经睫状体平坦部切口行晶状体后囊膜切开术治疗后发性白内障

目的探讨经睫状体平坦部切口行晶状体后囊膜切开术治疗后发性白内障的临床价值。方法对因白内障人工晶体植入术后的后发性白内障患者73例80眼行经睫状体平坦部切口的晶状体后囊膜切开术。结果术后视力均好于术前并达到或超过了白内障人工晶体植入术后后发性白内障发生之前的视力。术后的平均视力为0.72±0.36,80眼中有62眼(77.5%)的矫正视力达0.5以上,其中有25眼(31.25%)达1.0以上。结论经睫状体平坦部切口行晶状体后囊膜切开术是治疗后发性白内障的一种简便、安全、有效的方法,特别适用于广泛的基层医院。     

后囊撕开联合前段玻璃体切除治疗先天性白内障

目的:探讨后囊膜撕开联合前段玻璃体切除治疗先天性白内障的临床疗效。方法:对40例48眼先天性白内障患者行超声乳化吸除术,并行后囊膜撕开联合前段玻璃体切除,观察术前、术后视力及并发症。结果:患者48眼中有5眼(10%)在术后3mo～1a出现后发性白内障,术后常见并发症有:角膜水肿、前段葡萄膜炎反应、后发性白内障。结论:后囊膜撕开联合前段玻璃体切除能有效降低后发性白内障出现,是一种安全有效的手术方式。     

Nd:YAG激光治疗后发性白内障临床分析

目的:探讨Nd:YAG激光治疗后发性白内障的临床疗效。方法:应用Nd:YAG激光对147例(176眼)后发性白内障行后囊膜切开术,散瞳后于瞳孔区行十字形或圆形后囊切开。术后抗炎、散瞳、必要时控制眼压、随访。结果:后囊膜均切开,视力比治疗前增加的患者占94.9%,14眼术后眼压高在治疗后12～48h正常,36眼人工晶状体遗留局限性击射斑。结论:对于后发性白内障,Nd:YAG激光后囊膜切开可增加视力,且安全有效。     

儿童先天性白内障手术治疗临床观察

目的:探讨和评价不同手术方式治疗儿童先天性白内障,预防后囊膜混浊的临床疗效。方法:对采取不同手术方式的50例(96眼)先天性白内障术后后发性白内障的发生及视功能的恢复情况进行回顾性分析。其中采用白内障囊外摘除术的18例34眼(EC-CE组);白内障超声乳化吸出及行后囊膜连续环形撕囊术的12例23眼(PCCC组);白内障超声乳化吸出、后囊膜连续环形撕囊联合前段玻璃体切割术的20例39眼(AV组)。≥2岁的患儿施行Ⅰ期人工晶状体植入。术后随访12～36mo,观察术后视力、并发症及眼部情况。结果:治疗后3组患儿视力均有提高,ECCE组、PCCC组与AV组后发性白内障的发生率分别为100%(34/34)、35%(8/23)和13%(5/39),3组比较,差异均有统计学意义(P<0.05)。结论:后囊膜连续环形撕囊术联合前段玻璃体切割术较囊外摘除术及后囊膜连续环形撕囊术能更有效减少儿童先天性白内障术后后发性白内障的发生。     

结缔组织生长因子和转化生长因子与后发性白内障发病关系的研究进展

后发性白内障（亦称后囊膜混浊）是白内障术后常见并发症,由术后残留的晶状体上皮细胞在囊膜上转分化、增生、移行,产生胶原所致。结缔组织生长因子（connective
tissue growth factor,
CTGF）在正常晶状体上皮细胞中不表达,而在前囊膜下型白内障及后囊膜混浊时大量表达,产生胶原,参与前囊膜下型白内障和后发性白内障的发生、发展过程。
TGF（transforming growth
factor,TGF） β诱导晶状体上皮细胞转分化、移行、过度增殖,是导致前囊膜下型白内障和后发性白内障发生的重要因素。CTGF与TGF β主要通过Smad信号通路诱导晶状体上皮细胞发生转分化。CTGF是TGF β的下游效应因子,TGF β调控CTGF的表达。     

后发性白内障Nd:YAG激光治疗的疗效探讨

目的探讨NdYAG激光治疗后发性白内障的疗效.方法应用NdYAG激光分别对69例白内障超声乳化人工晶体植入术后发障进行后囊膜切开.结果69病例中,后囊膜混浊者共45例(65.2%),后囊膜皱褶者共12例(17.4%),既有后囊膜混浊又有后囊膜皱褶者共12例(17.4%);NdYAG激光后囊膜切开术前后视力有显著性差异(P〈0.005),69例中有60例经过NdYAG激光后囊膜切开术后视力达到了白内障超声乳化术后的最佳视力;但仍有9例未达到该最佳视力.结论"囊袋收缩综合征"影响NdYAG激光后囊膜切开术的治疗效果,白内障手术方法和人工晶体的选择可降低后发障的发生.     

