Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis

High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome

AIMS

To predict high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence in eyes with pseudoexfoliation (PXF) syndrome.

METHODS

315 eyes of 315 consecutive patients with PXF scheduled for phacoemulsification surgery underwent preoperative examination of various ocular parameters using an anterior segment-optical coherence tomography and other devices. When zonular complications occurred during surgery due to zonular dehiscence, scleral fixation of the intraocular lens (IOL) or implantation of a capsular tension ring (CTR) was performed. High-risk factors for these intraoperative zonular complications were examined using classification-tree and logistic regression analyses.

RESULTS

Of the 315 eyes, 31 (9.84%) underwent scleral IOL fixation or CTR implantation. High-risk factors identified by classification-tree analysis were a small pupillary diameter after mydriasis <6.30 mm, a shallow anterior chamber depth <2.074 mm and lens decentration >0.260 mm. Based on exact logistic regression analysis, the OR was 4.81-fold higher for eyes with poor mydriasis than for eyes without poor mydriasis (p=0.006, 95% CI 1.49 to 18.23), 23.99-fold higher for eyes with poor mydriasis and a shallow anterior chamber (p<0.001, 5.92 to 109.02) and 287.39-fold higher for eyes with poor mydriasis, a shallow chamber and great lens decentration (p<0.001, 50.46 to infinity).

CONCLUSION

In eyes with PXF, high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence were poor mydriasis, shallow anterior chamber and large lens decentration, suggesting the importance of evaluating these conditions preoperatively.

Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre

OBJECTIVE

Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery.

METHODS

A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded.

RESULTS

ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes.

CONCLUSIONS

ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.

Traction suture fixation technique using a capsular tension ring fragment for severe lens displacement during cataract surgery in dogs

OBJECTIVES

To describe the traction suture fixation technique for severely displaced lenses (≥180°) using a capsular tension ring (CTR) fragment during cataract surgery in dogs, and to retrospectively investigate its clinical outcomes.

ANIMALS STUDIED

Eight dogs (nine eyes).

PROCEDURES

The medical records of dogs with severe lens displacement (≥180°) due to cataracts that underwent traction suture fixation during cataract surgery using a CTR fragment at the Grand Animal Hospital (Hyogo, Japan) between November 2019 and September 2022 were retrospectively reviewed. The retrieved data included the signalment, type of CTR, and postoperative outcomes.

RESULTS

A single CTR fragment was used to fix the capsular bag to the sclera in six eyes, and two CTR fragments were used at two sites in three eyes. The lengths of the CTR fragments used were 1 one-fifth fragment, 3 one-fourth fragments, and 8 one-third fragments. Postoperative complications included uveitis (nine eyes), glaucoma (one eye), posterior iris adhesion (one eye), corneal ulcer (one eye), and intracorneal stromal hemorrhage (one eye). Vision was maintained in all dogs during the follow-up period (2 months to 2 years and 8 months) without recurrent capsular bag displacement.

CONCLUSIONS

This technique can correct and stabilize capsular bag displacement relatively easily through a small incision during cataract surgery in dogs with severe lens displacement. Intraocular lens implantation was also possible.

Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery

PURPOSE

To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery.

SETTING

Department of Ophthalmology Graz, Graz, Austria.

DESIGN

Single-center, retrospective cohort study.

METHODS

The medical records of patients who underwent cataract operation between 1996 and 2017 were analyzed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, sex, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations.

RESULTS

ITB dislocations were found in 111 (0.16%) of 68199 eyes (46 632 patients). In the multivariate analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR], 0.29; 95% CI, 0.11-0.80; P = .017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04-0.70; P = .015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14-4.41; P = .793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR, 0.37; 95% CI, 0.12-1.12; P = .078).

CONCLUSIONS

According to the dataset, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was association with a lower risk of ITB dislocations. In patients without PEX, no association was established.

Sutureless technique for repositioning and scleral fixation of the capsular bag-intraocular lens complex with permanent use of iris retractors

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.

Results of using the AssiAnchor capsule device for subluxated crystalline lenses

Purpose:

To describe our results with the AssiAnchor capsule device in cases of subluxated crystalline lenses.

Methods:

This was a retrospective consecutive case series. Seven eyes of four patients with subluxated crystalline lenses underwent lensectomy/phacoemulsification with intraocular lens (IOL) implantation using the AssiAnchor capsule device in the Kaplan medical center, ophthalmology department. Three patients had Marfan syndrome and one patient had experienced blunt trauma. Demographic data were collected as well as parameters of pre- and postoperative distance visual acuity and refraction, intra-, and postoperative complications, and IOL stability and centration.

