Studies on Progression of Cataract Observed After Vitreous Surgery

术后核性白内障多见于术前透明晶状体，是玻璃体手术患者晶状体最典型的变化。本研究旨在通过临床和实验研究来分析上述类型白内障的发生和发展。临床研究对象为20例行单纯玻璃体切除术并能随访的患者。实验研究的对象是5只接受了简单玻璃体切除术的猴子。在临床研究中，对晶状体的观察方法为常规裂隙灯检查，通过Scheimpflug晶状体图像分析测量晶状体中的散射光强度，用晶状体不透明度计测量晶状体的透明度，用激光散射光谱法测量晶状体中的蛋白质颗粒大小。在动物实验中，通过裂隙灯检查和散射光强测量进行观察，更多的是通过Scheimpflug图像进行观察。在扫描电子显微镜下观察切除的猴眼。在上述观察之前，已经建立了核性白内障的客观诊断方法。在玻璃体手术后出现的晶状体的几种变化中，前、后深皮层散射光的增加是特征性的。半数临床病例在术后3个月内观察到这种变化。在猴子的眼睛中，同样的趋势在术后一个月内在皮质区被注意到，但程度较轻。扫描电镜显示晶状体纤维排列不规则，呈层状波状排列，纤维外侧和顶端的球和窝形状发生变化。在体内显示上述结构变化的区域与散射光增加的区域相对应。从临床和实验研究中可以清楚地看出，玻璃体手术后晶状体的变化比先前认为的要早，典型的初始变化是皮层区域散射光强度的增加。这一发现被认为是由不规则的晶状体纤维排列引起的。本研究所建立的猴模型对今后核性白内障的研究有一定的参考价值。少

Post-operative nuclear cataracts, which are often seen in a preoperatively transparent crystalline lens, are the most characteristic change of the lens in patients receiving vitreous surgery. This investigation aimed to analyze the appearance and progression of the above type of cataract through clinical and experimental studies. The subjects of the clinical study were 20 patients who underwent simple vitrectomy and were able to be followed up. Subjects of the experimental study were 5 monkeys that underwent simple vitrectomy. In the clinical study, observation methods of the lens were conventional slit lamp examination, measurement of scattering light intensity in the lens through a image analysis of Scheimpflug lens pictures, measurement of lens transparency by a lens opacitymeter and measurement of protein particle size in the lens by laser scattering spectrosocpy. In the animal- study in vivo, observation was done by slit lamp examination and scattering light intensity measurement … More through Scheimpflug images. Removed monkey eyes were observed under a scanning electron microscope. Before the above observations, objective methods for the diagnosis of nuclear cataracts were established. Among several changes in the lens that appeared after vitreous surgery, an increase in the scattering light in both the anterior and posterior deep cortex was charachteristic. This change was observed in half of the clinical cases within three months post-operatively. In monkey eyes the same tendency was noted to a lesser extent in the cortical region within one month post-operatively. Scanning electron microscope revealed irregular lens fiber association showing a lamerallar wave-like arrangement and change in the shape of balls and sockets on the lateral and apical surface of the fibers. The area that showed the above structural changes corresponded to that of the scattering light increase, in vivo. From both clinical and experimental studies, it was clear that changes in the crystalline lens after vitreous surgery appear earlier than previously considered and the typical initial change was an increase in scattering light intensity in the cortical region. This finding was considered to be caused by irregular lens fiber arrangement. The monkey model which was established in this investigation may be useful for future study of nuclear cataract. Less