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Lin H, Zhang J, Zhang Y, Jin A, Zhang Y, Jin L, Xu Y, Xie X, Tan X, Luo L, Liu Y. Capsular Tension Ring Implantation for Intraocular Lens Decentration and Tilt in Highly Myopic Eyes: A Randomized Clinical Trial. JAMA Ophthalmol 2024:2820325. [PMID: 38935400 PMCID: PMC11211984 DOI: 10.1001/jamaophthalmol.2024.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024]
Abstract
Importance Capsular tension rings (CTRs) can support weak zonules and inhibit capsular shrinkage, thus potentially reducing intraocular lens (IOL) decentration and tilt. However, it has been debated whether CTRs can reduce IOL decentration and tilt in highly myopic eyes and whether CTR implantation is necessary for all highly myopic eyes. Objective To evaluate the influence of CTR implantation on IOL decentration and tilt in highly myopic eyes. Design, Setting, and Participants This randomized clinical trial was conducted between November 2021 and September 2023 at the Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract and an axial length (AL) of 26 mm or longer were enrolled. Interventions Participants were stratified into 3 groups based on the AL (stratum 1, 26 mm ≤ AL <28 mm; stratum 2, 28 mm ≤ AL <30mm; stratum 3, AL ≥30 mm), and further randomly assigned to the CTR group (a C-loop IOL combined with a CTR) or the control group (only a C-loop IOL) within each stratum. Main Outcomes and Measures IOL decentration at 3 months after cataract surgery was evaluated using anterior segment optical coherence tomography. Results A total of 186 eyes of 186 participants (mean [SD] age, 57.3 [10.9] years; 118 female [63.4%]) were randomized into the CTR group (93 [50%]) or control group (93 [50%]), with 87 eyes (93.6%) and 92 eyes (98.9%) completing follow-up at 3 months, respectively. The CTR group showed smaller IOL decentration (0.19 mm vs 0.23 mm; difference, -0.04 mm; 95% CI, -0.07 to -0.01 mm; P = .02) and tilt at 3 months, and lower proportions of clinically significant IOL decentration (≥0.4 mm) and tilt (≥7°) at 3 months compared with the control group. Similar results were only found in eyes with an AL of 30 mm or longer (IOL decentration: 0.20 mm vs 0.28 mm; difference, -0.08 mm; 95% CI, -0.14 to -0.02 mm; P = .01). Additionally, the CTR group showed a smaller change in IOL decentration from 1 week to 3 months, higher prediction accuracy, and better visual quality and patient satisfaction in this stratum. No differences were observed between the CTR and control groups in eyes with an AL less than 30 mm. Conclusions and Relevance CTR implantation reduced C-loop IOL decentration and tilt, increased position stability, and improved visual quality in eyes with an AL of 30 mm or longer. These findings support use of CTR implantation in eyes with an AL of 30 mm or longer and implanted with C-loop IOLs. Trial Registration ClinicalTrials.gov Identifier: NCT05161520.
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Affiliation(s)
- Haowen Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jiaqing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Aixia Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaohang Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xuhua Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Kwon H, Choi A, Kim B, Jeon S. Effect of Capsular Tension Ring on Refractive Outcomes in Patients With Implantation of the Quadrifocal Acrysof PanOptix TFNT00 IOL. J Refract Surg 2021; 37:174-179. [PMID: 34038298 DOI: 10.3928/1081597x-20201229-01] [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: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of a capsular tension ring (CTR) on refractive outcomes in eyes undergoing implantation of the quadrifocal Acrysof PanOptix TFNT00 intraocular lens (IOL) (Alcon Laboratories, Inc). METHODS A retrospective case-control study was undertaken of 91 eyes implanted with the TFNT00 IOL. Of these 91 eyes, a CTR was implanted in 33 and these eyes were compared to the 58 eyes in which a CTR was not implanted. The main outcome measure was the mean absolute error (MAE) of the refractive prediction error. To evaluate the consistency of refractive outcomes, variance of MAE was measured. Using a swept-source optical coherence tomography device, postoperative aqueous depth (AQD) was measured to estimate the position of the IOL. RESULTS Eyes with a CTR showed a significantly smaller MAE when compared with eyes without a CTR (P = .038 at 1 m, P = .003 at 2 m, and P = .001 at 6 m). There was a lower variance of MAE in the eyes implanted with a CTR, with higher precision of refraction (P = .058 at 1 m, P = .007 at 2 m, and P = .001 at 6 m). There was a significant difference in the percentage of the eyes showing more than 0.50 D from the estimated target of the Barrett Universal II formula (P = .007 at 1 m, P = .064 at 2 m, and P = .004 at 6 m, respectively). AQD was significantly shallower in eyes with a CTR than in eyes without a CTR (P = .006). CONCLUSIONS Use of the CTR enhanced the accuracy of postoperative refractive outcomes after TFNT00 IOL implantation by preventing the posterior bowing of the optic-haptic junction. [J Refract Surg. 2021;37(3):174-179.].
