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Chen Z, Jia W, Chen T, Shen X, Wang Y, Sun Y, Jiang Y. Safety and efficacy of capsular tension ring and capsular hook implantation for managing ectopia lentis in Marfan syndrome: real-world study. J Cataract Refract Surg 2024; 50:698-706. [PMID: 38409756 DOI: 10.1097/j.jcrs.0000000000001434] [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: 11/07/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL). SETTING Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Retrospective propensity score-matched cohort study. METHODS This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM). RESULTS This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group ( P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups ( P = .057). The posterior capsular opacification took place earlier ( P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage ( P = .037) compared with the MCTR group. CONCLUSIONS The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.
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Affiliation(s)
- Zexu Chen
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China (Z. Chen, Jia, T. Chen, Shen, Wang, Sun, Jiang); NHC Key Laboratory of Myopia, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China (Z. Chen, Jia, T. Chen, Shen, Wang, Sun, Jiang); Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China (Z. Chen, Jia, T. Chen, Shen, Wang, Sun, Jiang)
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Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis. Int Ophthalmol 2023; 43:131-140. [PMID: 35794404 DOI: 10.1007/s10792-022-02395-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis. METHODS Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180° were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated. RESULTS The mean age of the patients was 57.4 ± 15.1 years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 ± 6.5 months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 ± 0.16 logMAR and 0.13 ± 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 ± 1.4 D and 1.0 ± 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7° ± 5.2°. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%). CONCLUSION The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.
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Jiang H, Fu W, Xu H. The Technique of Phacoemulsification and Intraocular Lens Implantation in Subluxated Cataract Surgery. Stem Cells Int 2022; 2022:3188710. [PMID: 36248257 PMCID: PMC9560858 DOI: 10.1155/2022/3188710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to investigate the effectiveness and practicability of phacoemulsification and intraocular lens implantation for subluxated cataracts. A retrospective review of subluxated cataract surgeries of 19 eyes performed in Kunhua Hospital Affiliated with Kunming University of Science and Technology between January 2017 and June 2021 was conducted. We choose to use the rotate-and-chop phacoemulsification techniques described when the crystal nucleus is rotated out of the capsular bag and simultaneously perform horizontal chops over the capsule. The viscoelastic agent was the important material that filled the capsule to support the capsular bag, and capsular hooks were used in 10 eyes necessarily. Anterior vitrectomy was undergone in 15 eyes. Single-piece intraocular lenses (IOL) were implanted in the capsular bag in 12 eyes including 8 capsular tension ring (CTR) implantation. Three-piece IOLs were fixed scleral layer in 7 eyes. Follow-up was 6 months to 2 years, and all eyes were successfully implanted with centered IOL. The best corrected visual acuity (BCVA) increased from 0.06 ± 0.04 to 0.62 ± 0.15. The cornea of all patients was clear, the intraocular lens was centered, the pupil was round, and the intraocular pressure was normal. Subluxated cataracts are a challenging surgery. The technique of phacoemulsification in subluxated cataract surgery is a key procedure to rotate and remove the lens from the capsule and at the same time horizontal chops and emulsification over the capsular bag to be performed. Viscoelastic agents and capsular hooks were important choices to support the capsule to reduce the incidence of complications related to the vitreous and retina and prevent the range enlarging of the zonular dialysis. A capsular tension ring was also an effective device to maintain capsular stability. Double-needle-guided scleral interlamellar fixation is an effective and practical method for IOL. Overall, the incision technique explored in this study and the surgical technique to support capsular stabilization provide a safe approach and satisfactory results in cataract surgery for subluxation.
