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Abdelmassih Y, Lecoge R, El Hassani M, Dureau P, Caputo G, Metge F, Chapron T. Risk Factors for Retinal Detachment in Marfan Syndrome After Pediatric Lens Removal. Am J Ophthalmol 2024; 266:190-195. [PMID: 38821454 DOI: 10.1016/j.ajo.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 05/01/2024] [Accepted: 05/04/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To determine retinal detachment (RD) risk factors after lens removal surgery in children with Marfan syndrome (MS). DESIGN Retrospective, case control study. METHODS This was an institutional case series including children (age <18 years) with MS who underwent lens removal surgery. Clinical and surgical characteristics were extracted from the children's electronic files: age, axial length (AL), gender, number of surgeries received, intraocular lens (IOL) implantation at the first surgery, complete removal of the capsular bag, and final best-corrected visual acuity. Risk factors associated with RD occurrence were identified. RESULTS Among 158 eyes included (85 children), 35 eyes (22.2%) developed RD during follow-up. Bilateral detachment occurred in 11 patients (45.8%). Age at the time of the lens removal surgery was not different between groups. Children in the RD group had a higher AL (P < .001), longer follow-up, IOL implantation, and capsular residue. Multivariate analysis identified capsular residue (odds ratio, 16.8; 95% CI, 1.9-148.8; P = .01) and AL (odds ratio, 1.3; 95% CI, 1.01-1.7; P = .03) as predictors for RD. CONCLUSIONS Children with MS and increased AL were more likely to develop an RD after lens surgery. When considering lens removal surgery in a pediatric population presenting with MS, a complete capsular removal seemed to be the safer option regarding RD risk.
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Affiliation(s)
- Youssef Abdelmassih
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France
| | - Régis Lecoge
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France
| | - Mehdi El Hassani
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France
| | - Pascal Dureau
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France
| | - Georges Caputo
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France
| | - Florence Metge
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France
| | - Thibaut Chapron
- Pediatric Ophthalmology Department (Y.A., R.L., M.E.H., P.D., G.C., F.M., T.C.), Rothschild Foundation Hospital, Paris, France; Université Paris Cité (T.C.), CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research, EPOPé, INSERM, INRAE Epidemiology and Statistics Research Team, INRAE, Paris, France.
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Porat Rein A, Abulafia A, Assayag E, Goldberg M, Zadok D. Comprehensive approach for capsular bag fixation in subluxated crystalline lens: preserving the anterior/posterior anatomical segment barrier. J Cataract Refract Surg 2023; 49:1236-1241. [PMID: 37616179 DOI: 10.1097/j.jcrs.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. SETTING Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. DESIGN Retrospective, consecutive case series. METHODS This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. RESULTS 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA ( P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. CONCLUSIONS A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.
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Affiliation(s)
- Adi Porat Rein
- From the Department of Ophthalmology, Shaare Zedek Medical Center, affiliated to the Hebrew University, Hadassah School of Medicine Jerusalem, Jerusalem, Israel
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Chen ZX, Zhao ZN, Sun Y, Jia WN, Zheng JL, Chen JH, Chen TH, Lan LN, Jiang YX. Phacoemulsification Combined With Supra-Capsular and Scleral-Fixated Intraocular Lens Implantation in Microspherophakia: A Retrospective Comparative Study. Front Med (Lausanne) 2022; 9:869539. [PMID: 35492301 PMCID: PMC9047048 DOI: 10.3389/fmed.2022.869539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/23/2022] [Indexed: 01/19/2023] Open
Abstract
BackgroundMicrospherophakia (MSP) is a rare ocular condition, the lens surgery of which is complicated by both insufficient zonules and undersized capsule.MethodsThis study included MSP eyes managed with phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens implantation (SCSF-IOL) and made the comparison with those treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL).ResultsA total of 20 MSP patients underwent SCSF-IOL, and 17 patients received MCTR-IOL. The postoperative best corrected visual acuity was significantly improved in both groups (P < 0.001), but no difference was found between the groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd:YAG laser posterior capsulotomy was performed 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment and one eye (5.00%) had a decentered capsule opening. Posterior capsule opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up.ConclusionsSCSF-IOL is a viable option for managing MSP and is comparable with the MCTR-IOL. Nd:YAG laser posterior capsulotomy was necessary to prevent residual capsule complications after the SCSF-IOL procedure.
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Affiliation(s)
- Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhen-Nan Zhao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Lei Zheng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Li-Na Lan
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- *Correspondence: Yong-Xiang Jiang
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Karasavvidou EM, Wilde C, Zaman A, Orr G, Kumudhan D, Panos GD. Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support. J Ophthalmol 2021; 2021:2253486. [PMID: 34904056 PMCID: PMC8665890 DOI: 10.1155/2021/2253486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficient approach for paediatric aphakic patients.
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Affiliation(s)
| | - Craig Wilde
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Anwar Zaman
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gavin Orr
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dharmalingam Kumudhan
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Georgios D. Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Heo H, Lambert SR. Incidence of retinal detachment after lens surgery in children and young adults with nontraumatic ectopia lentis. J Cataract Refract Surg 2021; 47:1454-1459. [PMID: 33929802 PMCID: PMC8490488 DOI: 10.1097/j.jcrs.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the incidence of retinal detachment after lens surgery in children and young adults with nontraumatic ectopia lentis. SETTING Population-based claims data. DESIGN Population-based retrospective cohort study. METHODS Patients with nontraumatic ectopia lentis aged 30 years or younger who had undergone lens surgery with or without intraocular lens (IOL) implantation and had 1 year or greater continuous enrollment after lens surgery were included in the Optum deidentified Clinformatics Data Mart Database (2003 to 2019) and IBM MarketScan Databases (2007 to 2016). Both databases were assessed for sex, age, etiology of ectopia lentis, IOL implantation, and postoperative retinal detachment separately. Univariate and multivariate analyses were conducted to identify the risk factors for postoperative retinal detachment. RESULTS Among a total of 298 eyes (210 patients), IOL implantation was coupled with lens surgery in 151 eyes (49.8%) that underwent lens surgery for nontraumatic ectopia lentis. The median follow-up was 32 months in aphakic eyes and 29 months in pseudophakic eyes. Patients undergoing IOL implantation were older at the time of lens surgery (median age: no IOL, 6 years; IOL, 16 years; P < .001). Retinal detachment developed in 13 patients (14 eyes [4.7%]) 14 eyes (4.7%). Older age was the baseline characteristic that correlated most closely with the risk for retinal detachment (P = .05). CONCLUSIONS The rate of retinal detachment was similar with or without IOL implantation after lens surgery for nontraumatic ectopia lentis in children and young adults.
