病例27　56歲男性，白內(nèi)障術(shù)后無(wú)痛性視力下降

CASE 27　A 56-year-old man complained of painless loss of vision after undergoing cataract surgery

見圖1-44。See Fig. 1-44.

鑒別診斷

Differential Diagnosis

◎ 根據(jù)病史及眼部檢查容易作出明確診斷。囊袋收縮綜合征主要源于撕囊直徑過(guò)小。懸韌帶離斷、松弛，慢性眼內(nèi)炎癥、葡萄膜炎、假性剝脫綜合征、視網(wǎng)膜色素變性、年齡老化、糖尿病、Beh?et病、肌強(qiáng)直性營(yíng)養(yǎng)不良、高度近視等是常見的誘因。

◎ A def initive diagnosis is easy to made on the basis of ocular signs and a history of surgery. Anterior capsular contraction syndrome: The most common etiology is associated with a small-diameter capsulorhexis. Zonular break or weakness, chronic intraocular inf lammation,uveitis, pseudoexfoliation syndrome, retinitis pigmentosa,advanced age, diabetes mellitus, Beh?et’s syndrome,myotonic muscular dystrophy, and high myopia are known risk factors for this condition.

病史詢問(wèn)

Asking History

◎ 詢問(wèn)白內(nèi)障的手術(shù)時(shí)間，視力下降時(shí)間。

◎ Enquire about the period of cataract surgery; period of vision decline.

◎ 是否伴眩光、眼脹、眼痛和/ 或其他。

◎ History of glare, puffiness, and sore eyes, etc.

◎ 是否有眼部疾病和外傷史。

◎ History of other eye diseases or trauma.

檢查

Examination

◎ 視力、眼壓（正常或者降低），同時(shí)需要驗(yàn)光，比較屈光狀態(tài)是否有變化。

◎ Check visual acuity and IOP (normal or decre a s ed), whilst do refraction to f ind if there are changes with before.

◎ 裂隙燈檢查：可見前囊撕囊口縮小，前囊可見放射狀皺褶、前囊下混濁、IOL移位或包裹。

◎ Slit lamp examination: The capsulotomy region is narrowed with f ibrosis, lateral spread fold of the ant eri or capsule, subcapsular opacity, IOL displa c e m ent, or encapsulation.

◎ 同時(shí)可行B超、UBM、OCT、眼底照相等檢查觀察睫狀體和眼底情況。

◎ B-scan ultrasonography, ultrasound biomicr o s copy(UBM), optical coherence tomography (OCT), and fundus photography may be used to observe the ciliary body and fundus.

診斷

Diagnosis

囊袋皺縮綜合征。

Anterior capsular contraction syndrome.

治療

Management

◎ 早期可行Nd∶YAG激光前囊切開術(shù)。

◎ Nd:YAG laser anterior capsulotomy for early stage disease.

◎ 對(duì)于激光無(wú)效的嚴(yán)重病例常需考慮手術(shù)治療。

◎ Surgery may be considered if laser treatment proves ineffective, especially for severe cases.

患者教育和預(yù)后

Patient Education & Prognosis

◎ 定期眼科門診復(fù)查。

◎ Regular follow-ups are advised.

◎ 對(duì)于眼壓降低的患者應(yīng)注意眼壓監(jiān)測(cè)。

◎ IOP should be monitored if it is low.

◎ 預(yù)后一般較好，皺縮通常在術(shù)后2個(gè)月后趨于穩(wěn)定。

◎ The prognosis is usually good since the disease attains stability 2 months postoperatively.