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Affiliation(s)
- Huaiyan Jiang
- The First People's Hospital of Yunnan Province (Kunhua Hospital Affiliated to Kunming University of Science and Technology), Kunming, China
| | - Wenzhong Fu
- The First People's Hospital of Yunnan Province (Kunhua Hospital Affiliated to Kunming University of Science and Technology), Kunming, China
| | - Hongxia Xu
- The First People's Hospital of Yunnan Province (Kunhua Hospital Affiliated to Kunming University of Science and Technology), Kunming, China
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Soyler M, Sabur H, Unsal U. Flanged iris hook for capsular bag stabilization. J Cataract Refract Surg 2022; 48:1088-1091. [PMID: 36026473 DOI: 10.1097/j.jcrs.0000000000000985] [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: 12/21/2021] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
A new surgical technique was demonstrated for fixating the capsular bag to the sclera using a capsular tension segment (CTS) and a flanged iris hook. In a patient with a 180-degree zonular dialysis, a capsular tension ring was implanted into the capsular bag, and a CTS was placed into the zonular dialysis area after cataract removal. Then, an iris hook was directed to the anterior chamber through a side port opposite the zonular dialysis area. After the hook tip was placed into the eyelet of the CTS, a 30-gauge injector was used to guide the hook tip out. Tension was adjusted to ensure the capsular centralization, and a flange was created using cautery. Finally, the procedure was completed by embedding the flange into the sclera. This method is simple, minimally invasive, and time-saving by eliminating the scleral suturing, scleral flaps, or large conjunctival dissections.
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Affiliation(s)
- Mehmet Soyler
- From the Department of Ophthalmology, Batigoz Eye Health Center, Izmir, Turkey (Soyler, Unsal); Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey (Sabur)
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Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s) to Reconstruct Capsular Support for Out-of-the-Bag Intraocular Lens Fixation in Vitrectomized Eyes. Retina 2022; 42:1816-1821. [PMID: 31021902 DOI: 10.1097/iae.0000000000002554] [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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Femtosecond Laser Combined with Double-Flange Polypropylene Suture Capsular Tension Ring Suspension for the Treatment of Subluxation of Lens in Marfan Syndrome. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9348311. [PMID: 35991146 PMCID: PMC9385373 DOI: 10.1155/2022/9348311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the use of femtosecond laser combined with double-flange polypropylene suture capsular tension ring (CTR) suspension to treat subluxation of lens in Marfan syndrome. The objective is to provide safer and more effective surgical procedures for patients. Setting. Eye Hospital, Aier Eye Hospital of Wuhan University, Wuhan, China Methods In this retrospective study, we observed sixteen patients (16 eyes) with Marfan syndrome who had undergone this operation. Femtosecond laser incision was performed on the anterior capsule with the lens as the center. The suspending CTR was clipped to anterior capsule to support it, which was secured to the sclera with a double-flange polypropylene suture. Uncorrected visual acuity (UCVA), intraocular pressure (IOP), tilt, and decentration of the intraocular lens (IOL) and postoperative complications were evaluated. Results All 16 patients were successfully implanted with suspended CTR and IOL after femtosecond laser assisted surgery. Visual acuity improved significantly after surgery (p < 0.01). At 1 month, 3 months and 6 months postoperatively, the tilt of the IOL was 2.70 ± 0.934, 2.65 ± 0.897, and 2.66 ± 0.781, and the decentration of the IOL was 0.30 ± 0.770, 0.30 ± 0.682, and 0.29 ± 0.737; both had no statistically significant difference between the three groups. After the operation, 4 patients had hyphema and 2 patients experienced a temporary postoperative IOP increase. Only one flange was exposed one month after operation and recovered right after secondary adjustment. Conclusion Femtosecond laser combined with double-flange polypropylene suture CTR suspension was effective in fixing the lens capsule to the scleral wall in cases of subluxation of lens seen in Marfan syndrome during our short-term observation. The long-term efficacy of this operation needs further observation and follow-up.
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Canabrava S, Pinheiro L, Chaves V, Barrientos R. Late internalized double-flanged polypropylene with canabrava technique in patient with marfan syndrome. Eur J Ophthalmol 2022:11206721221092216. [PMID: 35384783 DOI: 10.1177/11206721221092216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This paper reports the first occurrence of a late internalized flange due to capsular contraction syndrome after undergoing the double-flanged surgical technique. CASE DESCRIPTION A 32-year-old woman with Marfan syndrome underwent phacoemulsification using the double-flanged technique in both eyes. Two years postoperatively, a slit lamp examination revealed a capsular bag with anterior phimosis (capsular contraction syndrome) and the external flange internalized. The patient was submitted for a new surgery to re-fixate the capsular bag. The procedure was successfully accomplished. The intraocular lens was centered by the end of the procedure without areas of traction. The patient presented with best corrected visual acuity of 20/25 in both eyes postoperatively. CONCLUSIONS This paper recounts a successful re-approach of a late internalized double-flange two years after the first procedure in a patient that developed capsular contraction syndrome.
