Kuo Irene C
Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, 4924 Campbell Blvd. #100, Baltimore, MD, 21236, USA.
Am J Ophthalmol Case Rep. 2020 May 30;19:100754. doi: 10.1016/j.ajoc.2020.100754. eCollection 2020 Sep.
To describe a patient who developed radial displacement of the capsular bag and toric intraocular lens implant within approximately 5 weeks after surgery.
A patient underwent uncomplicated cataract extraction and implantation of a toric IOL for 2.5 diopters (D) of preoperative corneal astigmatism. Uncorrected visual acuity (UCVA) on postoperative day 1 was 20/20. Blurriness developed 5 weeks after surgery when UCVA was 20/70 but corrected to 20/20 with 2 D of cylinder in a new axis. The IOL was in the proper axis, but it and the capsular bag were radially displaced. Dilated examination revealed posterior capsular opacification superotemporally, outside the visual axis. The patient's biometry revealed axial myopia and megalocornea (white-to-white measurement of 13.44 mm), suggesting a larger than average capsular bag. Surgery was performed at postoperative week 6 to expand the capsular bag using a capsular tension ring and to re-center the IOL keeping the same axis. The patient recovered UCVA of 20/25 after the IOL was recentered.
It is important to review biometry for large white-to-white measurements. Eyes with megalocornea may require capsular tension rings at time of toric IOL implantation so as to maintain IOL centration and good UCVA.
描述一名患者在手术后约5周出现囊袋和有晶状体眼人工晶状体植入物径向移位的情况。
一名患者接受了简单的白内障摘除术，并植入了一枚用于矫正术前2.5屈光度（D）角膜散光的有晶状体眼人工晶状体。术后第1天的未矫正视力（UCVA）为20/20。术后5周出现视力模糊，此时UCVA为20/70，但在新轴向上加2 D柱镜后矫正至20/20。人工晶状体轴位正常，但人工晶状体及其囊袋发生了径向移位。散瞳检查发现视轴外颞上方的后囊膜混浊。患者的生物测量显示为轴性近视和大角膜（白对白测量值为13.44 mm），提示囊袋大于平均尺寸。术后第6周进行手术，使用囊袋张力环扩大囊袋，并在保持相同轴位的情况下将人工晶状体重新居中。人工晶状体重新居中后，患者恢复至UCVA为20/25。
对于白对白测量值较大的情况，回顾生物测量结果很重要。患有大角膜的眼睛在植入有晶状体眼人工晶状体时可能需要囊袋张力环，以维持人工晶状体的居中位置和良好的UCVA。