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Yang S, Jiang H, Nie K, Feng L, Fan W. Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules. BMC Ophthalmol 2021; 21:19. [PMID: 33413210 PMCID: PMC7792360 DOI: 10.1186/s12886-020-01772-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. METHODS A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. RESULTS Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. CONCLUSION CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.
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Affiliation(s)
- Shangfei Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liwen Feng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Vanags J, Erts R, Laganovska G. Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support. ACTA ACUST UNITED AC 2021; 57:medicina57010035. [PMID: 33401604 PMCID: PMC7823552 DOI: 10.3390/medicina57010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
Background and Objectives: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. Materials and Methods: For this prospective study, we enlisted cataract surgery patients in our hospital with preoperative diagnoses of weak zonules. All patients received phacoemulsification surgery with implantation of a hydrophobic acrylic IOL and capsular tension ring (CTR). ACO reductions were measured for six months after enrolment. Data on late IOL dislocations were collected five years after enrolment of the last patient. Results: Fifty-three patients were enrolled from 2011 to 2015. Over the six-month active follow-up period, ACO area reduction was 23% in patients receiving CTRs of 11 mm diameter and 8% for patients with CTRs of 12 mm, with an overall mean of 15% reduction. Five years after the last patient was enrolled, seven patients (13%) had experienced late IOL-CTR-capsular bag dislocation. For these patients, the mean ACO reduction in the first six months of follow-up was 33%, including for those who had received neodymium-doped yttrium aluminum garnet (Nd: YAG) anterior capsulotomies. Conclusion: Use of hydrophobic acrylic lenses and CTR reduces ACO contraction, with rates comparable to those after cataract surgery without ocular comorbidity. Our patients experienced a relatively high rate of late IOL-CTR-capsular bag dislocation. However, dislocated complexes were easily repositioned and few patients required IOL exchange. Frequent visits are warranted to promptly detect late complications of cataract surgery in patients with weak zonular support.
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Affiliation(s)
- Juris Vanags
- Clinic of Ophthalmology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
- Department of Ophthalmology, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +37-12-6068-123; Fax: +37-16-7069-549
| | - Renārs Erts
- Faculty of Medicine, University of Latvia, LV-1079 Riga, Latvia;
| | - Guna Laganovska
- Clinic of Ophthalmology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
- Department of Ophthalmology, Riga Stradins University, LV-1007 Riga, Latvia
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Kim JW, Eom Y, Chung HW, Song JS, Jeong JW, Park SK, Kim HM. Factors for good near and distance visual outcomes of multifocal intraocular lens with inferior segmental near add. Graefes Arch Clin Exp Ophthalmol 2020; 258:1735-1743. [DOI: 10.1007/s00417-020-04761-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022] Open
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Comparison of 3-month visual outcomes of a spherical and a toric trifocal intraocular lens. J Cataract Refract Surg 2019; 45:135-145. [DOI: 10.1016/j.jcrs.2018.09.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/27/2018] [Accepted: 09/27/2018] [Indexed: 11/23/2022]
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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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Poyales F, Garzón N, Pizarro D, Cobreces S, Hernández A. Stability and visual outcomes yielded by three intraocular trifocal lenses with same optical zone design but differing material or toricity. Eur J Ophthalmol 2018; 29:417-425. [PMID: 30198329 DOI: 10.1177/1120672118795065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare rotational stability, centration and visual outcomes provided by three trifocal lens models that have the same optical zone design but different material, composition, and/or toricity. METHODS The study included 78 patients with symmetric bilateral intraocular lens implantation. The lenses