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Affiliation(s)
- Sérgio Canabrava
- Cataract Department, 193570Santa Casa de Belo Horizonte 197, 1704 - Claudio Manoel Av. Belo Horizonte, Minas Gerais - Brazil
| | | | - Vizibelli Chaves
- Cataract Department, 193570Santa Casa de Belo Horizonte 197, 1704 - Claudio Manoel Av. Belo Horizonte, Minas Gerais - Brazil
| | - Robinson Barrientos
- Cataract Department, 193570Santa Casa de Belo Horizonte 197, 1704 - Claudio Manoel Av. Belo Horizonte, Minas Gerais - Brazil
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Sutureless technique for repositioning and scleral fixation of the capsular bag-intraocular lens complex with permanent use of iris retractors. J Cataract Refract Surg 2022; 48:118-124. [PMID: 34855644 DOI: 10.1097/j.jcrs.0000000000000838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
A new sutureless technique used for repositioning and scleral fixation of the capsular bag-intraocular lens (IOL) complex in the surgical treatment of subluxated lenses is described. Iris retractors were used not only to induce a tent effect on the capsule but also to permanently fix the capsular bag to the sclera in this method, without the need to prepare scleral or conjunctival flaps. Surgery with the use of a capsular tension ring (CTR) and iris retractors, the ends of which were brought out through the sclera and cauterized, was performed in 7 eyes of 7 patients with moderate or severe subluxation of the crystalline lens. In all cases, simultaneous use of a CTR and iris retractors ensured good centration of the capsular bag-IOL complex. The method was safe and effective in fixing the capsule to the sclera in the case of significant damage to the ligamentous apparatus of the lens.
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Venkateswaran N, Henderson BA. Loose zonules in cataract surgery. Curr Opin Ophthalmol 2022; 33:53-57. [PMID: 34783703 DOI: 10.1097/icu.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review will focus on identifying causes of zonulopathy during cataract surgery and discuss various modalities for treatment. RECENT FINDINGS There are multiple different options for capsular bag support in the setting of zonulopathy, including capsular or iris hooks, capsular tension rings as well as capsular tension segments (CTS). Surgical techniques on how to insert these devices are many and can be customized based upon the surgeon's preference and the patient's eye anatomy. SUMMARY Recognizing zonular weakness is critical to achieve stable postoperative vision and avoid future complications. Depending on the degree of zonulopathy, various treatment options can be pursued, ranging from capsular tension hooks or iris hooks, capsular tension rings or sutured or scleral fixated CTS.
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Affiliation(s)
| | - Bonnie A Henderson
- Ophthalmic Consultants of Boston, Tufts University School of Medicine, Boston, Massachusetts, USA
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Chee SP, Ti SE, Chan NSW. Management of the subluxated crystalline lens: A review. Clin Exp Ophthalmol 2021; 49:1091-1101. [PMID: 34264007 DOI: 10.1111/ceo.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Cataract surgery for the subluxated crystalline lens is challenging. A thorough preoperative evaluation is important to determine the appropriate surgical approach for lens removal and the subsequent technique of intraocular lens placement. Important considerations include the extent and location of zonular weakness, and whether the zonular deficiency is caused by a static or progressive disease. The capsular bag should be preserved where possible. Creating a good-sized and centred continuous curvilinear capsulorhexis is crucial to facilitate the use of capsular retractors and capsular tension devices, which provide capsular stability. Nucleus sculpting and rotation should be minimised to reduce zonular stress. Being cognisant of the possible intraoperative complications that may occur at each stage of the surgery and knowing how to reduce the risk of these complications occurring will enable surgeons to perform safe cataract surgery in these complex cases.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
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Evaluation of the Utility of Capsular Stabilization Devices in a Zonular Fiber Defect Model with the Slit Side View System. J Ophthalmol 2020; 2020:5921965. [PMID: 32832137 PMCID: PMC7429767 DOI: 10.1155/2020/5921965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
Capsular stabilization devices were evaluated in a zonular fiber defect model using the slit side view (SSV) system to confirm their utility for capsular stabilization during phacoemulsification. A zonular fiber defect model was made by cutting Zinn’s zonule under observation with a slit lamp microscope in a porcine eye. Phacoemulsification was performed, and the movement of the lens capsule and the depth of the anterior chamber were observed using the SSV in three groups: control group: no surgical instruments used, CE group: a capsule expander was inserted, and CTR group: a capsular tension ring was inserted. In the control group, the equator of the lens was unstable and was easily suctioned to the port of the ultrasound handpiece. The lens capsule was stable in both in the CE and CTR groups. In the CTR group, the equator responsible for the zonular rupture also returned and closed true to its original position. The utility of the capsular stabilization devices in this zonular fiber defect model was confirmed with the SSV system.
