Phacoemulsification And Zonular Weakness: Contribution Of The Capsular Tension Ring With A Thread

Femtosecond Laser Combined with Double-Flange Polypropylene Suture Capsular Tension Ring Suspension for the Treatment of Subluxation of Lens in Marfan Syndrome

Purpose

To evaluate the use of femtosecond laser combined with double-flange polypropylene suture capsular tension ring (CTR) suspension to treat subluxation of lens in Marfan syndrome. The objective is to provide safer and more effective surgical procedures for patients. Setting. Eye Hospital, Aier Eye Hospital of Wuhan University, Wuhan, China

Methods

In this retrospective study, we observed sixteen patients (16 eyes) with Marfan syndrome who had undergone this operation. Femtosecond laser incision was performed on the anterior capsule with the lens as the center. The suspending CTR was clipped to anterior capsule to support it, which was secured to the sclera with a double-flange polypropylene suture. Uncorrected visual acuity (UCVA), intraocular pressure (IOP), tilt, and decentration of the intraocular lens (IOL) and postoperative complications were evaluated.

Results

All 16 patients were successfully implanted with suspended CTR and IOL after femtosecond laser assisted surgery. Visual acuity improved significantly after surgery (p < 0.01). At 1 month, 3 months and 6 months postoperatively, the tilt of the IOL was 2.70 ± 0.934, 2.65 ± 0.897, and 2.66 ± 0.781, and the decentration of the IOL was 0.30 ± 0.770, 0.30 ± 0.682, and 0.29 ± 0.737; both had no statistically significant difference between the three groups. After the operation, 4 patients had hyphema and 2 patients experienced a temporary postoperative IOP increase. Only one flange was exposed one month after operation and recovered right after secondary adjustment.

Conclusion

Femtosecond laser combined with double-flange polypropylene suture CTR suspension was effective in fixing the lens capsule to the scleral wall in cases of subluxation of lens seen in Marfan syndrome during our short-term observation. The long-term efficacy of this operation needs further observation and follow-up.

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.

Small incision phacoemulsification with topical anesthesia during perioperative period: nursing experience and its application

PURPOSE

To investigate the perioperative clinical nursing experience and application effect of small incision phacoemulsification with topical anesthesia.

METHODS

Retrospectively analysis of 126 patients who came to our hospital for small incision phacoemulsification with topical anesthesia from November 2018 to November 2019. These patients were randomly divided into a study group and a control group, with 63 patients in each group. Patients from both groups underwent small incision phacoemulsification with topical anesthesia. The control group used routine nursing care during the perioperative period, and the study group used comprehensive nursing care. The clinical intervention effects of the two groups were compared.

RESULTS

The visual acuity of the two groups of patients after intervention was significantly improved (P<0.001), and the visual acuity of the study group after intervention was significantly better than that of the control group (P<0.001); the astigmatism of the study group after intervention was obviously lower (P<0.001); the Self-rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of the two groups of patients after intervention were significantly lower than those before the intervention, and the decrease of SAS and SDS scores of the study group were more significant (P<0.001); The clinical nursing satisfaction of the study group was significantly higher than that of the control group (P<0.05); the postoperative complication rate of the study group was significantly lower than that of the control group (P<0.05); the cataract knowledge scores of the two groups of patients after intervention were both significantly higher than before the intervention, and the increase of cataract knowledge score of the study group was more remarkable (P<0.001).

CONCLUSION

The comprehensive nursing mode used in small incision phacoemulsification with topical anesthesia for cataract extraction can effectively improve the patient's visual acuity, reduce the astigmatism, and have a lower incidence of postoperative complications, which has high clinical application value.