I read with interest the review by Fișuș and Findl on the prevention and management of capsular fibrosis [1]. Apart for small-sized capsulorhexis, IOL factors and pseudoexfoliation syndrome, I would like to highlight two other important associations of anterior capsular contraction and phimosis, namely retinitis pigmentosa and zonular dehiscence [2–4]. In both of these instances, the capsular contraction can be severe and rapid [2], with onset as early as 4 weeks postoperatively and may result in significant loss of vision after an apparently successful cataract operation. These may occur despite an adequately sized capsulorhexis [3]. In patients with zonular dehiscence, the capsule may contract and cause subluxation of the implant in a direction opposite to the area of the zonular dehiscence. In the author’s experience, the phimosis and subluxation can be more severe when a capsular tension ring has not been inserted. In both instances, surgeons should consider carrying out radial relieving incisions of the anterior capsule at the end of lens implantation, to prevent the formation of a fibrotic purse-string. Alternatively, Nd:YAG laser should be applied to the edge of the anterior capsule [2, 3] preferably within four weeks of surgery and without the use of a contact lens.

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评论：包膜纤维化：预防方法和管理综述

我感兴趣地阅读了 Fişuș 和 Findl 撰写的关于包膜纤维化预防和管理的综述 [1]。除了小尺寸撕囊、IOL 因素和假性剥脱综合征外，我想强调前囊收缩和包茎的另外两个重要关联，即色素性视网膜炎和小带裂开 [2-4]。在这两种情况下，包膜收缩可能是严重而迅速的 [2]，最早在术后 4 周开始出现，并且在明显成功的白内障手术后可能导致视力显着丧失。尽管撕囊尺寸足够大，但仍可能发生这些情况 [3]。在小带裂开的患者中，包膜可能会收缩并导致植入物在与小带裂开区域相反的方向上半脱位。根据作者的经验，如果没有插入包膜张力环，包茎和半脱位会更严重。在这两种情况下，外科医生都应考虑在晶状体植入结束时对前囊进行径向减压切口，以防止形成纤维化荷包。或者，最好在手术后 4 周内将 Nd:YAG 激光应用于前囊边缘 [2, 3]，并且不使用隐形眼镜。