under evaluation were trifocal intraocular lenses made of hydrophilic acrylic material: a spherical lens 26% hydrophilic acrylic (POD FineVision), a similar lens but having a toric design (POD Toric FineVision), and a trifocal lens 25% hydrophilic acrylic material (FineVision/MicroF). Moreover, the lenses share the same optical zone design. The lenses' rotational stability and centration were measured by means of the PIOLET software, which relies on recording and image processing techniques to determine lens rotation and centration based on slit-lamp images. We also assessed patients' visual quality by means of 25, 40, and 80 cm VA tests. RESULTS The best centration results were achieved with the POD Toric FineVision model, although the differences were not statistically significant. As for lens rotation, it was below 5° in all cases under study. Regarding VA, all subjects attained at least 0.3 logMAR for far distance uncorrected VA, at 80 cm VA was about 0.2 logMAR, at 40 cm it was above 0.15 logMAR, and at 25 cm it was about 0.3 logMAR for both lens types. CONCLUSION All three intraocular lens models yield excellent visual results at far, near as well as intermediate distances. The POD FineVision and POD Toric FineVision models, with double C-loop design, yielded the best results centration-wise and rotation-wise. Differences had no clinical relevance.
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Affiliation(s)
| | | | - Daniel Pizarro
- 2 Department of Electronics, University of Alcalá, Madrid, Spain
| | | | - Adolfo Hernández
- 1 IOA Madrid Innova Ocular, Madrid, Spain.,2 Department of Electronics, University of Alcalá, Madrid, Spain
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9
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Multifocal intraocular lenses: An overview. Surv Ophthalmol 2017; 62:611-634. [DOI: 10.1016/j.survophthal.2017.03.005] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 01/18/2023]
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Koçak Altıntaş AG, Omay AE, Çelik S. Spontaneous Late Intraocular Lens and Capsule Tension Ring Dislocation. Turk J Ophthalmol 2017; 47:106-109. [PMID: 28405485 PMCID: PMC5384115 DOI: 10.4274/tjo.79836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 07/27/2015] [Indexed: 12/01/2022] Open
Abstract
In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.
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Affiliation(s)
| | - Aslıhan Esra Omay
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Selda Çelik
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
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Park HJ, Lee H, Kim DW, Kim EK, Seo KY, Kim TI. Effect of Co-Implantation of a Capsular Tension Ring on Clinical Outcomes after Cataract Surgery with Monofocal Intraocular Lens Implantation. Yonsei Med J 2016; 57:1236-42. [PMID: 27401657 PMCID: PMC4960392 DOI: 10.3349/ymj.2016.57.5.1236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The objective was to evaluate the effect of co-implantation of a preloaded capsular tension ring (CTR) and aberration-free monofocal intraocular lens (IOL) on clinical outcomes and visual quality after cataract surgery. MATERIALS AND METHODS Patients who underwent cataract surgery were randomized into two groups that were implanted with a CTR and IOL (group 1, 26 eyes) or an IOL only (group 2, 26 eyes). At 1 and 3 months after surgery, visual acuity, refractive errors, refractive prediction errors, ocular aberrations, and modulation transfer function (MTF) were analyzed. At 3 months postoperatively, anterior chamber depth (ACD) and contrast sensitivity were evaluated. RESULTS Group 1 showed greater hyperopic shift, which caused the refractive prediction error at 3 months after surgery to be significantly different between the two groups (p=0.049). Differences in ACD between the preoperative and postoperative periods tended to be greater in group 1 than in group 2. At 3 months postoperatively, internal MTF values at 20, 25, and 30 cycles per degree were significantly better in group 1 than in group 2 (p=0.034, 0.017, and 0.017, respectively). Contrast sensitivity showed comparable results at almost all spatial frequencies between the groups. CONCLUSION Regarding visual acuity and quality, both groups showed comparable results. Co-implantation of a CTR and aberration-free monofocal IOL was associated with hyperopic refractive outcomes. Surgeons should consider the position of the IOL when planning co-implantation of a CTR and IOL.