Nd：YAG激光治疗后发性白内障的临床观察

目的 探讨Nd:YAG激光治疗后发性白内障的时机、疗效和并发症.方法 对78例(103只眼)(I级膜76只眼,Ⅱ级膜18只眼,Ⅲ级膜9只眼)后发性白内障应用Nd:YAG激光行后囊膜切开术进行治疗,术后随访3个月.结果 103只眼后囊膜一次击穿,随访3个月未见复发.所有病例术后1周视力较术前有显著改善(P＜0.01),术后1周、1个月及3个月视力之间无显著性差异(P＞0.05).术后并发症主要有房水闪辉(为1～3级,术后一周随访基本吸收)、人工晶状体损伤9只眼(8.91%)和眼压升高12只眼(11.65%).结论 Nd:YAG激光治疗后发性白内障术后视力提高明显,并发症少.     

25 G玻璃体手术系统在厚的后发性白内障手术中的应用

目的 探讨应用25 G玻璃体手术系统治疗厚的后发性白内障的疗效.方法 应用25 G经结膜无缝合玻璃体切割术对16例(16眼)厚的后发性白内障患者行后囊膜切开+前段玻璃体切割术.术后随访2～6个月,记录视力、眼压,观察晶状体后囊膜切开区情况及并发症情况.结果 所有手术均顺利完成.术后视力均明显提高,术后1周和末次随访时最佳矫正视力≥0.5的术眼分别占75.0%(12/16)、81.3%(13/16).除1眼术后发生暂时性低眼压(术后3 d恢复正常)外,其余患眼随访期内眼压均在正常范围.全部术眼晶状体后囊膜中央均形成直径为3.0～4.0 mm的圆形透明区,视轴区透明,术中、术后均未见明显并发症发生.结论 25 G经结膜无缝合玻璃体切割系统通过切开晶状体后囊膜和切除前段玻璃体治疗厚的后发性白内障安全、有效.     

两种先天性白内障手术方式预防后发性白内障的比较

目的比较2种先天性白内障手术方式预防后发性白内障的临床效果。方法回顾性分析先天性白内障患者89例（98眼）,按手术方式分为2组,A组42例（47眼）为超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊术组;B组47例（51眼）为超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊＋前段玻璃体切割术组,分别观察2组术后视力和后发性白内障的发生情况。结果A组发生后发性白内障者24眼,占51.06%;其中21眼行YAG激光后囊膜切开,3眼不合作者行手术后囊膜切开术。B组发生后发性白内障者10眼,占19.61%;其中8眼行YAG激光后囊膜切开术,2眼不合作行手术后囊膜切开术。2组术后后发性白内障发生率的比较,差异有统计学意义（P=0.001）。结论与超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊术相比,超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊＋前段玻璃体切割术能更好地减少先天性白内障术后后发性白内障的发生率。     

儿童人工晶状体瞳孔夹持合并后发性白内障的手术治疗

目的探讨儿童人工晶状体瞳孔夹持合并后发性白内障的治疗方法及疗效。方法对26例(26只眼)儿童人工晶状体植入术后人工晶状体瞳孔夹持合并后发性白内障进行超声截囊仪进行后囊切开、前部玻璃体切除、人工晶状体光学区后囊嵌顿术。观察手术并发症、术后眼部情况。结果 26只眼后发性白内障切除和人工晶状体光学部后囊膜夹持复位成功,术后患者随访期间均未出现视轴混浊,人工晶状体位置无偏离,位置稳定,仅出现短期的炎症反应,无其他严重并发症及晶状体后囊膜切开区再次混浊等并发症发生,术后视力有不同程度的改善。结论儿童人工晶状体瞳孔夹持合并后发性白内障进行手术治疗切除后发性白内障及人工晶状体复位是安全、有效的办法。     

Expression of connective tissue growth factor (CTGF) mRNA in plaques of human anterior subcapsular cataracts and membranes of posterior capsule opacification

PURPOSE: To investigate the correlation between connective tissue growth factor (CTGF) mRNA expression and immunohistochemical characteristics of anterior subcapsular cataract (ASC) formation as well as posterior capsule opacification (PCO) development (expression of type I collagen, alpha-smooth muscle actin and tenascin) under in vivo and under in vitro conditions in human and porcine lens epithelial cells. METHODS: CTGF mRNA expression was investigated using in situ hybridization and RT-PCR. Expression of type I collagen, alpha-smooth muscle actin and tenascin was detected by immunohistochemical staining. RESULTS: CTGF mRNA was expressed in human cataractous plaques of ASC and human PCO membranes, and appeared simultanously with the expression of type I collagen, alpha-smooth muscle actin and tenascin. CONCLUSION: The predominant expression of CTGF mRNA in human ASC and human PCO membranes suggests a significant role of CTGF in the pathological course of these ocular disorders.     