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Novel double-flanged technique for managing Marfan syndrome and microspherophakia. J Cataract Refract Surg 2020; 46:333-339. [DOI: 10.1097/j.jcrs.0000000000000116] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW To review current, effective and more popular techniques for scleral fixation of intraocular lens (IOLs) and IOL-capsular bag complex. RECENT FINDINGS Scleral fixation of IOLs became popular, originally with sutured scleral fixated IOLs and later the Scharioth technique of intrascleral haptic fixation. This was further developed as the Glued IOL technique which enjoys widespread adoption all over the world. Recently the Yamane technique has also become popular and is being widely adopted as well. SUMMARY Scleral fixated IOLs have evolved in the last 2 decades with technical modifications, extended indications and improvised instrumentation. Though sutured and sutureless techniques have been growing equally, the sutureless scleral fixation techniques have attracted special interest. Reduced suture-related complications, technical ease and high-quality functional outcomes may be possible reasons. Sutureless capsular bag fixation also has distinct advantages.
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Om Parkash R, Mahajan S, Om Parkash T, Om Parkash T, Rai M. Nuclear scaffold: Three-dimensional indigenous capsular bag support combined with IOL scaffold and capsular tension ring to prevent posterior capsule rupture in zonulopathy. J Cataract Refract Surg 2019; 45:1696-1700. [PMID: 31856977 DOI: 10.1016/j.jcrs.2019.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
We describe a technique for performing phacoemulsification in eyes with zonular fiber dehiscence of less than 90 degrees using hard nuclear fragments as a scaffold. In conjunction with a capsular tension ring (CTR), hard nuclear fragments and the intraocular lens (IOL) are used as scaffolds during different steps of nuclear emulsification to prevent posterior capsule rupture and aggravation of zonulopathy. Devices such as capsular hooks, CTRs, and IOLs are used to support the capsular bag associated with zonulopathy. The mass of hard nuclear fragments provides support toward the anteroposterior and the horizontal planes, thereby providing 3-dimensional capsular bag support.
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Affiliation(s)
| | | | | | - Tushar Om Parkash
- Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Milan Rai
- Dr. Om Parkash Eye Institute, Amritsar, India
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Su D, Stephens JD, Obeid A, Borkar D, Storey PP, Khan MA, Hsu J, Garg SJ, Gupta O. Refractive Outcomes after Pars Plana Vitrectomy and Scleral Fixated Intraocular Lens with Gore-Tex Suture. Ophthalmol Retina 2019; 3:548-552. [PMID: 31277795 DOI: 10.1016/j.oret.2019.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/08/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate refractive outcomes after combined pars plana vitrectomy (PPV) and scleral fixation of an intraocular lens (IOL) using Gore-Tex suture. DESIGN Retrospective cohort study. PARTICIPANTS Fifty-five eyes from 53 patients who underwent PPV with a Gore-Tex sutured IOL from June 2013 through December 2017. METHODS Patients who underwent combined PPV and scleral fixation of an IOL with Gore-Tex suture were identified. All eyes underwent scleral fixation of either an Akreos A060 or enVista MX60 IOL and were fixated either 2 mm or 3 mm posterior to the limbus. Postoperative manifest refractions were performed at least 3 months after surgery and were compared with preoperative predicted target refraction based on in-the-bag IOL calculations. Subgroup analyses based on sclerotomy placement and IOL models were performed. MAIN OUTCOME MEASURES Postoperative manifest refraction and difference with sclerotomy placement and IOL model. RESULTS The mean postoperative spherical equivalent (SEQ) was -0.99±1.00 diopters (D). The mean difference in SEQ (ΔSEQ) from preoperative predicted target was -0.64±1.00 D. The IOL was fixated 2 mm posterior to the limbus in 14 eyes and 3 mm in 41 eyes. Within these 2 subgroups, the mean postoperative SEQ was -1.53±1.35 D for fixation 2 mm posterior to the limbus and -0.82±0.83 D for fixation 3 mm posterior to the limbus (P = 0.09). The mean ΔSEQ was -0.43±0.71 D for fixation 3 mm posterior to the limbus and -1.35±1.32 D for fixation 2 mm posterior to the limbus (P = 0.03). The mean amount of surgically induced astigmatism in the overall cohort was 0.77±0.65 D. The mean ΔSEQ and induced astigmatism were similar between IOL models. CONCLUSIONS After combined PPV and Gore-Tex-sutured IOL implantation, mean postoperative refractive outcomes were more myopic when the IOL was fixated 2 mm from the limbus compared with 3 mm from the limbus. No significant difference was found between IOL models. Based on these results, future implant power calculations may be adjusted to approximate preoperative target refraction more accurately.