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Affiliation(s)
- Hwan Heo
- Department of Ophthalmology, Stanford University School of
Medicine, Palo Alto, California
- Department of Ophthalmology, Chonnam National University
Medical School and Hospital, Gwangju, Republic of Korea
| | - Scott R. Lambert
- Department of Ophthalmology, Stanford University School of
Medicine, Palo Alto, California
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Chen Z, Zhang M, Deng M, Chen T, Chen J, Zheng J, Jiang Y. Surgical outcomes of modified capsular tension ring and intraocular lens implantation in Marfan syndrome with ectopia lentis. Eur J Ophthalmol 2021; 32:11206721211012868. [PMID: 33887970 DOI: 10.1177/11206721211012868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate surgical outcomes of modified capsular tension ring (MCTR) and intraocular lens (IOL) implantation in eyes of Marfan syndrome (MFS). METHODS This retrospective case series included MFS patients receiving MCTR transscleral fixation and IOL in-the-bag implantation. The MCTR was sutured to the sclera through a sulcus by 9-0 polypropylene with the modified knotless Z-suture technique. Main outcomes were visual acuity and postoperative complications. RESULTS A total of 109 MFS patients (187 eyes) had the surgery. Patients were 15.47 ± 14.36 years old and followed up for 10.07 ± 8.99 months. MCTR and IOL implantations were performed in 174 eyes (93.05%). The postoperative BCVA (LogMAR) was 0.24 ± 0.24 (1 month), 0.26 ± 0.20 (3 months), 0.22 ± 0.20 (6 months), 0.20 ± 0.19 (12 months) and 0.25 ± 0.32 (over 12 months), which was significantly better than preoperatively (0.63 ± 0.35) (p < 0.001). Major complications included posterior capsular opacification (PCO) in 41 eyes (23.56%) and decentered anterior capsular opacification (ACO) in 15 eyes (8.62%). The mean occurrence time was 9.44 ± 7.08 and 8.87 ± 15.08 months respectively. Other complications included transient intraocular pressure elevation in seven eyes (4.02%), retinal detachment in two eyes (1.15%), cystoid macula edema in one eye (0.57%), and endophthalmitis in one eye (0.57%). No eye had suture breakage or IOL dislocation. CONCLUSIONS The visual improvement is significant in eyes of MFS undergoing MCTR transscleral fixation and IOL in-the-bag implantation. The long-term monitoring of complications is warranted, especially in the first-two years.
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Affiliation(s)
- Zexu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Min Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Michael Deng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tianhui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiahui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jialei Zheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yongxiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Cai L, Han X, Jiang Y, Qiu X, Qian D, Lu Y, Yang J. Three-Year Outcomes of Cionni-Modified Capsular Tension Ring Implantation in Children Under 8 Years Old With Ectopia Lentis. Am J Ophthalmol 2021; 224:74-83. [PMID: 33253663 DOI: 10.1016/j.ajo.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE This study evaluated visual outcomes and complications at 3 years post-implantation of a Cionni-modified capsular tension ring (MCTR) with an intraocular lens (IOL) in ectopia lentis patients ≤8 years old. DESIGN Prospective clinical cohort study. METHODS Included were 101 eyes from 57 patients <8 years of age, who underwent surgery for nontraumatic ectopia lentis between November 2015 and December 2016. Exclusion criteria were planned IOL fixation in the ciliary sulcus, severe intraoperative complications, and incomplete follow-up. All eyes received in-the-bag implantation of a posterior IOL and Cionni-MCTR. Posterior capsulectomy and anterior vitrectomy were performed through the pars plana in 23 eyes of children <5 years of age. Patients were examined at 1 day, and 1, 6, and 12 months, and at 2 and 3 years postoperatively. Outcome; measurements included best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and posterior capsule opacification (PCO). RESULTS In all eyes, BCVA improved significantly after surgery, especially during the first 12 months (P < .05). Three years post-operatively, 44 eyes had BCVA 0.9 or better. Prophylactic Nd:YAG laser capsulotomy was performed 3 months post-surgery in 24 eyes; 34 eyes underwent this; procedure 6 months post-surgery because of PCO. A second surgery was; warranted in 4 eyes because of severe IOL decentration and combined anterior capsule contraction. No severe postoperative complications, such as retinal detachment or endophthalmitis, occurred. CONCLUSIONS Implantation of in-the-bag IOL with Cionni MCTR is effective for visual rehabilitation in young children with ectopia lentis. A close follow-up of these patients is necessary to monitor IOL centration and stability.
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Affiliation(s)
- Lei Cai
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Xiaoyan Han
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Yongxiang Jiang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Xiaodi Qiu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Dongjin Qian
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Jin Yang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China.