Results:

Six out of the seven surgical procedures were uneventful with in-the-bag implantation of the IOL. In the first surgery, a tear of the capsular bag lead to IOL exchanging and fixating to the AssiAnchor and to the iris. In the traumatic cataract case, two AssiAnchors were used. A capsular tension ring was implanted in six out of seven surgeries. The average follow-up time was 9.5 ± 6.8 months. All the IOLs were stable and well centered except for the first IOL that exhibited a slight temporal, but not clinically significant, decentration. The distance visual acuity and the refractive parameters improved significantly in all cases.

Conclusion:

We found the AssiAnchor capsule device an effective tool with a short learning curve for treating subluxated lenses.

Effect of capsular tension ring implantation during phacoemulsification on postoperative refraction

PURPOSE

To assess refractive outcomes of phacoemulsification (PE) with additional capsular tension ring (CTR) implantation.

MATERIAL AND METHODS

In total, 37 eyes of 37 patient who underwent PE with intraocular lens (IOL) implantation were divided into 2 groups: study group (n = 18) with CTR co-implantation (inclusion criteria was preoperative irido-phacodonesis) and control group (n = 19) without CTR. Optical biometry (IOL-Master 500) was performed for each patient before PE. Barrett Universal II Formula was used for IOL calculation. IOL power calculation error was assessed by comparing target refraction and final refraction measured by Topcon-8800 autorefractometer 1 month after surgery.

RESULTS

Despite almost identical preoperative values in both groups refractive result was different. Patients with CTR co-implantation had more hyperopic IOL power calculation error of 0.41 ± 0.52 D versus 0.04 ± 0.59 D in the control group (p = 0.043). Postoperative spherical equivalent in study group was more hyperopic (-0.40 ± 1.47 D) than in control group (-0.77 ± 1.24), nevertheless, this difference was insignificant (p = 0.166).

CONCLUSION

CTR co-implantation in patients with weak zonules and preoperative irido-phacodonesis leads to more hyperopic IOL power calculation error compared with control group.

Capsular tension ring assisted phacoemulsification of morgagnian cataract

Purpose:

To describe a novel technique of phacoemulsification in morgagnian cataract using capsular tension ring (CTR).

Methods:

This was a retrospective, non-comparative, clinical interventional study. Patients with hypermature morgagnian cataract who had undergone CTR-assisted phacoemulsification were included in the study. After capsulorhexis, CTR was inserted in a clockwise manner to stabilize the capsular bag in each case. Phacoemulsification was then performed using either horizontal chopping or vertical chopping. We have used the CTR in these cases without any obvious lens subluxation in order to perform safe emulsification of the nuclear pieces in the capsular bag. We have performed the procedure successfully in eleven eyes with hypermature morgagnian cataract.

Results:

The mean corrected distance visual acuity (CDVA) improved from 2.62 ± 0.25 Log MAR to 0.35 ± 0.28 Log MAR at 3 months postoperatively (P = 0.00008). Total nine out of 11 patients gained CDVA of 20/40 or better at 3 months postoperatively. No intraoperative complications such as posterior capsular rupture, zonular dialysis, iris trauma, vitreous loss were noted. The mean endothelial cell loss was 148.82 ± 41.52 cells/mm² after 3 months of surgery.

Conclusion:

The main culprit for intraoperative complications during phacoemulsification in a morgagnian cataract is the vulnerable capsular bag. Following insertion of a CTR after capsulorhexis, the bag becomes stable and the subsequent steps of the surgery become uneventful, thereby, preventing any further complications.

Effect of Capsular Tension Ring on Refractive Outcomes in Patients With Implantation of the Quadrifocal Acrysof PanOptix TFNT00 IOL

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.].

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM

To compare the rotational stability of Toric intraocular lens (IOLs) implantation combined with four-eyelet or two-eyelet capsular tension rings (CTRs) in eyes with high myopia and cataract.

METHODS

This prospective randomized controlled interventional study included 33 eyes which had preoperative corneal astigmatism ≥1.5 D and ocular axial length ≥25.5 mm. These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation (group A, n=16) or two-eyelet CTR implantation (group B, n=17). Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), phoropter examination results, and toric IOL rotation degrees were tested 6mo after the surgery.

RESULTS

In both groups, the toric IOL was in the capsular sac 6mo after surgery. The difference between the two groups in terms of visual outcome was not found to be statistically significant (P>0.05) at a follow-up of 6mo. The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups, respectively (P<0.001). The mean rotation degree of IOL was 1.00°±0.73° in group A and 3.53°±1.46° in group B (P<0.001).

CONCLUSION

In cataract patients with high myopia and astigmatism, four-eyelet CTR can effectively increase the rotation stability of toric IOLs, achieving the desired goal of correcting corneal astigmatism.

The effect of capsule tension ring on posterior capsule opacification: A meta-analysis

Background

Posterior capsule opacification is one of the most common complications after cataract surgery. Studies have suggested that the introduction of a capsule tension ring might play a critical role in the prevention of capsule opacification, yet quantitative evidence is still lacking. This work consists of a meta-analysis on available data in order to explore the influence of a capsule tension ring on posterior capsule opacification.