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Affiliation(s)
- Daniel Su
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - John D Stephens
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Durga Borkar
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Philip P Storey
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - M Ali Khan
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Retina Division, Doheny and Stein Eye Institutes, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Omesh Gupta
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
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Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s): A Sutureless Technique to Fixate the Capsular Bag for Intraocular Lens Implantation in Subluxated Lenses. Retina 2018; 39 Suppl 1:S33-S38. [PMID: 30586352 DOI: 10.1097/iae.0000000000002425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benarous A, Drimbea A, Milazzo S. [Study of the results scleral-fixated intraocular lenses in the absence of capsular support]. J Fr Ophtalmol 2018; 41:1-13. [PMID: 29331294 DOI: 10.1016/j.jfo.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the absence of sufficient capsular support, scleral fixation of the intraocular lens is an interesting alternative. The goal is to evaluate this implantation technique when traditional implantation is impossible. PATIENTS AND METHODS This is an observational, retrospective, monocentric study at the Amiens university medical center between August 2013 and March 2016. Patients all underwent scleral fixation of a three-piece implant without suturing of the haptics, after posterior vitrectomy. All patients requiring implantation in the absence of stable capsular support were included. Patients with adequate iris or capsular support were excluded from our study. RESULTS Eighteen patients were included, with an average age of 69.3±16.9 years. The surgical indications were: complicated surgery, trauma and endothelial decompensation. The preoperative mean corrected visual acuity was 1.2±0.4 LogMAR while the postoperative acuity was 0.7±0.5 LogMAR. The mean postoperative corneal astigmatism was 1.9±1.9 diopters. The main complications observed were ocular hypertension, macular edema, retinal detachment, iris incarceration and exteriorization of the haptic. DISCUSSION There are two alternatives when faced with lack of a sufficient capsular support: scleral fixation or iris fixation. Our technique is the only one achievable in the presence of iris atrophy. Furthermore, it induces less astigmatism and enables the repositioning of a three-piece implant dislocated into the vitreous. CONCLUSION Scleral fixation is a technique allowing both a satisfactory and a lasting functional result and is to be considered when faced with a lack of sufficient capsular support.
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Affiliation(s)
- A Benarous
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens-Picardie, chemin de Longpré, 80080 Amiens, France; Université de Picardie-Jules-Verne, 80080 Amiens, France.