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Saadet GI, Fatih Ö. Effect of the capsular tension ring on refractive outcome after phacoemulsification. Rom J Ophthalmol 2021; 65:59-63. [PMID: 33817435 PMCID: PMC7995511 DOI: 10.22336/rjo.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate how capsular tension rings (CTR) affect refractive outcomes following cataract extraction by phacoemulsification complicated by zonular instability. Study design: Retrospective. Methods: In a retrospective case-control study, the 29 eyes of 29 patients with CTRs were compared with the 29 eyes of patients without zonular instability following routine phacoemulsification, with mean arithmetic refractive prediction error (ArRPE) and mean absolute refractive prediction error (AbRPE) as primary outcome measures. Results: A comparison of eyes with and without CTRs according to the SRK/ T formula revealed no statistically significant difference in ArRPE (0.52 vs. 0.45 D, p = 0.570) or AbRPE (0.52 vs. 0.55 D, p = 0.799). Postoperative hypermetropic shift occurred in most cases in both groups, although the mean difference between eyes with CTR (22/ 29) and without CTR (25/ 29) was not statistically significant (p = 0.315). Conclusion: Implanting CTRs did not consistently affect refractive outcomes versus routine phacoemulsification. Results suggest that intraocular lens power can be calculated as usual when CTRs are used. Abbreviations: CTR = capsular tension ring, ArRPE = arithmetic refractive prediction errors, AbRPE = absolute refractive prediction errors, IOL = intraocular lens, WTW = white-to-white, ACD = anterior chamber depths, AL = axial lengths, RPE = refractive prediction error
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Affiliation(s)
- Gültekin Irgat Saadet
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kutahya, Turkey
| | - Özcura Fatih
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kutahya, Turkey
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Erdogan G, Kandemir Besek N, Onal Gunay B, Agca A. Outcomes of three surgical approaches for managing ectopia lentis in Marfan syndrome. Eur J Ophthalmol 2021; 32:242-248. [PMID: 33550842 DOI: 10.1177/1120672121992950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the clinical outcomes of three surgical approaches for ectopia lentis in Marfan syndrome (MS) patients who had undergone crystalline lens removal with posterior chamber intraocular lens (IOL) implantation techniques comprising the intrascleral fixation of IOL, sutured scleral fixation of IOL, and IOL implantation with the use of a Cionni capsular tension ring (CTR). METHODS This is a retrospective comparative study, including 35 eyes of 21 patients who underwent the intrascleral fixation of IOL (group 1), scleral IOL fixation with the Z-suture (group 2), and IOL implantation with the use of a Cionni CTR (group 3) following crystalline lens removal. The surgical indications were as follows: no improvement in visual function after eyeglasses or contact lens application due to excessive irregular astigmatism and advanced crystalline lens decentration in which the edge of the crystalline lens came up to the optical axis, or dislocation of the crystalline lens resulting in aphakia and secondary glaucoma due to lens dislocation. The surgical outcomes and complications due to surgery were compared between the groups. RESULTS The mean age of the patients in the study was 12.3 ± 8.7 years (5-32 years). There were 10 eyes in group 1, 13 eyes in group 2, and 12 eyes in group 3. Visual acuity improved significantly in each group after surgery. Ocular residual astigmatism did not differ significantly between the groups (p = 0.51). CONCLUSION There were no significant differences between the three surgical approaches in the current study in terms of the postoperative results and complications.
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Affiliation(s)
- Gurkan Erdogan
- Department of Ophthalmology, University of Health Sciences, Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Nilay Kandemir Besek
- Department of Ophthalmology, University of Health Sciences, Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Betul Onal Gunay
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Alper Agca
- Department of Ophthalmology, University of Health Sciences, Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Chen T, Deng M, Zhang M, Chen J, Chen Z, Jiang Y. Visual outcomes of lens subluxation surgery with Cionni modified capsular tension rings in Marfan syndrome. Sci Rep 2021; 11:2994. [PMID: 33542371 PMCID: PMC7862488 DOI: 10.1038/s41598-021-82586-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/21/2021] [Indexed: 01/28/2023] Open
Abstract
Marfan syndrome (MFS) is a hereditary disease with an incidence of 0.3% in the general population. Approximately 60% of MFS patients with FBN1 gene mutation will suffer ectopia lentis (EL) from the age of 3. With the development of EL, severe loss of vision will accrue because of lens tilt and glaucoma. Cionni modified capsular tension rings (MCTR) has been applied in the surgery for EL in MFS patients. To evaluate visual acuity and safety of using MCTR during lens subluxation surgery in MFS patients, 66 MFS patients (110 eyes) were included in our study, with the mean duration of follow-up of 4.7 months (SD 1.76 months). The capsular bags were preserved in 101 eyes (91.81%) with MCTR implantation. There was an overall significant improvement in BCVA at 1-month follow-up which was maintained at 3 months. Multivariable linear regression revealed that older age at first visit was associated with greater postoperative BCVA at the 1-month follow-up (P = 0.007). A significant difference was found between different degrees of lens subluxation and the length of surgical time and complications. At follow-up, only two eyes (1.98%) were identified to have developed retinal detachments. In conclusion, better visual outcomes can be achieved when patients received an early operation with MCTR implantation.
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Affiliation(s)
- Tianhui Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Michael Deng
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Min Zhang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Jiahui Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Zexu Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 200031, China. .,Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China.
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11
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Cheung CSY, VanderVeen DK. Intraocular Lens Techniques in Pediatric Eyes with Insufficient Capsular Support: Complications and Outcomes. Semin Ophthalmol 2019; 34:293-302. [DOI: 10.1080/08820538.2019.1620809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Crystal SY Cheung
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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12
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Li B, Wang Y, Malvankar-Mehta MS, Hutnik CML. Surgical indications, outcomes, and complications with the use of a modified capsular tension ring during cataract surgery. J Cataract Refract Surg 2018; 42:1642-1648. [PMID: 27956292 DOI: 10.1016/j.jcrs.2016.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/11/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the surgical indications, outcomes, and complications with the use of modified capsular tension rings (CTRs) during cataract surgery. SETTING Ivey Eye Institute, Western University, London, Ontario, Canada. DESIGN Systematic review. METHODS A systematic review of databases was conducted for studies related to the use of modified CTRs during cataract surgery that were published between 1992 and 2015. Primary research papers on human participants published in English were screened. The surgical indications, outcomes, and complications of modified CTR use during cataract surgery were compiled and analyzed. RESULTS The search identified 6035 records from published and gray literature. After screening, 10 studies involving 320 eyes were included in the systematic review. The most common surgical indications for modified CTR use were Marfan syndrome (40.3%), idiopathic zonular insufficiency (27.2%), and previous ocular trauma (22.8%). The weighted average of indicated zonular insufficiency was 173 degrees, with 75.4% of eyes achieving visual acuity better than 20/40 postoperatively. The use of modified CTRs resulted in a reduction in intraocular lens (IOL) decentration and tilt. Vitrectomy during surgery was required in 19.8% of eyes. The rate of posterior capsule opacification (PCO) was 41.1%. Intraocular pressure (IOP) elevation, suture breakage, and uveitis were the most common postoperative complications. CONCLUSIONS The use of modified CTRs during cataract surgery was associated with causes of large and progressive zonular insufficiency. Use of the CTR produced good postoperative visual outcome and reduced IOL decentration and/or tilt. The most common complications were PCO, IOP elevation, and suture breakage. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Bo Li
- From the Department of Ophthalmology (Li, Malvankar-Mehta, Hutnik) and the Department of Epidemiology and Biostatistics (Malvankar-Mehta), Schulich School of Medicine and Dentistry (Wang), Western University, London, Ontario, Canada.
