Hirata Akira, Mine Keiko, Hayashi Ken, Ohta Keisuke
Hayashi Eye Hospital, Fukuoka, Japan.
Department of Anatomy, Kurume University School of Medicine, Kurume, Japan.
J Cataract Refract Surg. 2025 Jan 21;51(4):337-44. doi: 10.1097/j.jcrs.0000000000001607.
To identify the histopathologic changes in the lens capsule of eyes with in-the-bag intraocular lens (IOL) dislocation.
Pathological analysis and correlation with clinical findings.
Hayashi Eye Hospital (Fukuoka, Japan).
Specimens of twenty-five IOL-lens capsule complexes obtained during surgery were processed for scanning electron microscopy (SEM). Backscattered electron images of cross-sections of the lens capsule were obtained using SEM. Ultrastructural changes in the lens capsule were examined and analyzed based on preoperative clinical findings.
The mean age was 70.0±18.0 years. The mean time from initial cataract surgery to IOL removal was 12.5±7.0 years. Of these, nine eyes had exfoliation syndrome (XFS), seven had high myopia, five underwent vitrectomy, and three had atopic dermatitis. The mean age of the XFS cases was 86.6±4.3 years. All XFS specimens demonstrated highly associated ruptured zonular fibers (p <.01). In the 16 non-XFS cases, the mean age was 61.2±17.5 years, significantly younger than in the XFS cases (p <.01); 14 of the 16 specimens had a detachment of zonular lamella (ZL), which was highly associated (p <.01). Four non-XFS eyes exhibited clear capsules, demonstrating significant associations with capsular delamination (p < .01) and the absence of lens epithelial cells (p < .01), resembling dead-bag syndrome.
Structural changes in the lens capsule associated with IOL dislocation are mainly of three types: ruptured zonular fibers in XFS, detachment of the ZL, and capsular delamination. They vary according to the associated diseases, suggesting that prevention and treatment should consider the underlying pathophysiology.
确定行囊内人工晶状体（IOL）脱位患者晶状体囊膜的组织病理学变化。
病理分析及与临床发现的相关性研究。
林眼科医院（日本福冈）。
对手术中获取的25个IOL-晶状体囊膜复合体标本进行扫描电子显微镜（SEM）处理。使用SEM获取晶状体囊膜横截面的背散射电子图像。根据术前临床发现对晶状体囊膜的超微结构变化进行检查和分析。
平均年龄为70.0±18.0岁。从初次白内障手术到取出IOL的平均时间为12.5±7.0年。其中，9只眼患有剥脱综合征（XFS），7只眼患有高度近视，5只眼接受了玻璃体切除术，3只眼患有特应性皮炎。XFS病例的平均年龄为86.6±4.3岁。所有XFS标本均显示高度相关的晶状体悬韧带纤维断裂（p<.01）。在16例非XFS病例中，平均年龄为61.2±17.5岁，明显低于XFS病例（p<.01）；16个标本中有14个出现晶状体悬韧带层分离（ZL），两者高度相关（p<.01）。4只非XFS眼的囊膜清晰，显示与囊膜分层（p<.01）和无晶状体上皮细胞（p<.01）显著相关，类似于死袋综合征。
与IOL脱位相关的晶状体囊膜结构变化主要有三种类型：XFS中的晶状体悬韧带纤维断裂、ZL分离和囊膜分层。它们因相关疾病而异，提示预防和治疗应考虑潜在的病理生理学。