| | - A Drimbea
- Institut ophtalmologique de Picardie, 80080 Amiens, France
| | - S Milazzo
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens-Picardie, chemin de Longpré, 80080 Amiens, France; Université de Picardie-Jules-Verne, 80080 Amiens, France; Centre européen n(o) 86 EVICR.net, chemin de Longpré, 80080 Amiens, France
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Kumar DA, Sivangnanam S, Agarwal A, Samiullah SB, Das S. Short-term fluctuation of lens corneal distance and clinical correlation with phacodonesis. Graefes Arch Clin Exp Ophthalmol 2017; 256:567-573. [PMID: 29279994 DOI: 10.1007/s00417-017-3862-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/13/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To analyze the role of short-term lens-corneal distance (LCD) fluctuation in quantifying preoperative phacodonesis and predicting intraoperative zonular weakness. METHODS Patients were divided into control (lens without clinical phacodonesis) and study (lens with suspicious and clinical phacodonesis) groups for evaluation. Slit-lamp examination followed by IOLMaster (Carl Zeiss) for LCD assessment was performed. Five readings were taken at five time points (0 s, 15 s, 30 s, 45 s & 60 s) continuously over a minute (short term) for the LCD fluctuation calculation. RESULTS A total of 135 eyes (82 controls and 53 study) were assessed. Study group included 32 (60.3%) suspicious and 21 (39.6%) moderate to severe phacodonesis. There was difference between the control and study eyes (p = 0.000) in short-term LCD fluctuation. Twenty-one study eyes (39.6%) showed LCD difference > 1 mm, including 11 eyes (52.3%) with > 2 mm. There was a difference in LCD with respect to severity of phacodonesis (p = 0.000). In the study eyes, 13 eyes underwent glued IOL implantation (clinical phacodonesis - ten, suspicious phacodonesis - three), and two eyes (suspicious phacodonesis) had glued capsular hook. Thirteen eyes (clinical phacodonesis - ten, suspicious phacodonesis - three) required intraoperative vitrectomy due to vitreous ingress. Intraoperative zonular weakness in 62.5% of eyes with suspicious donesis and association (Chi-square = 0.000) of weakness with preoperative LCD fluctuation was noted. CONCLUSIONS Short-term lens-corneal distance fluctuation can be used as a parameter for quantifying lens stability and as an aid in assessing the intraoperative risk.
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Affiliation(s)
- Dhivya Ashok Kumar
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
| | - Soundari Sivangnanam
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
| | - Amar Agarwal
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India.
| | - Sumaiya Banu Samiullah
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
| | - Sanjiv Das
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
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Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s): A New Sutureless Technique to Reposition Dislocated Intraocular Lens-Capsular Bag Complex. Retina 2017; 39 Suppl 1:S44-S49. [PMID: 29135890 DOI: 10.1097/iae.0000000000001915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Double-flanged-haptic and capsular tension ring or segment for sutureless fixation in zonular instability. Int Ophthalmol 2017; 38:2653-2662. [DOI: 10.1007/s10792-017-0746-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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Karadag R, Sari U, Gunes B. Intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis. Int Ophthalmol 2017; 38:1765-1768. [PMID: 28676990 DOI: 10.1007/s10792-017-0623-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To report a technique of intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis. METHODS Two scleral flaps, two scleral tunnels and two sclerotomies were formed. The anterior capsule was captured and pulled by the iris hooks resulting in the IOL adopting an appropriate position at which point the iris hooks extracted from the sclerotomies. The tips of the iris hooks were implanted into the scleral tunnels. Each of them was fixed with a 10.0 nylon suture to the scleral bed. The scleral flaps and conjunctiva were sutured. One of the iris hooks was seen loosened at the first-week postoperative examination but the IOL remained centralized. The loosened hook was removed. RESULTS No complications were witnessed during the patient's 24-month follow-up. CONCLUSION Intra-scleral fixation using iris retractors in the capsular bag for patients having suffered dislocation of IOL despite the attachment of a capsular hook because of zonular dialysis can be safely implemented.
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Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey.
| | - Unsal Sari
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
| | - Bahar Gunes
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
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Jacob S, Narasimhan S, Agarwal A, Mazzotta C, Rechichi M, Agarwal A. Supracapsular glued intraocular lens in progressive subluxated cataracts: Technique to retain an intact vitreous face. J Cataract Refract Surg 2017; 43:312-317. [DOI: 10.1016/j.jcrs.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/17/2016] [Accepted: 11/19/2016] [Indexed: 10/19/2022]
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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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Suture-guided capsular tension ring insertion to reduce risk for iatrogenic zonular damage. J Cataract Refract Surg 2015; 41:1564-7. [DOI: 10.1016/j.jcrs.2015.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/15/2015] [Accepted: 03/18/2015] [Indexed: 11/22/2022]
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Jacob S, Agarwal A, Agarwal A, Narasimhan S. Closed-chamber haptic reexternalization for posteriorly displaced sclerotomy and inadequate haptic tuck in glued posterior chamber intraocular lenses. J Cataract Refract Surg 2015; 41:268-71. [DOI: 10.1016/j.jcrs.2014.12.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 07/15/2014] [Accepted: 08/01/2014] [Indexed: 12/01/2022]
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