| | - Yongjun Wang
- From the Department of Ophthalmology (Li, Malvankar-Mehta, Hutnik) and the Department of Epidemiology and Biostatistics (Malvankar-Mehta), Schulich School of Medicine and Dentistry (Wang), Western University, London, Ontario, Canada
| | - Monali S Malvankar-Mehta
- From the Department of Ophthalmology (Li, Malvankar-Mehta, Hutnik) and the Department of Epidemiology and Biostatistics (Malvankar-Mehta), Schulich School of Medicine and Dentistry (Wang), Western University, London, Ontario, Canada
| | - Cindy M L Hutnik
- From the Department of Ophthalmology (Li, Malvankar-Mehta, Hutnik) and the Department of Epidemiology and Biostatistics (Malvankar-Mehta), Schulich School of Medicine and Dentistry (Wang), Western University, London, Ontario, Canada
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13
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Byrd JM, Young MP, Liu W, Zhang Y, Tate DB, Crandall AS, Owen LA. Long-term outcomes for pediatric patients having transscleral fixation of the capsular bag with intraocular lens for ectopia lentis. J Cataract Refract Surg 2018; 44:603-609. [PMID: 29752046 DOI: 10.1016/j.jcrs.2018.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the long-term outcomes of transscleral fixation of capsular tension rings (CTR) with intraocular lens (IOL) placement in pediatric patients with ectopia lentis. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Retrospective case series. METHODS Pediatric patients requiring lens extraction with transscleral capsular bag fixation with a CTR and IOL for ectopia lentis between January 2006 and January 2016 were analyzed. RESULTS Thirty-seven patients (67 eyes) who had transscleral fixation of the capsular bag using a CTR fixated with 9-0 or 10-0 polypropylene (Prolene), 8-0 polytetrafluoroethylene (Gore-Tex), or 9-0 nylon were identified. The mean age at time of surgery was 7.25 years (2 to 18 years) and the mean follow-up was 35.3 months (0.25 to 120 months). The proportion of eyes showing improvement in corrected distance visual acuity (CDVA) postoperatively was 78.5%, which demonstrated significance with a 95% confidence interval. In the immediate postoperative period, 1 eye developed a hyphema and 1 eye required IOL repositioning. Long-term complications included posterior capsule opacification in 35 eyes (52%) and uveitis-glaucoma-hyphema syndrome in 1 eye (1.5%). Three eyes (4.4 %) required IOL repositioning for spontaneous delayed IOL dislocation, 2 sutured with 8-0 polytetrafluoroethylene at postoperative month 8 and postoperative year 3 and 1 sutured with 9-0 polypropylene at postoperative year 7. CONCLUSION Transscleral fixation of the capsular bag using a CTR improved CDVA and provided IOL stability in pediatric patients with ectopia lentis.
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Affiliation(s)
- Julia M Byrd
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marielle P Young
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Wei Liu
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Yue Zhang
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David B Tate
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alan S Crandall
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leah A Owen
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA.
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14
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Comparison of ocular wavefront aberrations in subluxated lenses before and after lens extraction with intraocular lens implantation. J Cataract Refract Surg 2018; 44:336-340. [PMID: 29615280 DOI: 10.1016/j.jcrs.2017.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the change in ocular higher-order wavefront aberrations (HOAs), visual acuity, and modulation transfer function (MTF) after lens extraction with intraocular lens (IOL) implantation in patients with subluxated lenses. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN Prospective case series. METHODS Eyes with subluxated lenses having lens extraction with IOL implantation were included. Capsular bag fixation with in-the-bag IOL implantation or sutured or sutureless scleral fixation of the IOL was performed. Aberrometry was performed preoperatively and 6 months postoperatively. The following were compared: root-mean-square (RMS) value for total ocular HOAs, coma aberration, spherical aberration, MTF, and corrected distance visual acuity (CDVA). RESULTS Of the 39 eyes with subluxated lenses, 26 eyes had Cionni ring fixation, 9 had sutured scleral fixation, and 4 had intrascleral fixation of the IOL. The mean preoperative and postoperative values, respectively, were as follows: RMS HOAs, 10.5 μm ± 9.5 (SD) and 4.73 ± 4.6 μm (P < .001); coma aberration, 2.46 ± 2.4 μm and 0.11 ± 0.1 μm (P = .03); and spherical aberration, 0.37 ± 0.9 μm and 0.02 ± 0.06 μm (P = .02). The MTF improved significantly in all eyes (mean 0.05 ± 0.02 preoperatively and 0.32 ± 0.16 postoperatively) (P = .005). The CDVA was statistically significant improved 6 months postoperatively. CONCLUSION Lens extraction with IOL fixation in eyes with subluxated lenses significantly reduced ocular HOAs and improved the MTF.
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15
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Thevi T, Maizura Z, Abas AL. The Melaka Hospital cataract complications study analysis of 12,992 eyes. Indian J Ophthalmol 2017; 65:24-29. [PMID: 28300736 PMCID: PMC5369289 DOI: 10.4103/ijo.ijo_452_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations. Materials and Methods: The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20. Results: Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes. Conclusion: Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication.
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Affiliation(s)
- Thanigasalam Thevi
- Department of Ophthalmology, Hospital Melaka; Clinical Research Centre, Hospital Melaka, Malaysia
| | - Zin Maizura
- Clinical Research Centre, Hospital Melaka, Malaysia
| | - Adinegara Lutfi Abas
- Department of Community Medicine, Melaka-Manipal Medical College, Melaka, Malaysia
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16
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Do AT, Holz HA, Cionni RJ. Subluxated cataract lens surgery using sutured segments or rings and implantation of toric intraocular lenses. J Cataract Refract Surg 2016; 42:392-8. [PMID: 27063519 DOI: 10.1016/j.jcrs.2015.10.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the intraoperative performance and postoperative outcomes of toric intraocular lens (IOL) with suture ring implantation in adult patients with subluxated lenses. SETTING Department of Ophthalmology, Kaiser Permanente, Santa Clara, California, and the Eye Institute of Utah, Salt Lake City, Utah, USA. DESIGN Retrospective case review. METHODS Eyes with subluxated cataractous lenses and preoperative corneal astigmatism having toric IOL implantation with a sutured ring or segment were studied. Preoperative and postoperative analyses included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and cylindrical power postoperatively and 3, 6, and 12 months postoperatively. RESULTS Twenty-one eyes of 15 patients were studied. The median follow-up was 14.6 months. The mean CDVA at the final follow-up (0.10 logMAR ± 0.15 [SD]) was significantly improved from the mean preoperative CDVA (0.73 ± 0.40 logMAR). Postoperative cylindrical power was significantly improved in all patients (mean reduction in astigmatism 2.37 ± 1.46 diopters). Patients who required postoperative enhancement had anterior laser capsulotomy for bilateral capsule phimosis (2 eyes), photorefractive keratectomy (1 eye), pupilloplasty (1 eye), and posterior laser capsulotomy (2 eyes). CONCLUSION Cataract removal and implantation of a toric IOL combined with a sutured ring or segment capsule stabilizing device was a safe and efficacious long-term solution for patients with subluxated cataract lenses and corneal astigmatism.