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Affiliation(s)
- Hyun Ju Park
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Do Wook Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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Grove K, Condon G, Erny BC, Chang DF, Kim T. Complication from combined use of capsule retractors and capsular tension rings in zonular dehiscence. J Cataract Refract Surg 2015; 41:2576-9. [PMID: 26703509 DOI: 10.1016/j.jcrs.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED We describe a new complication associated with capsular tension ring (CTR) implantation after placement of capsule retractors. We report 3 cases from 3 different surgeons of inadvertent threading of a CTR through a capsule retractor loop. In each case, the distal loop was opened or amputated to facilitate hook removal. We report this case series to alert cataract surgeons to a potential complication of using CTRs and capsule retractors together and to offer potential strategies for preventing and managing an intracapsular entanglement. FINANCIAL DISCLOSURE Dr. Kim is a consultant to Alcon Surgical, Inc. Dr. Chang receives personal fees from Abbott Medical Optics, Inc. Dr. Condon receives personal fees from Alcon Surgical, Inc. and Microsurgical Technology. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Karen Grove
- From Duke University (Grove, Kim), Durham, North Carolina; Allegheny Ophthalmic and Orbital Associates (Condon), Pittsburgh, Pennsylvania; Palo Alto Medical Foundation (Erny) and Altos Eye Physicians (Chang), Los Altos, California, USA
| | - Garry Condon
- From Duke University (Grove, Kim), Durham, North Carolina; Allegheny Ophthalmic and Orbital Associates (Condon), Pittsburgh, Pennsylvania; Palo Alto Medical Foundation (Erny) and Altos Eye Physicians (Chang), Los Altos, California, USA
| | - Barbara C Erny
- From Duke University (Grove, Kim), Durham, North Carolina; Allegheny Ophthalmic and Orbital Associates (Condon), Pittsburgh, Pennsylvania; Palo Alto Medical Foundation (Erny) and Altos Eye Physicians (Chang), Los Altos, California, USA
| | - David F Chang
- From Duke University (Grove, Kim), Durham, North Carolina; Allegheny Ophthalmic and Orbital Associates (Condon), Pittsburgh, Pennsylvania; Palo Alto Medical Foundation (Erny) and Altos Eye Physicians (Chang), Los Altos, California, USA
| | - Terry Kim
- From Duke University (Grove, Kim), Durham, North Carolina; Allegheny Ophthalmic and Orbital Associates (Condon), Pittsburgh, Pennsylvania; Palo Alto Medical Foundation (Erny) and Altos Eye Physicians (Chang), Los Altos, California, USA.
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Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature. J Ophthalmol 2015; 2015:805706. [PMID: 26798506 PMCID: PMC4698990 DOI: 10.1155/2015/805706] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.
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Single suture iris-to-capsulorhexis fixation for in-the-bag intraocular lens subluxation. J Cataract Refract Surg 2015; 41:2347-52. [DOI: 10.1016/j.jcrs.2015.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/22/2015] [Accepted: 07/01/2015] [Indexed: 11/23/2022]
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Keles S, Kartal B, Apil A, Ondas O, Dertsiz Kozan B, Topdagi E, Ekinci M, Ceylan E, Baykal O. Nd: YAG laser posterior capsulotomy rates in myopic eyes after implantation of capsular tension ring. Med Sci Monit 2014; 20:1469-73. [PMID: 25132225 PMCID: PMC4144949 DOI: 10.12659/msm.890767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim f this study was to evaluate the effect of capsular tension ring implantation during cataract surgery on the incidence of neodymium: YAG (Nd: YAG) laser posterior capsulotomy in myopic (axial length [AL] ≥25.00 mm) eyes. Material/Methods In this retrospective study, the records of the cases of 117 myopic patients who underwent cataract surgery between January 2004 and January 2011 were reviewed. A total of 153 eyes with an axial length of 25 mm or higher were included in the study with consideration of exclusion criteria mentioned below. Eyes were grouped by presence or lack of capsular tension ring (CTR+ and CTR−, respectively). Results The study included 153 eyes from 107 myopic patients. Hydrophilic acrylic IOL and capsular tension ring (CTR) were implanted in 78 eyes (CTR+ group), and 75 eyes received only the hydrophilic acrylic IOL (CTR− group). Six eyes (7.6%) in CTR+ and 16 eyes (21.3%) in CTR− required Nd: YAG laser capsulotomy within 7 years. The difference between the 2 groups was statistically significant (p=0.021). Conclusions Because CTRs significantly decrease subsequent need for Nd: YAG laser posterior capsulotomy in myopic patients, are very inexpensive, and provide other benefits, our data suggest that the use of CTRs in myopic eyes undergoing cataract surgery with an hydrophilic acrylic IOL implantation is advantageous and should be standard practice.