Methods

A comprehensive review of the literature on capsule tension ring and posterior capsule opacification was carried out using the Embase, Pubmed, Web of Science, and Cochrane electronic databases. The selected studies included randomized controlled trials, retrospective studies and prospective studies published before June 2020. The studies of interest were selected by two reviewers independently from the included studies. Odds ratios (ORs) and standardized mean differences (SMD) were used in order to assess the association. A fixed-effects model or a random-effects model was applied to combine data according to heterogeneities. Sensitivity analysis was used to assess the heterogeneity of the studies. Publication bias was estimated using the Egger test. Statistical analysis was performed using the stata15.1 software.

Results

The meta-analysis included in total 8 studies involving 379 cases and 333 controls. There was a statistically significant difference of Nd:YAG laser capsulotomy rate (OR=0.241, 95% CI: 0.145, 0.400 I²=42.1%) between the capsule tension ring group and the control group, indicating that the tension ring reduced the Nd:YAG laser capsulotomy rate. Further studies with continuous data also revealed that the use of capsule tension ring was associated with a lower posterior capsule opacification score (SMD = -1.402, 95% CI: -2.448, -0.355 I²=95.0%). The sensitivity analysis suggested that the result of the re-combined analysis did not change notably, indicating that the result was reliable and stable. Both pooled analysis showed no evidence of publication bias.

Conclusion

The findings of this meta-analysis confirmed that capsule tension ring might reduce capsule opacification. Further studies should be made to validate the result.

Effect of the capsular tension ring on refractive outcome after phacoemulsification

Purpose: To evaluate how capsular tension rings (CTR) affect refractive outcomes following cataract extraction by phacoemulsification complicated by zonular instability.

Study design: Retrospective.

Methods: In a retrospective case-control study, the 29 eyes of 29 patients with CTRs were compared with the 29 eyes of patients without zonular instability following routine phacoemulsification, with mean arithmetic refractive prediction error (ArRPE) and mean absolute refractive prediction error (AbRPE) as primary outcome measures.

Results: A comparison of eyes with and without CTRs according to the SRK/ T formula revealed no statistically significant difference in ArRPE (0.52 vs. 0.45 D, p = 0.570) or AbRPE (0.52 vs. 0.55 D, p = 0.799). Postoperative hypermetropic shift occurred in most cases in both groups, although the mean difference between eyes with CTR (22/ 29) and without CTR (25/ 29) was not statistically significant (p = 0.315).

Conclusion: Implanting CTRs did not consistently affect refractive outcomes versus routine phacoemulsification. Results suggest that intraocular lens power can be calculated as usual when CTRs are used.

Abbreviations: CTR = capsular tension ring, ArRPE = arithmetic refractive prediction errors, AbRPE = absolute refractive prediction errors, IOL = intraocular lens, WTW = white-to-white, ACD = anterior chamber depths, AL = axial lengths, RPE = refractive prediction error

Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support

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.

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

Retinitis pigmentosa (RP) is a set of inherited retinal degenerative diseases that affect photoreceptor and retinal pigment epithelial cells (RPEs), possibly associated with some ocular complications, including cataract. The complicated cataract formation is most likely the result of RP-related inflammation response, and the most common morphology category is posterior subcapsular cataract (PSC). Despite the absence of curative pharmacologic treatment, phacoemulsification with intraocular lens implantation to deal with opacification in the lens is preferred due to the considerable visual outcomes. However, the incidence of intraocular and postoperative complications is higher in RP patients than those without, including intraoperative phototoxic retinal damage, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased postoperative intraocular pressure (IOP), and intraocular lens (IOL) dislocation. Hence, it needs much attention to surgery progress and close follow-up. In this review, we discuss the current understanding of RP patients with complicated cataracts from morphology to potential pathogenesis to cataract surgical procedure and provide a concise description and the recommended management of related surgery complications to broaden the knowledge and lower the latent risks to yield better clinical outcomes.

Effect of capsular tension ring on refractive results in cases with pseudoexfoliation syndrome

PURPOSE

To investigate the effect of capsular tension rings (CTRs) on postoperative refractive results in patients with pseudoexfoliation (PSX) syndrome.

MATERIALS AND METHODS

Sixty-nine patients with PSX syndrome who had uncomplicated cataract surgery between March 2016 and February 2019 were reviewed retrospectively. The patients were divided into two groups. The 35 patients in Group 1 received CTRs prior to intraocular lens implantation during cataract surgery, and the 34 patients in Group 2 had cataract surgery without CTRs. Significant zonular weakness, uncontrolled glaucoma, and ocular pathologies causing low visual acuity were excluded. The preoperative and postoperative keratometry and autorefraction measurements, preoperative expected refractive values, and absolute refractive error were recorded.

