From the Department of Ophthalmology (Steinwender, Varna-Tigka, Shajari, Kohnen), Goethe-University, Frankfurt, Germany; Department of Ophthalmology (Steinwender), Medical University of Graz, Graz, Austria.
From the Department of Ophthalmology (Steinwender, Varna-Tigka, Shajari, Kohnen), Goethe-University, Frankfurt, Germany; Department of Ophthalmology (Steinwender), Medical University of Graz, Graz, Austria.
J Cataract Refract Surg. 2017 Jul;43(7):969-974. doi: 10.1016/j.jcrs.2017.03.045.
To report the rare entity of anterior subcapsular cataract after implantation of a posterior chamber phakic intraocular lens (pIOL) with a central hole.
Department of Ophthalmology, Goethe-University, Frankfurt, Germany.
Retrospective case series.
Medical reports were reviewed of patients with vision loss caused by anterior subcapsular cataract after implantation of the V4c Visian Implantable Collamer Lens with a central hole. Patients were identified during regular follow-up visits between January and September 2015. Possible causative factors, such as microbial contamination of surgical instruments, type of ophthalmic viscosurgical device (OVD) and irrigation substance, intracameral application of mydriatics and antibiotics, duration of surgeries, and surgical technique were analyzed.
Eleven eyes of 8 patients showed white opacification behind the anterior capsule of the crystalline lens 1 day postoperatively. Opacification led to a significant loss of corrected distance visual acuity in all eyes. In 9 eyes, the pIOL was explanted and in 8 eyes, phacoemulsification with IOL implantation was performed. All other analyzed possible causative factors were excluded; thus, the opacification was attributed to the surgical technique of OVD removal by irrigation with a cannula in the presence of a central hole in the pIOL. After the surgical technique was adapted, no further cases of anterior subcapsular cataract occurred.
Anterior subcapsular cataract was induced during implantation of a pIOL with a central hole by cannula irrigation with enforced stream onto the capsule through that hole. This entity can be avoided by a change in surgical technique.
报告后房型有孔型房角固定型人工晶状体（pIOL）植入术后发生前囊下白内障这一罕见现象。
德国法兰克福歌德大学眼科。
回顾性病例系列。
回顾因前囊下白内障导致视力丧失而在植入中央有孔的 V4c Visian 可植入Collamer 透镜的患者的病历。这些患者是在 2015 年 1 月至 9 月期间的常规随访中发现的。分析了可能的致病因素，如手术器械的微生物污染、眼用粘弹剂（OVD）和冲洗液的类型、房水内应用散瞳剂和抗生素、手术时间以及手术技术。
8 例患者的 11 只眼在术后 1 天出现晶状体前囊下的白色混浊。混浊导致所有患者的矫正远视力明显下降。在 9 只眼中，pIOL 被取出，在 8 只眼中，行白内障超声乳化吸除术并植入人工晶状体。排除了所有其他分析的可能致病因素；因此，混浊归因于在 pIOL 中央有孔的情况下用套管冲洗去除 OVD 的手术技术。在手术技术得到改进后，没有再发生前囊下白内障。
在植入中央有孔的 pIOL 时，通过套管冲洗，迫使水流通过中央孔冲击囊袋，会导致前囊下白内障。通过改变手术技术可以避免这种情况的发生。