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Affiliation(s)
- Sadullah Keles
- Department of Ophthalmology, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Baki Kartal
- Department of Ophthalmology, Regional Training and Research Hospital, Erzurum, Turkey
| | - Aytekin Apil
- Department of Ophthalmology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Osman Ondas
- Department of Ophthalmology, Erbaa Government Hospital, Tokat, Turkey
| | - Betul Dertsiz Kozan
- Department of Ophthalmology, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Elif Topdagi
- Department of Ophthalmology, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Metin Ekinci
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Erdinc Ceylan
- Department of Ophthalmology, Regional Training and Research Hospital, Erzurum, Turkey
| | - Orhan Baykal
- Department of Ophthalmology, Medical Faculty of Ataturk University, Erzurum, Turkey
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Lorenz K, Dick HB, Grus F, Vetter JM, Stoffelns B, Schoepfer K, Korb C, Pfeiffer N. Series of fibrinous inflammation after implantation of capsular tension rings. J Cataract Refract Surg 2014; 40:192-8. [DOI: 10.1016/j.jcrs.2013.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/05/2013] [Accepted: 07/13/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Katrin Lorenz
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany.
| | - H Burkhard Dick
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
| | - Franz Grus
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
| | - Jan Markus Vetter
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
| | - Bernhard Stoffelns
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
| | - Kilian Schoepfer
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
| | - Christina Korb
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
| | - Norbert Pfeiffer
- From the Department of Ophthalmology (Lorenz, Dick, Vetter, Stoffelns, Schoepfer, Korb, Pfeiffer) and Experimental Ophthalmology (Grus), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, and the Center for Vision Science (Dick), Ruhr University Eye Hospital, Bochum, Germany
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Alió JL, Plaza-Puche AB, Javaloy J, Ayala MJ, Vega-Estrada A. Clinical and Optical Intraocular Performance of Rotationally Asymmetric Multifocal IOL Plate-Haptic Design Versus C-Loop Haptic Design. J Refract Surg 2013; 29:252-9. [PMID: 23557223 DOI: 10.3928/1081597x-20130318-04] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/17/2013] [Indexed: 11/20/2022]
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18
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Alió JL, Plaza-Puche AB, Piñero DP. Rotationally Asymmetric Multifocal IOL Implantation With and Without Capsular Tension Ring: Refractive and Visual Outcomes and Intraocular Optical Performance. J Refract Surg 2012; 28:253-8. [DOI: 10.3928/1081597x-20120314-01] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 02/24/2012] [Indexed: 11/20/2022]
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Mönestam EI. Incidence of dislocation of intraocular lenses and pseudophakodonesis 10 years after cataract surgery. Ophthalmology 2009; 116:2315-20. [PMID: 19815277 DOI: 10.1016/j.ophtha.2009.05.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To estimate the incidence of early and late intraocular lens (IOL) dislocation and the frequency of pseudophakodonesis in a population-based cohort of cataract surgery cases. The patients were followed up from before to 10 years after surgery. DESIGN Cohort study. PARTICIPANTS Eight hundred ten cataract surgery patients. METHODS A prospective population-based cohort of 810 cataract surgery patients with presenile or senile cataracts was examined before surgery. Ten years later, 289 (73%) of 395 survivors agreed to participate in an eye examination. In addition to a routine eye examination of the anterior and posterior segment, all eyes were assessed for pseudophakodonesis and significant dislocation of the IOL. The medical records were studied and information concerning previous postoperative surgical interventions such as IOL exchange or repositioning was noted. This information was also obtained from the records of the deceased patients and those unable or unwilling to participate. The material was analyzed statistically. MAIN OUTCOME MEASURES Previous IOL exchange or repositioning surgery, significant IOL dislocation, and degree of pseudophakodonesis. RESULTS Most patients (n = 795/810; 98%) underwent sutureless clear corneal phacoemulsification surgery with a 3.2-mm temporal incision. A foldable IOL was implanted, 95% of which were an Alcon MA60BM AcrySof (Alcon Inc, Fort Worth, TX). Approximately 40% of the patients had pseudoexfoliations (PEX). After a 10-year follow-up, 5 (0.6%) of the 800 patients at risk required surgery for a dislocated IOL. All of these patients were male, and in all cases, the dislocation was late and within the capsular bag. The cumulative incidence over 10 years was 1%. At the examination 10 years after surgery, 2 (0.7%) of 287 patients at risk had pronounced pseudophakodonesis and 4 (1.4%) had moderate pseudophakodonesis. CONCLUSIONS The 10-year cumulative incidence of dislocated IOLs needing surgical attention was low in this population-based cohort with a high frequency of PEX. Early dislocation did not occur in any of the patients. The risk of this complication in an individual patient seems to be low. Because of the large number of people with previous cataract surgery, dislocated IOLs may cause a relatively large public health care burden.
