인공수정체 혼탁으로 오인된 지연 낭폐쇄증후군 1예 = A Case of Late-onset Capsular Block Syndrome, Resulting in the Misdiagnosis of Intraocular Lens Opacity

국문 초록 (Abstract)

목적: 인공수정체 혼탁으로 오인된 지연 낭폐쇄증후군 1예에 대한 진단 및 치료경험을 보고하고자 한다.
증례요약: 59세 남자가 1년 전부터 진행된 우안 시력저하를 주소로 내원하였다. 고혈압 외에는 특이병력이 없었으며, 10년 전 타 병원에서 양안 백내장수술을 받았다. 안과 개인의원에서 우안 인공수정체 변성으로 인한 혼탁으로 진단받고 인공수정체 교체를 위해 본원으로 전원되었다. 내원 당시 나안시력은 0.06이며, 안압은 22 mmHg, 굴절력은 인공수정체 부위의 혼탁 때문에 측정되지 않았다. 세극등현미경검사에서는 인공수정체의 부위가 우유빛 변성으로 관찰되었다. 전안부 빛간섭광학단층촬영에서 인공수정체 뒤쪽 고반사 물질의 저류가 관찰되었고, 초음파생체현미경검사에서는 수정체 후낭의 팽창이 확인되었다. Neodymium-doped yttrium aluminium garnet (Nd:YAG) 레이저 후낭절개술을 시행한 후 합병증 발생 없이 나안시력이 1.0으로 호전되었다.
결론: 낭폐쇄증후군은 백내장수술 후 1일에서 2주 사이에 드물게 발생하는 합병증인데, 술 후 10년이 지나서도 발생하는 지연 낭폐쇄증후군은 전형적인 임상양상과 달리 나타나기에 인공수정체의 변성으로 인한 혼탁과 감별이 매우 중요하다.

다국어 초록 (Multilingual Abstract)

Purpose: We report a case of late-onset capsular block syndrome, which resulted in a misdiagnosis of intraocular lens (IOL)opacity.
Case summary: A 59-year-old man visited our clinic with reduced visual acuity in the right eye from 1 year prior. He had undergone uncomplicated bilateral cataract surgery by phacoemulsification with IOL implants at another hospital 10 years before. There was no specific history with the exception of hypertension. After being diagnosed in the ophthalmology clinic with IOL degeneration and opacity in the right eye, he was referred to our hospital for IOL replacement. Upon examination, his right uncorrected visual acuity was 0.06 and intraocular pressure was 22 mmHg. The refractive error could not be checked due to IOL opacity. Slit-lamp microscopy revealed a cloudy, milky IOL. Anterior-segment optical coherence tomography of the right eye showed retention of a highly reflective material in the lens capsule behind the IOL. Posterior capsule enlargement of the right eye was confirmed on ultrasound biomicroscopy. After neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy was performed, the homogeneous space disappeared and the eye recovered normal visual acuity.
Conclusions: Capsular block syndrome is a rare complication that can occur shortly (1 day to 2 days) after cataract surgery. Late-onset capsular block syndrome, which occurs 10 years after surgery differs from typical clinical manifestations. Thus, capsular block syndrome is an important consideration upon the presentation of opacification due to IOL degeneration.

목차 (Table of Contents)

• 대상과 방법
• 결 과
• 고 찰
• REFERENCES

참고문헌 (Reference)

1 이상준, "백내장 및 유리체절제 동시 수술 후 발생한 조기 낭폐쇄 증후군" 대한안과학회 54 (54): 716-722, 2013

2 Sorenson AL, "Ultrasonographic measurement of induced myopia associated with capsular bag distention syndrome" 107 : 902-908, 2000

3 Heo JY, "Two cases of late postoperative capsular block syndrome" 13 : 105-109, 1999

4 Qu J, "Surgical management of late capsular block syndrome" 36 : 1687-1691, 2010

5 Choi BJ, "Postoperative capsular bag distension in cataract surgery" 39 : 2031-2037, 1998

6 Holtz SJ, "Postoperative capsular bag distension" 18 : 310-317, 1992

7 Miyake K, "New classification of capsular block syndrome" 24 : 1230-1234, 1998

8 Rana M, "Late-onset capsular block syndrome: unusually delayed presentation" 4 : 299-302, 2013

9 Bompastor-Ramos P, "Late postoperative opacification of a hydrophilic-hydrophobic acrylic intraocular lens" 42 : 1324-1331, 2016

10 Neuhann IM, "Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants" 111 : 2094-2101, 2004

11 Kucukevcilioglu M, "Imaging late capsular block syndrome: ultrasound biomicroscopy versus Scheimpflug camera" 37 : 2071-2074, 2011

12 Ramos JL, "Clinical and research applications of anterior segment optical coherence tomography - a review" 37 : 81-89, 2009

13 Eifrig DE, "Capsulorhexis-related lacteocrumenasia" 23 : 450-454, 1997

14 Kim HK, "Capsular block syndrome after cataract surgery: clinical analysis and classification" 34 : 357-363, 2008

15 Geyer O, "Capsular bag distension associated with sulcus implantation of intraocular lenses" 24 : 1538-1540, 1998

16 Basti S, "Capsular bag distension after optic captureof a sulcus-fixated intraocular lens" 25 : 293-295, 1999

17 Davison JA, "Capsular bag distension after endophacoemulsification and posterior chamber intraocular lens implantation" 16 : 99-108, 1990

18 Sugiura T, "Analysis of liquid accumulated in the distended capsular bag in early postoperative capsular block syndrome" 26 : 420-425, 2000