BALB/c小鼠后发性白内障动物模型的建立和观察

目的建立BALB／c小鼠后发性白内障（posterior capsule opacification，PCO）动物模型并检测Sox1／2胚胎晶状体发育调控基因在PCO中的表达。方法腹腔麻醉联合表面麻醉下对30只BALB／c小鼠行右眼晶状体囊外摘出术，分别于术后即刻、3d、1周、2周和1个月对术眼进行裂隙灯显微镜及组织病理学检查，观察PCO形成的时间、部位、发展过程及组织形态学改变；采用逆转录聚合酶链反应（RT-PCR）方法检测Sox1／2胚胎晶状体发育调控基因在术后不同时间点PCO中的表达。结果裂隙灯显微镜观察：后囊膜皱褶、混浊由周边部向中央区发展伴Elschnig小体和晶状体纤维生成，其程度随时间推移日渐加重；再生晶状体形态和大小与正常晶状体相似但透明度明显下降。组织病理学检查：手术后即刻，赤道部和前囊膜下可见单层晶状体上皮细胞（lens elial cell，LEC），后囊膜表面无LEc及晶状体皮质残留；术后3d，赤道部LEC增生并迁移至后囊膜。囊袋周边部LEC开始早期纤维分化，但核仍靠近后囊膜表面；术后1周，赤道部LEC继续分化，细胞伸长呈带状伴核远离后囊膜表面；术后2周，周边部晶状体纤维细胞持续增多，形成与正常晶状体赤道部形态类似的弓形带；术后1个月。新生晶状体纤维几乎填充整个残余囊袋，排列欠规则，细胞核罕见。RT-PcR检测：术后3d、1周、2周及1个月的PC0组织中可检测到Sox1／2条带；术后即刻囊袋组织中无Sox1／2表达。结论BALB／c小鼠可成功建立PCO动物模型并检测到Sox1／2胚胎晶状体发育调控基因的表达，为在分子生物学水平上进一步探索PCO的发病机制提供了有利条件，具有重要的应用价值。【眼科新进展2007；27（2）：91-95]     

The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification

PURPOSE: To determine whether lens edge design or anterior capsule overlap on the intraocular lens (IOL) has greater effect on posterior capsule opacification (PCO). DESIGN: Retrospective cohort clinical study. METHODS: Retrospective. SETTING: Academic clinical practice. PATIENT POPULATION: The patient population consisted of 259 uncomplicated surgical patients (259 eyes) with no confounding comorbidity and at least 1 year of follow-up after surgical placement of a silicone or hydrophobic acrylic lens. OBSERVATION PROCEDURES: Digital retroilluminated photographs were taken to ascertain PCO, anterior capsular opacification (ACO), previous neodymium:YAG capsulotomy and degree of anterior capsule overlap on the IOL optic. MAIN OUTCOME MEASURES: PCO, ACO, YAG capsulotomy rate, and anterior capsule overlap on the IOL optic. RESULTS: One hundred forty-eight digital images (74 silicone and 74 acrylic) were measurable for both anterior capsule overlap and PCO. Complete 360 degrees of anterior capsule overlap on the IOL was associated with decreased PCO (P = <.001). A significant negative correlation was found between the degree of anterior capsule overlap and PCO (P = <.001). Evaluation of PCO, and YAG capsulotomy rates were similar between acrylic and silicone lenses. Minimal anterior capsule overlap may also be associated with PCO prevention. CONCLUSIONS: Implanting a lens with complete anterior capsule overlap on the IOL was found to significantly reduce PCO, which advantage appeared to be greater than PCO prevention by a truncated, sharp edge IOL design.     

Posterior capsule opacification

Posterior capsule opacification (PCO) is the most common complication following primary cataract surgery. Advances in intraocular lens (IOL) designs that have reduced the amount of PCO following surgery have been made. The understanding of how the IOL design effects PCO has also advanced. Lenses that provide a mechanical barrier between it and the posterior lens capsule seem to inhibit PCO to a greater degree. Intracapsular rings are now being explored to test and enhance this barrier effect. Major advances in the elimination of lens epithelial cells at the time of surgery especially by pharmacologic means have also been made. An immunotoxin specific for human lens epithelial cells shows promise and is under latter phase clinical development.     