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Affiliation(s)
- Eva I Mönestam
- Department of Clinical Sciences/Ophthalmology, Norrlands University Hospital, Umeå, Sweden.
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Rohart C, Gatinel D. Influence of a Capsular Tension Ring on Ocular Aberrations After Cataract Surgery: A Comparative Study. J Refract Surg 2009; 25:S116-21. [DOI: 10.3928/1081597x-20090115-07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Microincision multifocal intraocular lens with and without a capsular tension ring. J Cataract Refract Surg 2008; 34:1468-75. [DOI: 10.1016/j.jcrs.2008.05.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 05/28/2008] [Indexed: 11/21/2022]
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22
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Effect of a capsular tension ring on prevention of intraocular lens decentration and tilt and on anterior capsule contraction after cataract surgery. Jpn J Ophthalmol 2008; 52:363-367. [DOI: 10.1007/s10384-008-0570-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 04/23/2008] [Indexed: 12/18/2022]
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23
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Kim JH, Lee D, Cha YD, Oh SH, Mah KC, Lee MS. The analysis of predicted capsular bag diameter using modified model of capsule measuring ring in Asians. Clin Exp Ophthalmol 2008; 36:238-44. [DOI: 10.1111/j.1442-9071.2008.01726.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Georgopoulos GT, Papaconstantinou D, Georgalas I, Koutsandrea CN, Margetis I, Moschos MM. Management of large traumatic zonular dialysis with phacoemulsification and IOL implantation using the capsular tension ring. ACTA ACUST UNITED AC 2007; 85:653-7. [PMID: 17376189 DOI: 10.1111/j.1600-0420.2007.00901.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report our results and to evaluate the longterm effect of capsular tension ring (CTR) insertion in eyes with large traumatic zonular dialysis that underwent phacoemulsification with posterior chamber (PC) intraocular lens (IOL) implantation. METHODS This prospective study included 17 eyes of 17 consecutive patients with cataract and large traumatic zonular dialysis (range 80-160 degrees determined pre-or intraoperatively). After insertion of a CTR, phacoemulsification with foldable acrylic PC IOL implantation was performed. Posterior capsule rupture, vitreous loss, best corrected visual acuity (BCVA), intraocular pressure (IOP) in the pre- and postoperative periods and postoperative IOL decentration were recorded. RESULTS The mean follow-up period was 25.9 months (range 15-35 months). Capsule collapse did not occur in any eye with a CTR. Postoperatively, four eyes developed raised IOP that responded well to medical therapy. An improvement in BCVA was observed in all eyes except one because of co-existing fundus pathology. No IOL was found to be decentrated at the end of the follow-up period, apart from one eye in which the PC IOL was dislocated due to a postoperative trauma, in which an anterior chamber IOL was implanted. CONCLUSIONS In cases of cataract associated with large traumatic zonular dialysis, implanting a CTR before or during phacoemulsification with an in-the-bag PC IOL is relatively safe technique with a high success rate. The CTR was found to be efficient in preventing IOL decentration in eyes with traumatic zonular deficiency.