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Affiliation(s)
- Anna T Do
- From the School of Medicine (Do), Stanford University, Palo Alto, and Kaiser Permanente (Holz), Santa Clara, California; the Eye Institute of Utah (Cionni), Salt Lake City, Utah, USA
| | - Huck A Holz
- From the School of Medicine (Do), Stanford University, Palo Alto, and Kaiser Permanente (Holz), Santa Clara, California; the Eye Institute of Utah (Cionni), Salt Lake City, Utah, USA.
| | - Robert J Cionni
- From the School of Medicine (Do), Stanford University, Palo Alto, and Kaiser Permanente (Holz), Santa Clara, California; the Eye Institute of Utah (Cionni), Salt Lake City, Utah, USA
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17
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Faria MY, Ferreira N, Neto E. Retropupillary iris-claw intraocular lens in ectopia lentis in Marfan syndrome. Int Med Case Rep J 2016; 9:149-53. [PMID: 27382335 PMCID: PMC4918898 DOI: 10.2147/imcrj.s106382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective To report visual outcomes, complication rate, and safety of retropupillary iris-claw intraocular lens (ICIOL) in ectopia lentis in Marfan syndrome (MFS). Design Retrospective study. Methods Six eyes of three MFS patients with ectopia lentis underwent surgery for subluxation lens and retropupillary ICIOL implantation from October 2014 to October 2015 at the Department of Ophthalmology, Santa Maria Hospital in Lisbon, Portugal. Demographics, preoperative and postoperative best-corrected visual acuity (BCVA), and intraocular pressure were evaluated. Endothelium cell count was assessed using specular microscopy; anterior chamber depth was measured using Pentacam postoperatively; and intraocular lens position was viewed by ultrasound biomicroscopy. All patients were female; mean age was 20±14.264 years (range: 7–38 years). Results The average follow-up period was 6.66 months (range: 4–16 months). Preoperative BCVA was 0.568±0.149 logMAR units, and postoperative BCVA was 0.066±0.121 logMAR units. The mean BCVA gain was −0.502±0.221 on the logMAR scale. Postoperative average astigmatism and intraocular pressure were 1.292±0.697 mmHg (range: 0.5–2.25 mmHg) and 16 mmHg (range: 12–18 mmHg), respectively. The average endothelial cell density decreased from 3,121±178 cells/mm2 before surgery to 2,835±533 cells/mm2 after surgery (measured at last follow-up visit) and in the last follow-up, representing an average endothelial cell loss of 9.16%. Mean anterior chamber depth was 4.01 mm (±0.77 mm), as measured by Pentacam. No complications were found intra- or postoperatively in any of the six studied eyes. Conclusion Retropupillary ICIOL implantation is a safe and effective procedure in the treatment of aphakia in MFS eyes, without capsular support after surgery for ectopia lens. The six eyes that underwent lensectomy and retropupillary ICIOL implantation have had excellent visual outcomes with no complications so far.
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Affiliation(s)
- Mun Yueh Faria
- Vitreo Retinal Department, Santa Maria Hospital, Lisbon, Portugal
| | - Nuno Ferreira
- Ophthalmology Department, Santa Maria Hospital, Lisbon, Portugal
| | - Eliana Neto
- Vitreo Retinal Department, Santa Maria Hospital, Lisbon, Portugal
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18
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Thapa BB, Agarwal A, Singh R, Gupta PC, Ram J. Phacoaspiration with a Cionni ring versus pars plana lensectomy, vitrectomy and sutureless transscleral IOL fixation in pediatric patients with a subluxated lens. Graefes Arch Clin Exp Ophthalmol 2016; 254:901-9. [PMID: 26899898 DOI: 10.1007/s00417-016-3297-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare outcomes of phacoaspiration (PA) with Cionni ring-assisted posterior-chamber intraocular lens implantation (PCIOL) versus pars plana lensectomy (PPL) with anterior vitrectomy (AV) and sutureless transscleral fixation of the IOL (TSFIOL) assisted with fibrin glue in the management of a subluxated lens. METHODS In this prospective and comparative interventional study, one eye of children with a bilateral subluxated lens was randomized to undergo PA with PCIOL using a Cionni ring (group A: n = 14 eyes), and the other eye underwent PPL + AV with glue-assisted TSFIOL (group B: n = 14 eyes). The outcome measures included best-corrected visual acuity (BCVA) in logMAR units and rates of complications at 12-month follow-up visits. RESULTS 28 eyes of 14 children (age: 8.06 ± 4.49 years) were included in the study. BCVA improved from preoperative value of 1.21 to 0.4 (p = 0.001) in group A and from 1.53 to 0.31 (p = 0.001) in group B at month 12. There was no significant difference in the BCVA on comparing the two groups at month 12 (p > 0.411). Postoperative complications in group A included corneal edema (two eyes), Cionni hook capture (one eye), elevated IOP (one eye), and posterior capsular opacification (five eyes). In group B, corneal edema was seen in two eyes, hypotony in one eye, vitreous hemorrhage in one eye and pupillary optic capture in four eyes. CONCLUSION Head-to-head comparison of the two techniques demonstrates no significant difference in the rates of complications at month 12. The decision to choose either technique may be based on the operating surgeon's skill, experience and preference.
