOLs. The results indicate that PCO is prevented by the sharp capsular bend created by sharp optic edges and by quick bend formation.
评估白内障手术后人工晶状体（IOL）光学边缘处临床形成囊袋弯曲的方式及速度。
日本大阪西眼科医院金石凯医学基金会。
对45例老年性白内障患者的45只眼在最大瞳孔散大后用裂隙灯观察囊袋弯曲形成情况。每组15只眼分别植入爱尔康公司的AcrySof MA60BM丙烯酸酯人工晶状体、眼力健公司的PhacoFlex II SI - 40NB硅凝胶人工晶状体或目立康公司的UV26T聚甲基丙烯酸甲酯（PMMA）人工晶状体。对患者在白内障手术后1天、1周、2周和4周进行前瞻性评估，并在术后1年进行回顾性评估（每种人工晶状体15只眼）。制定囊袋弯曲指数以记录和分类人工晶状体光学边缘处的囊袋弯曲形成过程。
前后囊膜粘连，后囊膜被吸引至前囊膜。粘连总是从周边向光学边缘进展，使得后囊膜最终包裹后光学边缘，尽管并非在所有情况下都完全环绕。该过程分4个阶段进行。使用可折叠人工晶状体（AcrySof、PhacoFlex II）时，囊袋弯曲形成在术后1个月完成，但使用PMMA人工晶状体时明显延迟。1年后，所有类型人工晶状体在所有病例中光学边缘处的囊袋包裹均牢固且完全环绕。
囊袋弯曲形成方式相同，但不同人工晶状体之间速度差异显著，提示该过程取决于人工晶状体的材料和设计。快速早期形成囊袋弯曲可能是AcrySof和PhacoFlex II人工晶状体在统计学上比PMMA人工晶状体更好地预防后发性白内障（PCO）的原因之一。结果表明，PCO是由锐利的光学边缘产生的锐利囊袋弯曲以及快速的弯曲形成所预防的。