RESULTS

The mean ages of patients were 73.54 ± 9.78 years in Group 1 and 72.23 ± 6.72 years in Group 2 (p = 0.521). There was no statistically significant difference between Group 1 and Group 2 in terms of expected preoperative refraction values (-0.52 ± 0.12,-0.56 ± 0.08, respectively, p = 0.118). There was a statistically significant difference in postoperative spherical equivalent values between Group 1 and Group 2 (-0.05 ± 0.97 and -0.92 ± 0.57, respectively, p < 0.01). A statistically significant difference was found between the two groups in terms of absolute refractive error (0.46 ± 0.74 in Group 1 and -0.34 ± 0.59 in Group 2 p < 0.01).

CONCLUSION

CTR implantation causes hyperopic shift, which should be taken into consideration when calculating the lens power of intraocular lens in patients with PSX syndrome.

Impact of the possible prognostic factors for visual outcomes of traumatic cataract surgery

BACKGROUND AND OBJECTIVES

This study aimed to investigate the impact of the possible prognostic factors for postsurgical success on visual acuity (VA) in traumatic cataract patients.

MATERIALS AND METHODS

The files of 92 patients (19 women[20.6%]-73 men[79.4%], 44 right-48 left total 92 eyes) who underwent surgery for traumatic cataracts between 2004 and 2018 were retrospectively reviewed for preoperative and final corrected distance VA(CDVA), laterality of trauma, time of admission to a hospital after trauma(TAH), type of injury, location of the injury (zone 1 [corneal], zone 2 [corneal and scleral], zone 3 [scleral]), additional ocular injury, simultaneous or secondary surgery, surgical cataract techniques, and complications.

RESULT

Of the 92 patients enrolled in the study, the mean CDVA was improved from preoperative 1.95 ± 0.49 logMAR to postoperative 0.73 ± 0.72 logMAR.(p < 0.001) In 36.7% of cases, the final CDVA was ≥ 20/40; it was ≥ 20/60 in 58.7%, ≥ 20/200 in 73.9%, and ≥ 20/400 in 94.5%. The strongest correlation was found between postoperative CDVA and preoperative CDVA (Pearson's R = 0.969, p = 0.0001). No correlation was found between CDVA and age, sex, and laterality. The regression analysis showed a significant relationship between the increase in CDVA and TAH, trauma type and location, and surgical timing and techniques. The worst CDVA prognosis was found for patients with a zone 3 injury; patients with a zone 1 injury had the best prognosis. The prognosis is better for a closed globe injury than an open globe injury (p = 0.019). Early TAH was related to a better prognosis than later admissions. No difference was observed between simultaneous and secondary surgeries (p = 0.413) and surgical techniques (p = 0.12).

CONCLUSION

Postoperative CDVA is better in traumatic cataract patients with a better preoperative VA. Early hospital admission after trauma, closed globe, and zone 1 injuries are better prognostic factors than late hospital admission time, open globe, and zone 3 injuries.

Forceps-assisted, 10-0 monofilament nylon, suture-guided capsular tension ring insertion in subluxated cataracts

Capsular tension ring (CTR) and iris hooks have proved to be useful devices in cataract surgery in cases of zonular weakness and dialysis. We would like to describe the use of monofilament 10-0 nylon (MFN)- guided CTR insertion in a subluxated cataractous lens. Here, the MFN is passed through the distal trailing eyelet of the CTR (simple or Morcher's depending on the size of the defect and subluxation) for controlled insertion of the distal eyelet of the CTR beneath the anterior capsulorhexis margin and safe retrieval of CTR in case of an iatrogenic posterior capsular tear during CTR insertion or phacoemulsification.

The advantages of femtosecond laser-assisted cataract surgery for zonulopathy

Zonulopathy is a major concern if found during cataract surgery as it can cause further complications. Such complications may occur during continuous curvilinear capsulorhexis (CCC), lens fragmentation and intraocular lens (IOL) implantation. Femtosecond laser-assisted cataract surgery (FLACS) devices, such as the LenSX (Alcon Laboratories) are advantageous because they can detect the area and largest point of zonulopathy via anterior segment optical coherent tomography (AS-OCT) before the manual part of the procedure. CCC and lens fragmentation can also minimize further zonular stress. A symmetrical CCC is ideal for IOL implantation in the sulcus with optic capture. In the present study, we did not detect significant zonular dehiscence preoperatively in either of the eyes of our 68-year-old patient when using AS-OCT (CASIA2 Tomey). However, LenSx AS-OCT revealed zonular dehiscence in both eyes, perioperatively. We created CCC and lens fragmentation without causing stress to the zonules. In the subsequent manual part of procedure, we found zonular dehiscence in the same area as indicated by LenSx AS-OCT, which extended to approximately 200° in the right eye and 180° in the left. After lens fragmentation by LenSx, we successfully removed the lens without further zonular dialysis. However, zonular dialysis (>180°) in the right eye was too large to insert an IOL, either in the capsule or the sulcus. Therefore, we performed scleral IOL implantation. In the left eye, we avoided using capsular tension ring (CTR) for IOL placement to avoid further iatrogenic damage to the zonule. Instead, an IOL was inserted into the sulcus with optic capture to reduce the possibility of further stress to the zonula and phimosis. Post-surgically, the patient regained good eyesight in both eyes. This case illustrates the advantages of FLACS in addressing zonulopathy. The consistent creation of CCC and lens fragmentation by FLACS may increase success rates, even in unexpectedly challenging cases.

Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives

Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.

Modern methods of fixation of rear-camera intraocular lenses after facoemulsification of the cataract complicated by the violation of capsule support of the lumber

The review of domestic and foreign literature sources examining different methods of fixation of posterior chamber intraocular lenses after phacoemulsification of cataract, complicated capsular support of the lens is presented. There is a sufficiently widespread of transscleral suturing of the IOL and the prospect of developing IOL fixation in corneal layers.

Comparative evaluation of rotational stability and visual outcome of toric intraocular lenses with and without a capsular tension ring

Purpose:

To evaluate the rotational stability of toric intraocular lens (IOL) when co-implanted with a capsular tension ring (CTR) as compared to that of a toric IOL without a CTR.

Methods:

This was a prospective randomized clinical trial performed in a tertiary care centre in India. Fifty adult human eyes with visually significant cataract and regular corneal astigmatism ≥1.5D divided into two groups of 25 eyes each, A and B by simple randomization. Eyes with corneal pathology, lens subluxation, and a specular endothelial cell count <2000/mm² were excluded from the study. The eyes in both the groups underwent standard phacoemulsification and were implanted with a toric IOL. In Group A, a CTR was put in the bag before IOL implantation. The groups were called for follow-up on day 1, 1 week, 1 month, and 3 months, postoperatively. The axis of the toric IOL on each visit was measured by slit lamp imaging in retroillumination and analyzed digitally.

Results:

Mean rotation of toric IOL at 3 months postoperatively was 1.85 ± 1.72° in Group A and 4.02 ± 2.04° in Group B. The difference was statistically significant (P = 0.003).

Conclusion:

Coimplantation of a CTR is a safe and effective technique for ensuring better rotational stability of toric IOLs.

Cataract surgery in patients with pseudoex-foliation syndrome: current updates

Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated.

Intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis

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.

Association of Single Nucleotide Polymorphisms in XRCC1 (194) and XPD (751) with Age-related cataract

PURPOSE

Age-related cataract (ARC) is a multifactorial disease and different risk factors, including genetic and environmental, are responsible for the development of its various types. The aim of this study was to find out a correlation, if any, between ARC and the single nucleotide polymorphisms (SNPs) in DNA repair genes XRCC1 (X-ray repair cross-complementary-1) [Arg194Trp (rs1799782)] and XPD (xerodermapigmentosa complementation group D) [Lys751Gln (rs13,181].

METHOD

The genotype at these two SNPs was analyzed in 260 subjects (125 control and 135 patients) from Southern Punjab population (Pakistan) by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. Genotype at both analyzed codons was correlated either individually or in various combinations with the studied epidemiological factors known to be associated with ARC.

RESULTS

Our results indicated that both SNPs Arg194Trp in XRCC1 (P = 0.967) and Lys751Gln in XPD (P = 0.995) were not associated with ARC whether they were analyzed individually or in combined form (P > 0.05). Analysis of epidemiological factors revealed that age (P < 0.001), cast of subjects (P = 0.001), diabetes (P < 0.001), hypertension (P = 0.001), smoking habit (P = 0.01), drug abuse (P < 0.05), steroid use (P = 0.001) and body weight (P < 0.001) can influence the incidence of ARC in enrolled subjects. After applying Binary logistic regression it was found that the weight (P < 0.01), family history (P = 0.05), drug abuse (P = 0.05), smoking (P < 0.05) and steroid use (P < 0.05) has a significant association with the phenotype of the subjects. All epidemiological factors were also studied in association with various genotypic combinations of both SNPS, diabetes was the only factor that had a significant association (P < 0.001) association with ARC. Hypertension (P = 0.01), body weight (P < 0.05) and cast (P < 0.001) were found associated with ARC when epidemiological factors were individually correlated with ARC. Result of the two proportion test indicated that gender had no influence on the incidence of disease.

CONCLUSION

It is concluded that studied SNPs in XRCC1 and XPD have no association with the incidence of age related cataract in the analyzed group of subjects.

Objective classification of zonular weakness based on lens movement at the start of capsulorhexis

Purpose

To quantify zonular weakness based on lens movement at the start of continuous curvilinear capsulorhexis (CCC) and establish a classification system for it.