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Affiliation(s)
- Bikram Bahadur Thapa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Kemp PS, Longmuir SQ, Gertsch KR, Larson SA, Olson RJ, Langguth AM, Syed N, Oetting TA. Cataract surgery in children with uveitis: retrospective analysis of intraocular lens implantation with anterior optic capture. J Pediatr Ophthalmol Strabismus 2015; 52:119-25. [PMID: 25608281 DOI: 10.3928/01913913-20150114-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/12/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To present experience with cataract extraction in 9 eyes of 7 pediatric patients with chronic uveitis and compare the technique of anterior optic capture in 5 eyes that underwent cataract extraction without optic capture of the intraocular lens (IOL) or were left aphakic. METHODS A retrospective review of pediatric patients with chronic uveitis undergoing cataract surgery was performed, examining the preoperative and postoperative visual acuity, immunosuppressive therapy, surgical technique, complications, subsequent procedures, and need for escalation of systemic immunosuppressive therapy. The technique of anterior optic capture is described in detail. RESULTS Of the 9 eyes, 5 underwent cataract extraction with IOL placement with the haptics in the capsular bag and optic prolapsed through the anterior capsulorhexis. One eye underwent cataract extraction with IOL implantation in the bag. Three eyes had lensectomy without IOL placement. The eyes with anterior optic capture had no adverse outcomes and uveitis flares were controlled with topical medications and systemic immunosuppressants; the eye with IOL placement without optic capture had recurrent membranes and uveitis flares, necessitating increased systemic immunosuppression. All eyes achieved best-corrected visual acuity of 20/60 or better by 6 months following surgery and 20/30 or better at the most recent follow-up. CONCLUSIONS The technique of cataract extraction with IOL placement and anterior prolapse of the optic through the anterior capsulorhexis shows promise to be a safe and viable option for pediatric patients with chronic uveitis treated with systemic immunotherapy.
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Abstract
PURPOSE OF REVIEW To discuss capsular tension devices and recent evidence regarding their use. RECENT FINDINGS The capsular tension ring, modified capsular tension ring, and capsular tension segment are well established tools for use during phacoemulsification when zonular instability is present. Recent research has provided additional evidence of their benefits in decreasing intraoperative and postoperative complications. SUMMARY Endocapsular support devices allow for cataract surgery success in the setting of zonular instability.
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Park DH, Chung JK. Modified Capsular Tension Ring Scleral Fixation and Toric Intraocular Lens Implantation in a Patient with Homocystinuria. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.4.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dae Hyun Park
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jin Kwon Chung
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Cheonan, Korea
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22
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Ventura MC, Ventura BV, Ventura CV, Ventura LO, Arantes TE, Nosé W. Reply: To PMID 24530023. J Cataract Refract Surg 2014; 40:1057. [PMID: 24857456 DOI: 10.1016/j.jcrs.2014.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Indexed: 11/25/2022]
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23
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Kim EJ, Berg JP, Weikert MP, Kong L, Hamill MB, Koch DD, Yen KG. Scleral-fixated capsular tension rings and segments for ectopia lentis in children. Am J Ophthalmol 2014; 158:899-904. [PMID: 25127699 DOI: 10.1016/j.ajo.2014.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the short-term outcomes and complications of implantation of scleral-fixated capsular tension rings and/or capsular tension segments with intraocular lenses (IOL) in pediatric patients with ectopia lentis. DESIGN Retrospective, observational case series. METHODS Thirteen consecutive pediatric patients (19 eyes) underwent placement of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between January 1, 2009 and March 30, 2013 by 3 anterior segment surgeons at a single academic center. The scleral fixation suture was 9-0 polypropylene in 16 eyes and CV-8 Gore-Tex (expanded polytetrafluoroethylene) in 3 eyes. Outcome measures included change in corrected distance visual acuity (CDVA) and complications. RESULTS The mean age was 10.2 years ± 4.8 (SD) and the median follow-up, 23.4 months. A Cionni modified capsular tension ring was implanted in 5 eyes and a capsular tension segment with an unsutured capsular tension ring was implanted in 12 eyes. In 2 eyes, capsular tension segment alone was placed. The mean CDVA at the final follow-up (0.10 ± 0.11 logMAR, 18 eyes) was significantly better than preoperatively (0.58 ± 0.26 logMAR, 15 eyes) (P < .001). The CDVA at the final follow-up was 20/40 or better in 18 eyes (94.7%). All IOLs were well centered. Posterior capsule opacification developed in 11 eyes (57.9%), 9 eyes (47.4%) required neodymium-yttrium-aluminum-garnet capsulotomy, and 3 eyes (15.8%) required pars plana vitrectomy and posterior capsulotomy. Other complications included broken suture (5.3%) (9-0 polypropylene at CTR eyelet, repaired with CV-8 Gore-Tex), conjunctival dehiscence (5.3%), suture exposure (5.3%) (trans-scleral 9-0 polypropylene), and vitreous strand at inferior paracentesis (5.3%). CONCLUSIONS Implantation of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring appears to be a safe and effective technique for visual rehabilitation in pediatric ectopia lentis.
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Affiliation(s)
- Eric J Kim
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - James P Berg
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Mitchell P Weikert
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Lingkun Kong
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Marshall B Hamill
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Douglas D Koch
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Kimberly G Yen
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
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Wilkie DA, Stone Hoy S, Gemensky-Metzler A, Colitz CMH. Safety study of capsular tension ring use in canine phacoemulsification and IOL implantation. Vet Ophthalmol 2014; 18:409-15. [DOI: 10.1111/vop.12232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David A. Wilkie
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus OH 43017 USA
| | | | - Anne Gemensky-Metzler
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus OH 43017 USA
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Two-step technique for posterior optic buttonholing of intraocular lens. Optom Vis Sci 2014; 91:S17-9. [PMID: 24584307 DOI: 10.1097/opx.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aims to describe a two-step surgical technique for placement of a posterior chamber intraocular lens (IOL) in cases with crystalline lens subluxation resulting from non-progressive zonular dialysis. METHODS The first stage entails a phacoemulsification with creation of a 4-mm posterior capsular opening using an automated vitrector. The second stage performed 6 weeks later includes an anterior vitrectomy and injection of a foldable three-piece IOL in the sulcus. The haptics of IOL are positioned in the sulcus while the optic is pushed behind the posterior capsular opening therefore "buttonholing" the IOL. RESULTS Seven eyes of seven patients with posttraumatic zonular dialysis were operated using this technique. Follow-up of all cases revealed a well-centered IOL with good postoperative visual acuity (20/20 to 20/80). CONCLUSIONS Our two-stage surgical technique precludes the insertion of capsular tension ring in cases with non-progressive zonular dialysis. The technique is recommended in the presence of less than or equal to 6 clock hours of zonular dialysis with preexisting posterior capsular tear or herniation of vitreous in the anterior chamber.