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Kocabora MS, Gulkilik G, Yilmazli C, Taskapili M, Kucuksahin H, Doyduk-Kocabora A. The preventive effect of capsular tension ring in phacoemulsification of senile cataracts with pseudoexfoliation. ACTA ACUST UNITED AC 2007; 39:37-40. [PMID: 17914203 DOI: 10.1007/bf02697324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 11/30/1999] [Accepted: 01/05/2007] [Indexed: 10/22/2022]
Abstract
We evaluated the preventive role of the capsular tension ring (CTR) in zonular and capsular complications in the phacoemulsification surgery of cataracts with pseudoexfoliation (PEX) in two groups of eyes with senile cataract associated with PEX, with (Group A) or without (Group B) CTR implantation. CTR implantation did not prove as effective as expected in preventing the zonulo-capsular complications. Contradictory to the significant increase of intracapsular intraocular lens (IOL) implantation rate, post-operative visual acuity did not improve in the same value.
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Affiliation(s)
- M Selim Kocabora
- Ophthalmology Clinic, Vakif Gureba Education and Research Hospital, Vatan Cad. Fatih, Istanbul, Turkey.
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Scherer M, Bertelmann E, Rieck P. Late spontaneous in-the-bag intraocular lens and capsular tension ring dislocation in pseudoexfoliation syndrome. J Cataract Refract Surg 2006; 32:672-5. [PMID: 16698493 DOI: 10.1016/j.jcrs.2006.01.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 09/20/2005] [Indexed: 10/24/2022]
Abstract
Two patients with pseudoexfoliation syndrome (PEX) in whom late spontaneous in-the-bag intraocular lens (IOL) and capsular tension ring (CTR) dislocation occurred 3 and 6 years after cataract surgery are described. The patients received CTRs because of phacodonesis due to zonular laxity. The IOLs were centered postoperatively, and there was no postoperative ocular trauma. In both cases, removal of the IOL and CTR within the capsular bag was performed uneventfully by a scleral tunnel incision and an anterior chamber IOL was implanted. Capsular tension ring implantation in PEX-associated zonular weakening does not guarantee long-term zonular stability and capsular bag/IOL position in these patients after cataract surgery.
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Affiliation(s)
- Matthias Scherer
- Department of Ophthalmology, Charité, Campus Virchow Hospital, University Medicine in Berlin, Berlin, Germany.
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Gimbel HV, Condon GP, Kohnen T, Olson RJ, Halkiadakis I. Late in-the-bag intraocular lens dislocation: Incidence, prevention, and management. J Cataract Refract Surg 2005; 31:2193-204. [PMID: 16412938 DOI: 10.1016/j.jcrs.2005.06.053] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2005] [Indexed: 11/16/2022]
Abstract
Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.
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Bhattacharjee H, Bhattacharjee K, Das D, Jain PK, Chakraborty D, Deka S. Management of a posteriorly dislocated endocapsular tension ring and a foldable acrylic intraocular lens. J Cataract Refract Surg 2004; 30:243-6. [PMID: 14967296 DOI: 10.1016/j.jcrs.2003.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2003] [Indexed: 12/01/2022]
Abstract
We report a rare case of late spontaneous extension of a posterior capsule tear from lateral traction of an endocapsular ring, resulting in dislocation of the capsular tension ring and acrylic intraocular lens (IOL) into the vitreous cavity. A 3-port pars plana vitrectomy was performed to explant the prostheses; the eye was made pseudophakic by placement of a scleral-fixated posterior chamber IOL. The combined triple procedure was safe and effective.