Activation of SRC kinases signals induction of posterior capsule opacification

PURPOSE: Posterior capsule opacification (PCO) is a complication of cataract surgery resulting from the proliferation, migration, and epithelial-to-mesenchymal transition (EMT) of lens epithelial cells that remain associated with the lens capsule. These changes cause a loss of vision. The authors developed a chick embryo lens capsular bag model to study mechanisms involved in the onset of PCO. Because Src family kinases (SFKs) signal cell proliferation, migration, and EMT, the authors examined whether the inhibition of SFKs can prevent PCO. METHODS: After mock cataract surgery, chick lens capsular bags were pinned to a culture dish and grown in the presence or absence of the SFK inhibitor PP1. Cell movement was followed by photomicroscopy. Progression of proliferation and EMT in the PCO cultures was determined by Western blot analysis and immunofluorescence staining. RESULTS: As occurs in PCO, lens cells in this model proliferated, migrated across the posterior capsule, and expressed EMT markers, alpha-smooth muscle actin (alpha-SMA), and fibronectin (FN). Lens cells treated with PP1 maintained an epithelial phenotype, accumulated cadherin junctions, and did not migrate to the posterior capsule, increase proliferation, or express EMT markers. Therefore, exposure to PP1 prevented PCO. Short-term inhibition of SFKs was sufficient to prevent EMT, but longer inhibition was necessary to prevent lens cell migration. CONCLUSIONS: Progression of PCO involved early activation of SFKs. Lens cell migration preceded EMT, and each of these two events required activation of an SFK signaling pathway. Suppression of SFK activation blocked PCO, suggesting SFKs as a therapeutic target for the prevention of PCO.     

Histology and immunohistochemistry of fibrous posterior capsule opacification in an infant

We report the histological findings in posterior capsule opacification (PCO) in 2 eyes of a 10-month-old infant 8 months after cataract extraction and intraocular lens (IOL) implantation. The PCO in the right eye had a regenerated lenticular structure; in the left eye, it was fibrotic. The PCO in the right eye was soft and aspirated with Simcoe's irrigation/aspiration cannula; in the left eye, it was excised surgically. Paraffin sections of the fibrous PCO tissue from the left eye were examined histologically. Hematoxylin-eosin staining showed extracellular matrix (ECM) accumulation and the presence of elongated fibroblastic cells, presumed to be lens epithelial cells (LECs). Immunohistochemistry revealed the presence of fibrous collagen types and cellular fibronectin. The presumed LECs amid the ECM were positive for vimentin and alpha-smooth muscle actin. Histology of the fibrous PCO tissue from this infant was similar to that in adult patients.     

Posterior capsule opacification in pseudophakic eyes--etiopathogenesis, clinical picture, possibilities of prevention and therapy

Posterior capsule opacification (PCO) is a late complication after the cataract surgery, currently occurring most often. The epithelial cells which migrate to the surface of the posterior capsule participate in the mechanism of PCO formation. Clinical opacification of the posterior capsule appears as the foggy form, creasing, pearl mass and fibrosis. PCO can be cured by laser or surgical capsulotomy. The factors influencing a size and intensity of PCO are as follows: age of patient, other diseases, method of surgery and type of the implanted artificial intraocular lens. Prevention against PCO during surgery should include accurate hydrodissection, removing of cortical mass, polishing of the capsule and intracapsular fixation of the lens. It is necessary to carry out further studies on possibilities of PCO prevention.     

Use of a polylysine-saporin conjugate to prevent posterior capsule opacification.

PURPOSE: To determine the feasibility of applying a polylysine-saporin (PLS) conjugate to the lens capsule at surgery to prevent lens epithelial cell (LEC) proliferation and posterior capsule opacification (PCO). SETTING: Department of Research & Development, Bausch & Lomb Surgical, and Department of Ophthalmology, Saint Louis University, St. Louis, Missouri, USA. METHODS: Fluorescein-labeled polylysine was applied to the lens capsule of rabbits after phacoemulsification and analyzed histologically to determine the extent of binding to the lens capsule and surrounding tissues. The cytotoxin saporin was conjugated to polylysine using bifunctional cross-linkers. This PLS conjugate was applied to LECs in culture and to the lens capsules of rabbits. These eyes were monitored for PCO. RESULTS: Polylysine primarily bound to the lens capsule membranes, with little or no binding to surrounding tissues. When PLS was added to LECs in culture, it was internalized and destroyed the cells. Of 9 rabbit eyes treated with PLS during surgery, 1 remained free of PCO for the life of the animal (40 weeks), while 6 showed a delay of cortical regrowth approximately 2 to 3 times that of control eyes. CONCLUSIONS: Polylysine bound selectively to the lens capsule membrane. The PLS conjugation resulted in a toxic agent that targeted the lens capsule and destroyed proliferating LECs. The application of a PLS conjugate during surgery may prevent PCO.     

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery

PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING: Tertiary care institution in India. PATIENTS: Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS: Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS: Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.