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Siddiqui SN, Khan A. Visual outcome and changes in corneal endothelial cell density following aphakic iris-fixated intraocular lens implantation in pediatric eyes with subluxated lenses. J Pediatr Ophthalmol Strabismus 2013; 50:178-82. [PMID: 23316948 DOI: 10.3928/01913913-20130108-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 10/15/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcome and corneal endothelial cell density after Artisan aphakic intraocular lens (IOL) implantation (Ophtec, Groningen, the Netherlands) in pediatric eyes with subluxated lenses. METHODS Artisan aphakic IOLs were implanted in 18 eyes of 11 children with subluxated lenses. Idiopathic subluxations and ectopia lentis due to Marfan syndrome were included, whereas subluxations due to trauma or buphthalmos were excluded. Best-corrected visual acuity (BCVA) and endothelial cell density were monitored. Mean postoperative BCVA and endothelial cell density at last follow-up visit were calculated. RESULTS The age of children at the time of Artisan aphakic IOL implantation ranged from 8 to 16 years (mean: 11.58 ± 2.9 years). Mean follow-up was 9.12 ± 4.30 months. Mean postoperative logarithm of the minimum angle of resolution BCVA was 0.26 ± 0.13 (P = .001) and mean postoperative endothelial cell density was 2,860 ± 435 cells/mm(2) (P = .000). Mean endothelial cell loss was 17.1%. CONCLUSION Artisan aphakic IOL implantation is a safe surgical choice in the management of ectopia lentis in the pediatric age group. It has minimal complications and is less traumatic to pediatric eyes. However, long-term follow-up of these children is required.[J Pediatr Ophthalmol Strabismus 2013;50(3):178-182.].
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Affiliation(s)
- Sorath Noorani Siddiqui
- Department of Pediatric Ophthalmology and Strabismus (SNS), Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan.
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27
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Vasavada AR, Praveen MR, Vasavada VA, Yeh RY, Srivastava S, Koul A, Trivedi RH. Cionni ring and in-the-bag intraocular lens implantation for subluxated lenses: a prospective case series. Am J Ophthalmol 2012; 153:1144-53.e1. [PMID: 22317913 DOI: 10.1016/j.ajo.2011.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 11/02/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the intraoperative performance and postoperative outcomes of the Cionni-modified capsule tension ring (CTR) implantation in eyes with subluxated lenses. DESIGN Prospective, observational case series. METHODS This study was carried out at Iladevi Cataract & IOL Research Centre, Ahmedabad, India. The study population comprised 41 eyes with subluxated lenses that underwent lens extraction, capsular bag fixation with modified CTR, and in-the-bag single-piece AcrySof intraocular lens (IOL) implantation. Main outcome measures were intraoperative performance and postoperative best-corrected visual acuity (BCVA), IOL centration, and complications. RESULTS The mean age was 29.46 ± 16.16 years (3-68 years). Mean extent of subluxation was 6.1 ± 1.0 clock hours. Preoperatively, vitreous was detected in the anterior chambers of 5 eyes (12.2%). Two-port anterior chamber vitrectomy was performed in 2 eyes. Mean follow-up was 45.8 ± 2.9 months. Mean preoperative BCVA was 0.66 ± 0.22 logMAR (35 eyes). Mean postoperative BCVA at final follow-up was 0.33 ± 0.21 logMAR (41 eyes) (P < .001). BCVA improved in 35 eyes (85.4%) at the last follow-up. In 3 eyes (7.3%) IOL decentration was noted and repositioning was required in 2 eyes. Posterior capsule opacification developed in 14 eyes (34.2%); 12 eyes (29.3%) required Nd:YAG capsulotomy. Other complications included cystoid macular edema in 1 eye (2.4%), posterior synechiae in 1 eye (2.4%), and retinal detachment in 1 eye (2.4%). CONCLUSION In-the-bag implantation of a Cionni-modified CTR with IOL appears to be a safe option in eyes with subluxated cataract, ensuring a stable IOL with few complications.
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Rodrigues ACL, Trivedi RH, Wilson ME. Subluxation of the crystalline lens: a no-ring approach. J Pediatr Ophthalmol Strabismus 2012; 49:157-63. [PMID: 21800782 DOI: 10.3928/01913913-20110726-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 06/17/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the surgical technique and outcomes of a no-ring approach to posterior chamber intraocular lens (IOL) implantation in children and young adults with subluxation of the crystalline lens. METHODS A three-piece 5.5-mm hydrophobic acrylic IOL was implanted in which the optic and one haptic were inside the capsular bag and the other haptic was in the ciliary sulcus. The implantations were done in 13 eyes of 10 patients with lens subluxation. One haptic was fixated in the ciliary sulcus by passing it through an operculum-shaped opening in the capsular bag edge, made between 2 and 3 clock hours, clockwise from the middle point of the subluxated area. RESULTS The mean age of the 10 patients was 12.61 ± 8.04 years and the mean follow-up was 21.38 ± 11.29 months. The mean preoperative and postoperative best-corrected visual acuity (BCVA) was 1.15 ± 0.58 and 0.37 ± 0.17 logarithm of the minimum angle of resolution, respectively, in 11 measured eyes. The postoperative BCVA was 20/40 or better in 4 eyes (36.36%), between 20/40 and 20/60 in 6 eyes (54.54%), and between 20/80 and 20/100 in 1 eye (9.09%). The BCVA improved in all eyes. Postoperative IOL decentration between 1.0 and 1.5 mm occurred in 3 of 13 eyes (23.08%). CONCLUSION The results indicate that the no-ring technique allows centration of an IOL implanted into a subluxated capsular bag without using capsule tension rings.
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Affiliation(s)
- Antonio Carlos L Rodrigues
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
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Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract. J Ophthalmol 2012; 2012:205139. [PMID: 22523646 PMCID: PMC3317208 DOI: 10.1155/2012/205139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.