Setting

Kozawa Eye Hospital and Diabetes Center, Mito, Japan.

Design

Retrospective interventional case series.

Methods

We examined 402 consecutive eyes of 316 patients who underwent CCC, phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. The movement of the lens capsule was measured using images from video recordings of the CCC procedure. Zonular weakness was classified based on the shifted distance: Grade I, less than 0.20 mm; Grade II, 0.20–0.39 mm; and Grade III, greater than 0.40 mm. For each of these grades, we examined the use of the capsule stabilization device during PEA, the surgical procedure for lens removal, and IOL fixation.

Results

We classified 276 eyes (68.6%) as Grade I, 102 eyes (25.4%) as Grade II, and 24 eyes (6.0%) as Grade III. As the grade increased, the use of the capsule stabilization device in PEA and scleral suture fixation of IOL increased.

Conclusions

Zonular weakness was quantified by measuring the movement of the lens capsule. An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery.

Effect of Co-Implantation of a Capsular Tension Ring on Clinical Outcomes after Cataract Surgery with Monofocal Intraocular Lens Implantation

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.

Visual outcomes in patients with zonular dialysis following cataract surgery

PurposeTo evaluate the visual outcomes of patients with zonular dialysis following cataract surgery.Patients and methodsMedical records of all patients with documented zonular dialysis, either pre- or peri-operatively, undergoing cataract surgery between 2004-2010 at Queen Alexandra Hospital, Portsmouth, were retrospectively reviewed. Baseline demographics and biometry were analysed, and ocular co-morbidities documented. Intraoperative complications and the use of a capsular tension ring (CTR) were identified. Early and late best-corrected visual acuity (BCVA) post surgery were determined using LogMar values. Univariate and multivariate linear regression analysis was performed to determine associations with BCVA post surgery, and further subgroup analysis performed in groups determined by CTR use.ResultsThe records of 22 312 consecutive eyes undergoing cataract surgery were reviewed. The incidence of zonular dialysis was 0.50% (111 eyes). A CTR was inserted in 46 eyes. Using a multivariate linear regression model, better initial pre-operative BCVA (P=0.019), the use of a CTR (P=0.014), and the absence of vitreous loss during surgery (P=0.008, β 0.45) were associated with improved early postoperative BCVA (mean follow-up 6.6 weeks). Better medium-term postoperative BCVA was significantly associated with preoperative BCVA (P=0.002) and the use of a CTR during surgery (P=0.004, β -0.41).ConclusionsThe overall incidence of zonular dialysis is low. CTR use intra-operatively suggests improved early and medium-term BCVA and should be considered in all cases of zonular dialysis.

Complication from combined use of capsule retractors and capsular tension rings in zonular dehiscence

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.

Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature

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.

Outcome of Capsular Tension Ring (CTR) Implant in Complicated Cataracts

INTRODUCTION

Surgery in the presence of zonular weakness or subluxated lens was a great surgical challenge and included intracapsular cataract extraction with anterior chamber IOL implantation or pars plana lensectomy and vitrectomy with a sutured (IOL). Modern surgical approache involves placement of endocapsular flexible PMMA ring that prevents iatrogenic loss of zonular support, minimizing vitreous loss and enables placement of in the bag IOL.

AIM

To evaluate frequency and indications of capsular tension ring (CTR) implant and analyse the visual and anatomical outcome in various complicated cataract surgeries.

MATERIALS AND METHODS

Retrospective screening of database of 6000 consecutive cataract surgeries was done. BCVA, complete ocular examination with SLEx, intraocular pressure, direct ophthalmoscope, fundus examination with +78/+90D were noted. CTR was implanted in cases where Zonular dialysis of > 3 clock hours was present or capsular bag instability was detected during capsulorhexis or subsequent intraoperative maneuvers. In cases with capsulorrhexis extension, CTR was not implanted. Records were analysed for indication of CTR implant and clinical outcome on Day 1, 1 month and 6 month follow up.

RESULTS

In this series CTR implant was done in 45 cases. The indications were hypermature senile cataract in 9 cases, hypermature senile cataract with lens induced glaucoma in 9 cases, pseudoexfoliation syndrome in 9 cases, post blunt injury traumatic cataract in 6 cases, iridochoroidal coloboma in 6 cases, hypermature cataract with pseudoexfoliation and marfan syndrome in 3 cases respectively. Decision of CTR implant was intraoperative in 42 patients. At 6 month follow up, 39 patients had best corrected visual acuity ≥6/12. IOL decentration was detected in only 3 cases, but without any subjective visual complaints.

CONCLUSION

As per the results CTR was used very infrequently (0.75%) but remains useful in cataract surgeries with difficult pre and intraoperative conditions. It gives good postoperative result and creates satisfied patients.

Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: intermediate-term results

PURPOSE

To report the intermediate-term results of capsule stabilization for scleral fixation with implantation of the Yaguchi hook, a modified capsule expander stabilization hook.

SETTING

Department of Ophthalmology, School of Medicine, University of Showa, Fujigaoka Rehabilitation Hospital, Yokohama, Japan.

DESIGN

Retrospective case series.

METHODS

Patients with zonular dialysis and phacodonesis were followed postoperatively for at least 2 years. All eyes had phacoemulsification and aspiration using an ordinary capsule expander and in-the-bag implantation of an intraocular lens (IOL). Capsule expanders were removed after the residual cortex was removed, and the capsular bag was fixated to the scleral wall via the ciliary sulcus using the modified capsule expander stabilization hook. Preoperative findings, intraoperative complications, and postoperative courses were examined.

RESULTS

The mean age of the 11 patients (11 eyes) was 72.2 years ± 10.5 (SD); 5 patients were men. The mean postoperative follow-up was 48.6 ± 13.6 months. The zonular dialysis range was 90 to 180 degrees in 1 eye, 180 degrees in 4 eyes, and 180 to 270 degrees in 1 eye. In 5 eyes, severe phacodonesis was observed without obvious zonular dialysis. In all eyes, the capsular bag and IOL were well centered without severe intraoperative or postoperative complications.

CONCLUSION

The modified capsule expander stabilization hook provided good centration and stabilization of the capsule-IOL complex in eyes with severely weak zonular fibers.

FINANCIAL DISCLOSURE

Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.

All about capsular tension rings

PURPOSE OF REVIEW

To discuss capsular tension devices and recent evidence regarding their use.

RECENT FINDINGS

The capsular tension ring, modified capsular tension ring, and capsular tension segment are well established tools for use during phacoemulsification when zonular instability is present. Recent research has provided additional evidence of their benefits in decreasing intraoperative and postoperative complications.

SUMMARY

Endocapsular support devices allow for cataract surgery success in the setting of zonular instability.

Factors affecting refractive outcome after cataract surgery in patients with a history of acute primary angle closure

PURPOSE

This study was conducted to evaluate the influence of preoperative or intraoperative factors on the refractive outcome after cataract surgery in patients with a history of acute primary angle closure (APAC).

METHODS

Eyes were divided into two groups: those with stable refractive outcome and those with unstable refractive outcome at 8 weeks after uneventful cataract surgery. Univariate and multivariate regression analyses were performed to investigate factors associated with the postoperative refractive outcome.

RESULTS

Fifty-three eyes of 53 patients with a history of APAC (21 eyes with stable refractive outcome, 32 eyes with unstable refractive outcome) were enrolled. In the univariate regression analysis, longer duration of APAC [odds ratio (OR) 1.328; 95 % confidence interval (CI) 1.137-1.552; P = 0.001] and poor preoperative best corrected visual acuity (OR 4.648; 95 % CI 1.071-20.168; P = 0.040) were associated with unstable refractive outcome after cataract surgery in patients with a history of APAC. In the multivariate regression analysis, the duration of APAC was the only independent factor predicting refractive outcome after cataract surgery in patients with a history of APAC (OR 1.317; 95 % CI 1.113-1.558; P = 0.001).

CONCLUSIONS

Normalization of elevated intraocular pressure as soon as possible after APAC onset is recommended to obtain a stable refractive outcome after cataract surgery in patients with a history of APAC.

Successful visual rehabilitation in a case of anterior megalophthalmos

We report a case of 40-year-old female who presented with diminution of vision in both eyes. Ocular evaluation showed presence of bilateral megalocornea with deep anterior chamber, iridodonesis, cataract, and anterior embryotoxon. She was diagnosed with bilateral anterior megalophthalmos. She underwent an uneventful cataract extraction with standard posterior chamber intraocular lens implantation of overall large diameter in the left eye. Zonular dialysis was not evident intraoperatively despite the presence of iridodonesis. Postoperatively the intraocular lens was well centered throughout follow up. This case report reviews this rare disorder and highlights successful visual rehabilitation.

A retrospective study of the indications and outcomes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital

BACKGROUND

The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR) insertion during cataract surgery.

METHODS

A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient's demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained.

RESULTS

Eighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0%) did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%). An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%). Postoperatively, the most common complications were a decentered intraocular lens (8.3%) and persistent corneal edema (6.0%). Overall, 61 eyes (72.6%) had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8%) achieving vision of 20/40 or better.

CONCLUSION

For the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability.

A study to evaluate whether CTR increases refractive unpredictability between predicted and actual IOL position

BACKGROUND

The surgical management of cataract associated with extensive zonular loss presents a challenge for ophthalmic surgeon. Capsular Tension Ring (CTR) is commonly being used to stabilize the capsular bag in patients with zonular dialysis. CTR helps to avoid capsular collapse and vitreous presentation in AC during surgery and maintains the capsular bag, allowing the circular contour of the capsular bag, allowing intra ocular lens to be easily placed in the bag. The aim of the study was to know if there is any shift of IOL following use of CTR ring.

