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复位布朗-麦克莱恩综合征中脱位的巩膜固定人工晶状体

Resuturing a Dislocated Scleral-Fixated Intraocular Lens in Brown-McLean Syndrome.

作者信息

Nakagawa Suguru, Okubo Atsushi, Ishii Kiyoshi

机构信息

Department of Ophthalmology, Saitama Red Cross Hospital, Saitama 330-0081, Japan.

出版信息

J Clin Med. 2025 Aug 14;14(16):5769. doi: 10.3390/jcm14165769.

DOI:10.3390/jcm14165769
PMID:40869595
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12387824/
Abstract

: Brown-McLean syndrome (BMS) is a rare peripheral corneal edema that may arise years after cataract extraction or intraocular lens (IOLs) fixation. This article presents a case of IOL dislocation following scleral fixation in a patient with BMS, effectively managed by resuturing the existing IOL. Additionally, a literature review was conducted to summarize the clinical features, etiologies, and surgical outcomes of BMS. A PubMed search identified 30 reports encompassing 169 patients (244 eyes). Among these, corneal transplantation was performed in three eyes. Only four eyes underwent intraocular surgery after BMS onset, with no prior reports of IOL resuturing. : A 73-year-old man with a history of left-eye trauma underwent vitrectomy and scleral fixation of a polymethyl methacrylate IOL 18 years prior. The patient presented with reduced vision in his left eye. Examination revealed BMS-related peripheral corneal edema and partial IOL dislocation. The dislocated haptic was resutured using an ab externo approach under a scleral flap. : Postoperative IOL fixation remained stable, with best-corrected visual acuity improving from 0.6 to 0.9. Edema persisted without central spread, and endothelial cell density decreased slightly (2496 to 2364 cells/mm). One year postoperatively, no IOL tilt progression or suture-related complications were observed. : Partial resuturing of a scleral-fixated IOL is effective for managing IOL dislocation in BMS when haptics remain stable. This approach minimizes incision size and potential endothelial trauma compared to explantation. However, aqueous dynamics correction may not reverse established BMS. Long-term endothelial monitoring is advised due to its chronic and progressive nature.

摘要

布朗 - 麦克莱恩综合征(BMS)是一种罕见的周边角膜水肿,可能在白内障摘除或人工晶状体(IOL)植入数年之后出现。本文介绍了1例BMS患者在巩膜固定人工晶状体后发生人工晶状体脱位的病例,通过重新缝合现有的人工晶状体有效解决。此外,还进行了文献综述以总结BMS的临床特征、病因及手术结果。通过PubMed检索确定了30篇报告,涉及169例患者(244只眼)。其中,3只眼进行了角膜移植。BMS发病后仅有4只眼接受了眼内手术,此前尚无人工晶状体重新缝合的报道。

一名有左眼外伤史的73岁男性在18年前接受了玻璃体切除术及聚甲基丙烯酸甲酯人工晶状体的巩膜固定术。患者左眼视力下降。检查发现与BMS相关的周边角膜水肿及人工晶状体部分脱位。在巩膜瓣下采用外路法重新缝合脱位的袢。

术后人工晶状体固定保持稳定,最佳矫正视力从0.6提高到0.9。水肿持续存在但未向中央扩展,内皮细胞密度略有下降(从2496个细胞/mm降至2364个细胞/mm)。术后1年,未观察到人工晶状体倾斜进展或缝线相关并发症。

当袢保持稳定时,巩膜固定人工晶状体的部分重新缝合对于处理BMS中的人工晶状体脱位有效。与取出人工晶状体相比,这种方法可将切口大小和潜在的内皮损伤降至最低。然而,房水动力学矫正可能无法逆转已形成的BMS。鉴于其慢性和渐进性,建议进行长期内皮监测。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/39d0b587e14c/jcm-14-05769-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/d24322070865/jcm-14-05769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/390bc96ee12b/jcm-14-05769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/39d0b587e14c/jcm-14-05769-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/d24322070865/jcm-14-05769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/390bc96ee12b/jcm-14-05769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c7b/12387824/39d0b587e14c/jcm-14-05769-g003.jpg

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本文引用的文献

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Corneal Endothelial Cell Loss Following Cataract Surgery in Patients with Type 2 Diabetes Mellitus: A Comprehensive Review.2型糖尿病患者白内障手术后的角膜内皮细胞丢失:一项综述
Biomedicines. 2025 Jul 15;13(7):1726. doi: 10.3390/biomedicines13071726.
2
Secondary intrascleral intraocular lens (IOL) fixation with capsule preservation for IOL dislocation following mature cataract surgery with incomplete capsulorhexis: A case report.成熟白内障手术中连续环形撕囊不完整后人工晶状体脱位的二次巩膜内人工晶状体固定并保留晶状体囊:一例报告
Medicine (Baltimore). 2025 Jun 20;104(25):e43030. doi: 10.1097/MD.0000000000043030.
3
Brown-McLean syndrome secondary keratoconus.
布朗-麦克林综合征继发圆锥角膜。
BMC Ophthalmol. 2025 Feb 7;25(1):62. doi: 10.1186/s12886-025-03885-4.
4
Simple ab externo lens capsule removal in intraocular lens reuse and intrascleral fixation for intracapsular lens dislocation: A case report.眼内晶状体再利用中外源性晶状体囊膜简单切除术及囊内晶状体脱位的巩膜内固定术:一例报告
Medicine (Baltimore). 2024 Dec 6;103(49):e40840. doi: 10.1097/MD.0000000000040840.
5
A Modification on Hoffman's Pocket Technique With Scleral Fixation of Intraocular Lens (IOL), Case Series of Unique Scenarios.一种改良的霍夫曼巩膜固定人工晶状体植入术的袖珍技术,独特病例系列。
Case Rep Ophthalmol Med. 2024 Oct 16;2024:7479123. doi: 10.1155/2024/7479123. eCollection 2024.
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Secondary Intrascleral Intraocular Lens Fixation With Lens Capsule Preservation for Aphakic Eyes in Patients With Pseudoexfoliation Syndrome: A Case Series.假性剥脱综合征患者无晶状体眼的晶状体囊膜保留式二期巩膜内人工晶状体固定术:病例系列
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