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Buttanri IB, Sevim MS, Esen D, Acar BT, Serin D, Acar S. Modified capsular tension ring implantation in eyes with traumatic cataract and loss of zonular support. J Cataract Refract Surg 2012; 38:431-6. [DOI: 10.1016/j.jcrs.2011.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/04/2011] [Indexed: 11/29/2022]
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Gimbel HV, Camoriano GD, Aman-Ullah M. Bilateral Implantation of Scleral-Fixated Cionni Endocapsular Rings and Toric Intraocular Lenses in a Pediatric Patient with Marfan's Syndrome. Case Rep Ophthalmol 2012; 3:16-23. [PMID: 22615696 PMCID: PMC3357140 DOI: 10.1159/000335652] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The management of ectopia lentis in Marfan's syndrome is challenging. Multiple disease-associated factors conspire to deprive these patients of adequate vision. While optical correction with glasses and contact lenses is usually advocated early on, the irregular astigmatism and even partial aphakia that accompanies advanced cases generally warrant surgical intervention. Several surgical strategies have been devised to manage these challenging cases, including the combination of endocapsular or pars plana lensectomy and iris or scleral fixation of the intraocular lens (IOL) or IOL-bag complex. All of the reported cases have been implanted with IOLs that correct for myopia only. With toric lenses, it is now possible to correct for corneal astigmatism in these patients as well, provided that the capsular bag is maintained and can be properly centered. We report the combination of scleral-fixated Cionni endocapsular rings and toric IOLs in a pediatric patient with bilateral ectopia lentis secondary to Marfan's syndrome.
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Long-term corneal endothelial cell changes in pediatric intraocular lens reposition and exchange cases. Graefes Arch Clin Exp Ophthalmol 2011; 250:547-55. [PMID: 22005791 DOI: 10.1007/s00417-011-1837-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 09/23/2011] [Accepted: 09/28/2011] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate long-term corneal endothelial cell changes of intraocular lens (IOL) reposition and exchange in children. SETTING State key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China METHODS In this retrospective study, all IOL reposition and exchange procedures performed in patients under 14 years old between January 1999 and April 2009 were included. Follow-up outcomes included corneal endothelial cell density, hexagonality, coefficient of variance, average cell size. RESULTS IOL reposition procedures in 12 eyes (12 cases) (reposition group, RPG), and IOL exchanges in eight eyes (eight cases) (exchange group, EXG) were performed because of IOL pupillary capture or IOL dislocation. Median of follow-up was 44.5 months in RPG and 66.2 months in EXG. The density of corneal endothelial cells in RPG (2,053 ± 493/mm(2)) and EXG (2,100 ± 758/mm(2)) was significantly decreased in comparison to the control eyes (3,116 ± 335/mm(2)). Hexagonality of corneal endothelial cells and coefficient of variance showed no difference among the control group, RPG and EXG (P > 0.05). CONCLUSIONS The density of corneal endothelial cells was conspicuously decreased after IOL reposition or exchange procedures in childhood cases. Longer follow-up must be conducted in these cases.
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Chee SP, Jap A. Management of traumatic severely subluxated cataracts. Am J Ophthalmol 2011; 151:866-871.e1. [PMID: 21310378 DOI: 10.1016/j.ajo.2010.10.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/23/2010] [Accepted: 10/26/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine outcome of cataract surgery in severely subluxated traumatic cataracts. DESIGN Noncomparative case series. METHODS Retrospective review of cataract surgery in all consecutive eyes with at least 6 clock hours of zonulysis, for patient demographics, presenting best-corrected visual acuity (BCVA) and postoperative BCVA at various time points, extent of zonulysis, and type and timing of insertion of capsular tension device. Main outcome measures were retention of the capsular bag and BCVA at last visit. Secondary outcome measures included IOL stability and centration, and perioperative complications. RESULTS There were 41 eyes (41 patients). Mean age at time of surgery was 57 years and the mean duration of follow-up was 21.4 months. The capsular bag was preserved with aid of a Cionni modified capsular tension ring (CTR) in 36 eyes (87.8%) and a combination of a capsular tension segment (CTS) and CTR in 2 eyes. In 3 eyes with total zonulysis, the bag could not be preserved despite the use of a CTS in 2 eyes. Preoperatively only 9 of the 41 eyes (22.0%) had a BCVA of 20/40 or better, as compared to 38 eyes at the last visit (92.7%, P < .001, χ(2) test). Posterior capsule rupture occurred in 3 eyes, 2 of which occurred during fixation of the CTR. CONCLUSIONS The capsular bag can be successfully preserved even in severely subluxated traumatic cataracts with the aid of fixated capsular tension devices.
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Sharma A. Trans-scleral fixation of Cionni - modified capsule tension ring. Indian J Ophthalmol 2010; 58:447; author reply 447-8. [PMID: 20689211 PMCID: PMC2992932 DOI: 10.4103/0301-4738.67049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Guo S, Wagner R, Forbes B, Tannen B, Caputo A. Capsular tension ring in the management of occult lens zonular dehiscence in infantile glaucoma. J Pediatr Ophthalmol Strabismus 2010; 47 Online:e1-3. [PMID: 21158363 DOI: 10.3928/01913913-20100719-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 03/26/2010] [Indexed: 11/20/2022]
Abstract
The authors present a case of bilateral zonular dehiscence in a boy with infantile glaucoma who had developed cataracts. The zonular dehiscence was noted at the beginning of cataract surgery. The cataracts were removed and capsular tension rings and intraocular lenses were safely inserted and remained well centered.
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Affiliation(s)
- Suqin Guo
- The Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07101, USA.
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Das P, Ram J, Brar GS, Dogra MR. Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children. Indian J Ophthalmol 2010; 57:431-6. [PMID: 19861744 PMCID: PMC2812761 DOI: 10.4103/0301-4738.57149] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children. Setting: Tertiary care setting Materials and Methods: We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90° up to 210° after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO). Results: Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL. Conclusions: Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation
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Affiliation(s)
- Pranab Das
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh-160 012, India
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Current world literature. Curr Opin Ophthalmol 2009; 21:81-90. [PMID: 19996895 DOI: 10.1097/icu.0b013e3283350158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hoffman RS, Fine HI, Packer M. Primary anterior chamber intraocular lens for the treatment of severe crystalline lens subluxation. J Cataract Refract Surg 2009; 35:1821-5. [DOI: 10.1016/j.jcrs.2009.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/29/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
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Brown S. Complications of CTR implantation in pediatric eyes. J Cataract Refract Surg 2008; 35:2-3; author reply 3. [PMID: 19101409 DOI: 10.1016/j.jcrs.2008.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
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