Department of Ophthalmology, Beijing TianTan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China.
Department of Ophthalmology, Hiroshima University Hospital (Medical), Hiroshima, Japan.
BMC Ophthalmol. 2024 Feb 2;24(1):53. doi: 10.1186/s12886-024-03320-0.
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.
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.
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.
迟发性囊袋阻滞综合征（CBS）是白内障超声乳化吸除术和后房型人工晶状体（PCIOL）植入术后的一种罕见并发症，通常在术后 6 个月至数年内出现。CBS 的特征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。
一位 64 岁女性患者患有慢性闭角型青光眼（眼轴长度<21mm），接受了小梁切除术联合白内障超声乳化吸除术和 PCIOL 植入术。在 4 年的随访中，她的右眼视力因位于视轴中的不透明液体和囊袋扩张而下降。最初的治疗方法是释放被困的液体。由于瞳孔不扩大和后囊高度延伸，无法进行钕：钇铝石榴石（Nd：YAG）激光囊切开术。随后，进行了前囊膜撕除和前段玻璃体切除术。测量了手术前后前房深度（ACD）、后 IOL 面与后囊之间的距离、最佳矫正视力（BCVA）和视觉质量（VQ）。使用流式细胞仪评估了 PCIOL 和后囊之间被困的不透明物质（OS）中的炎症细胞因子水平，并与房水中的正常统计数据进行了比较。手术后，患者的 BCVA 和 VQ 显著改善。后 IOL 面与后囊之间的距离几乎消失。然而，ACD 在手术前后没有差异。OS 中的白细胞介素-8（IL-8）和碱性成纤维细胞生长因子（BFGF）浓度高于房水，尤其是前者。然而，OS 中的血管细胞黏附分子（VCAM）浓度低于房水。
前段玻璃体切除术证明是治疗迟发性 CBS 的一种成功方法，为该病例提供了一种挑战。在人晶状体中，来源于不透明物质的炎症细胞因子可能导致 CBS 晚期密封区域的异常代谢。