METHOD

We did a Ultrabiomicroscopy (UBM) examination to find out shift in PCIOL in cases in which CTR ring and compared it with cases without CTR ring.

RESULT

It was found out through UBM in this study that there is actually a posterior shift of PCIOL after use of CTR ring leading to hypermetropic correction needed after surgery.

CONCLUSION

It is suggested that posterior shift of IOL following use of CTR should be kept in mind and the IOL implanted should be of + 1.0 to 2.0 D more than that calculated preoperatively.

Glued endocapsular hemi-ring segment for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses

Surgical expertise, prolonged surgical time, suture-related problems, and delayed intraocular lens (IOL) subluxation or dislocation due to broken sutures are limitations of suture fixation of the capsular bag to the scleral wall. We describe a new device made of IOL haptic material (polyvinylidene fluoride) that allows sutureless fibrin glue-assisted transscleral fixation of the capsular bag to address these issues. The device has a hemi-ring portion that lies in the capsular fornix and a double scroll mechanism that engages the capsulorhexis rim. The scroll extends forward as a haptic that is exteriorized through a sclerotomy under a lamellar scleral flap and tucked into a scleral tunnel. The flap is closed with fibrin glue. The device is used for subluxated cataracts and IOLs. It anchors the capsular bag to the sclera, giving vertical and horizontal stability, while providing fornix expansion and allowing stabilization of the bag intraoperatively and postoperatively. The device has been used in 4 patients who had good intraoperative and postoperative courses over a 5-week period.

In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

PURPOSE

To compare the degree of tilt and decentration of an intraocular lens (IOL), refractive status, and prediction error between eyes that underwent trans-scleral suturing of the IOL within the capsular bag (in-the-bag scleral suturing) and eyes that underwent scleral suturing outside of the bag (out-of-the-bag scleral suturing) because of severe zonular dehiscence.

PATIENTS AND METHODS

Thirty eyes that underwent in-the-bag scleral suturing of an IOL and 38 eyes that underwent out-of-the-bag scleral suturing were recruited sequentially. The tilt and decentration of the IOL, anterior chamber depth, manifest refractive spherical equivalent (MRSE), prediction error, and incidence of complications were examined.

RESULTS

The mean tilt angle and the decentration length of the IOL of the in-the-bag suturing group were significantly less than those of the out-of-the-bag suturing group (P = 0.0003 in tilt and P = 0.0391 in decentration), although the anterior chamber depth was similar. The mean MRSE and prediction error of the in-the-bag suturing group were less than those of the out-of-the-bag suturing group (P=0.0006 in MRSE and P = 0.0034 in error). The incidence of vitreous loss was less in the in-the-bag suturing group than in the out-of-the-bag suturing group (20% vs63.2%, P = 0.0009).

CONCLUSIONS

The tilt and decentration of the IOL after in-the-bag scleral suturing are significantly less than those after out-of-the-bag scleral suturing, which may lead to less MRSE and less prediction error. As the incidence of vitreous loss is less after in-the-bag scleral suturing, in-the-bag suturing is advantageous for eyes of younger patients and of less complicated cases.

Management of traumatic severely subluxated cataracts

PURPOSE

To determine outcome of cataract surgery in severely subluxated traumatic cataracts.

DESIGN

Noncomparative case series.

METHODS

Retrospective review of cataract surgery in all consecutive eyes with at least 6 clock hours of zonulysis, for patient demographics, presenting best-corrected visual acuity (BCVA) and postoperative BCVA at various time points, extent of zonulysis, and type and timing of insertion of capsular tension device. Main outcome measures were retention of the capsular bag and BCVA at last visit. Secondary outcome measures included IOL stability and centration, and perioperative complications.

RESULTS

There were 41 eyes (41 patients). Mean age at time of surgery was 57 years and the mean duration of follow-up was 21.4 months. The capsular bag was preserved with aid of a Cionni modified capsular tension ring (CTR) in 36 eyes (87.8%) and a combination of a capsular tension segment (CTS) and CTR in 2 eyes. In 3 eyes with total zonulysis, the bag could not be preserved despite the use of a CTS in 2 eyes. Preoperatively only 9 of the 41 eyes (22.0%) had a BCVA of 20/40 or better, as compared to 38 eyes at the last visit (92.7%, P < .001, χ(2) test). Posterior capsule rupture occurred in 3 eyes, 2 of which occurred during fixation of the CTR.

CONCLUSIONS

The capsular bag can be successfully preserved even in severely subluxated traumatic cataracts with the aid of fixated capsular tension devices.