病例27 56岁男性，白内障术后无痛性视力下降
CASE 27 A 56-year-old man complained of painless loss of vision after undergoing cataract surgery
见图1-44。See Fig. 1-44.
图1-44 晶状体囊袋直径缩小，前囊膜纤维化和撕囊区面积缩小Fig. 1-44 Reduction in the diameter of the lens capsule,anterior lens capsule f ibrosis, and shrinkage in the capsulotomy region
鉴别诊断
Differential Diagnosis
◎ 根据病史及眼部检查容易作出明确诊断。囊袋收缩综合征主要源于撕囊直径过小。悬韧带离断、松弛，慢性眼内炎症、葡萄膜炎、假性剥脱综合征、视网膜色素变性、年龄老化、糖尿病、Behçet病、肌强直性营养不良、高度近视等是常见的诱因。
◎ 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, Behçet’s syndrome,myotonic muscular dystrophy, and high myopia are known risk factors for this condition.
病史询问
Asking History
◎ 询问白内障的手术时间，视力下降时间。
◎ Enquire about the period of cataract surgery; period of vision decline.
◎ 是否伴眩光、眼胀、眼痛和/ 或其他。
◎ History of glare, puffiness, and sore eyes, etc.
◎ 是否有眼部疾病和外伤史。
◎ History of other eye diseases or trauma.
检查
Examination
◎ 视力、眼压（正常或者降低），同时需要验光，比较屈光状态是否有变化。
◎ Check visual acuity and IOP (normal or decre a s ed), whilst do refraction to f ind if there are changes with before.
◎ 裂隙灯检查：可见前囊撕囊口缩小，前囊可见放射状皱褶、前囊下混浊、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.
◎ 同时可行B超、UBM、OCT、眼底照相等检查观察睫状体和眼底情况。
◎ 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.
诊断
Diagnosis
囊袋皱缩综合征。
Anterior capsular contraction syndrome.
治疗
Management
◎ 早期可行Nd∶YAG激光前囊切开术。
◎ Nd:YAG laser anterior capsulotomy for early stage disease.
◎ 对于激光无效的严重病例常需考虑手术治疗。
◎ Surgery may be considered if laser treatment proves ineffective, especially for severe cases.
患者教育和预后
Patient Education & Prognosis
◎ 定期眼科门诊复查。
◎ Regular follow-ups are advised.
◎ 对于眼压降低的患者应注意眼压监测。
◎ IOP should be monitored if it is low.
◎ 预后一般较好，皱缩通常在术后2个月后趋于稳定。
◎ The prognosis is usually good since the disease attains stability 2 months postoperatively.