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Jacob S, Agarwal A, Agarwal A, Agarwal S, Patel N, Lal V. Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis. J Cataract Refract Surg 2003; 29:315-21. [PMID: 12648643 DOI: 10.1016/s0886-3350(02)01534-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the safety and efficacy of capsular tension ring (CTR) insertion in eyes with zonular dialysis of less than 150 degrees having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. SETTING Dr. Agarwal's Eye Hospital, Chennai, India. METHODS This prospective study comprised 21 eyes of 19 patients with zonular dialysis of less than approximately 150 degrees determined preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with PC IOL implantation was performed. The mean follow-up was 242.33 days. RESULTS Capsule collapse did not occur in any eye with a CTR. Intraoperative extension of the dialysis occurred in 2 eyes (9.52%). The IOL was placed in the bag in all the eyes except 1 that had traumatic cataract and received a scleral-fixated IOL during a subsequent surgery. Postoperatively, there was minimal corneal edema in 2 eyes (9.52%) and mild iritis in 5 eyes (23.80%). Three eyes (14.28%) developed raised intraocular pressure that responded well to medical therapy. The symptoms resolved in the 3 patients with preoperative diplopia. Fifteen eyes (71.42%) had a final visual acuity of 6/12 or better. Six eyes had a final best corrected visual acuity of worse than 6/12 because of coexisting fundus pathology. A dilated pupil examination at 6 months showed a well-centered IOL in all eyes. CONCLUSIONS Phacoemulsification with in-the-bag PC IOL and CTR implantation in eyes with zonular dialysis of up to approximately 150 degrees had a success rate of 90.47%. Visual recovery was not as good as in normal eyes because of the problems associated with zonular dialysis.
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Affiliation(s)
- Soosan Jacob
- Dr. Agarwal's Eye Hospital, Chennai, Tamil-Nadu, India
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Shigeeda T, Nagahara M, Kato S, Kunimatsu S, Kaji Y, Tanaka S, Amano S, Oshika T. Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag. J Cataract Refract Surg 2002; 28:1689-93. [PMID: 12231332 DOI: 10.1016/s0886-3350(01)01178-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report 4 cases of complete posterior dislocation of an intraocular lens (IOL) in the capsular bag occurring a mean of 5.5 years after uneventful cataract surgery. In all 4 cases, posterior chamber IOLs were fixated within the capsulorhexis. The patients experienced sudden loss of vision without an episode of trauma or ocular disease. Using a 3-port pars plana vitrectomy, the IOLs were explanted through a limbal incision and a new IOL was sutured to the ciliary sulcus. Histological examination indicated that zonular fibers were severed at the site of insertion in the capsule.
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Affiliation(s)
- Takashi Shigeeda
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
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Lee DH, Shin SC, Joo CK. Effect of a capsular tension ring on intraocular lens decentration and tilting after cataract surgery. J Cataract Refract Surg 2002; 28:843-6. [PMID: 11978466 DOI: 10.1016/s0886-3350(01)01174-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of a capsular tension ring (CTR) on the tilting and decentration of intraocular lenses (IOLs) after cataract surgery. SETTING Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Kyunggyi-do, Korea. METHODS Cataract surgery was performed in both eyes of 20 patients ranging in age from 57 to 75 years. The 40 eyes were divided into 2 groups based on whether a CTR (Lucid Korea) was implanted. Each patient received a CTR in 1 eye only. All IOLs (AcrySof MA60BM, Alcon) were implanted in the capsular bag after a continuous curvilinear capsulorhexis smaller than the IOL optic was created and phacoemulsification performed. The extent of IOL tilting and decentration was measured with the EAS-1000 anterior eye segment analysis system 7, 30, and 60 days after surgery. RESULTS The extent of IOL decentration was statistically significantly less in eyes with both an IOL and CTR than in those with an IOL only. The mean decentration in the CTR-IOL group was 0.38 mm +/- 0.16 (SD) at 7 days, 0.43 +/- 0.15 mm at 30 days, and 0.42 +/- 0.17 mm at 60 days. The mean values in the IOL-only group were 0.49 +/- 0.11 mm, 0.53 +/- 0.14 mm, and 0.57 +/- 0.16 mm, respectively. The amount of IOL tilting was also significantly less in the CTR-IOL group. The mean tilting in the CTR-IOL group was 2.22 +/- 0.46 degrees at 7 days, 2.36 +/- 0.50 degrees at 30 days, and 2.47 +/- 0.40 degrees at 60 days. The mean values in the IOL-only group were 3.14 +/- 0.65 degrees, 2.91 +/- 0.67 degrees, and 3.06 +/- 0.56 degrees, respectively. CONCLUSION These results indicate that the CTR reduces undesirable postsurgical IOL movement for at least 60 days.
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Affiliation(s)
- Do-Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Koyang, Kyunggyi-do, South Korea.
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Bayraktar Ş. Cataract surgical problem: Reply 7. J Cataract Refract Surg 2002. [DOI: 10.1016/s0886-3350(02)01288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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