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He J, Zhang L, Zheng F, Fang X. Case Report: Dislocation Into Vitreous Cavity and Removal of a Posterior Chamber Phakic Intraocular Lens. Front Med (Lausanne) 2022; 8:792253. [PMID: 35155472 PMCID: PMC8832095 DOI: 10.3389/fmed.2021.792253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose:To report a rare case of delayed dislocation of a novel posterior chamber phakic intraocular lens into the vitreous cavity, which was successfully treated by a reformed technique.Case PresentationA 29-year-old female received Ejinn phakic refractory lens (EPRL) implantation to correct her high myopia. Spontaneous dislocation into the vitreous cavity occurred 26-months post-operatively without traumatic history. Pars plana vitrectomy combined with cutting the EPRL into two equal pieces was performed to remove the dislocated EPRL.ConclusionDislocation into the vitreous cavity of EPRL can be successfully and easily removed by our reformed technique. Concerns about zonules-related complications pre-operatively, intraoperatively, and post-operatively must be raised in the practice of EPRL implantation.
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Goldfeather Ben-Zaken S, Kleinmann G. Results of using the AssiAnchor capsule device for subluxated crystalline lenses. Indian J Ophthalmol 2021; 69:3511-3514. [PMID: 34826985 PMCID: PMC8837323 DOI: 10.4103/ijo.ijo_576_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Shalhevet Goldfeather Ben-Zaken
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel, Affiliated with the Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Guy Kleinmann
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Tel Aviv University Tel Aviv, Israel
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Bhatt V, Bhatt D, Barot R, Sheth J. Ultrasound Biomicroscopy for Zonular Evaluation in Eyes with Ocular Trauma. Clin Ophthalmol 2021; 15:3285-3291. [PMID: 34393478 PMCID: PMC8357616 DOI: 10.2147/opth.s323349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of ultrasound biomicroscopy (UBM) in detecting zonular abnormalities in eyes with ocular trauma. Patients and Methods Prospective study of 143 eyes of 143 patients with ocular trauma and having opaque media was evaluated using a UBM. The presence or absence of zonular damage (zonular tears and/or zonular stretching) was examined and the clock-hour involvement was noted. Results One-hundred and one eyes had blunt trauma (70.63%; group 1), while 42 eyes had penetrating trauma (29.37%; group 2) The mean age of the patient population was 48.01±17.93 years with a male:female ratio of 2.11:1. Group 1 had significantly greater visual acuity than group 2 (p = 0.03). Zonular damage was present in 79 (55.2%) eyes, including zonular tears (48 eyes; 33.6%) and zonular stretching (31 eyes; 21.7%). Zonular damage was seen significantly more in eyes with blunt trauma (64.28%) as compared to penetrating trauma (25.74%) (p = 0.015). On quantitative analysis, zonular damage between 3 and 6 clock hours was most frequent, both in eyes having zonular tears (70.83%) and zonular stretching (96.77%). Additionally, 3–6 clock hours of zonular stretching was seen significantly more in blunt trauma as compared to penetrating trauma (p = 0.015). Conclusion UBM is an effective imaging modality to diagnose zonular abnormalities in patients with ocular trauma having opaque media. The ability to detect the presence of zonular weakness and their quantification by performing a UBM is critical to formulate the optimal surgical approach and avoid any untoward surgical complications.
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Affiliation(s)
- Vaidehi Bhatt
- Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Memorial Hospital, Thane, Maharashtra, India
| | - Deepak Bhatt
- Department of Imaging, UBM Institute, Mumbai, Maharashtra, India
| | - Rakesh Barot
- Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Memorial Hospital, Thane, Maharashtra, India
| | - Jay Sheth
- Department of Vitreoretinal, Surya Eye Institute and Research Center, Mumbai, Maharashtra, India
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Bardoloi N, Sarkar S, Burgute PS, Ghosh D, Deb AK. Capsular tension ring assisted phacoemulsification of morgagnian cataract. Indian J Ophthalmol 2021; 69:1781-1785. [PMID: 34146028 PMCID: PMC8374776 DOI: 10.4103/ijo.ijo_2723_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Narayan Bardoloi
- Cataract & Cornea Services, Chandraprabha Eye Hospital, Jorhat, Assam, India
| | - Sandip Sarkar
- Cataract & Cornea Services, Chandraprabha Eye Hospital, Jorhat, Assam; Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry, India
| | | | - Debaruna Ghosh
- Cataract & Cornea Services, Chandraprabha Eye Hospital, Jorhat, Assam, India
| | - Amit Kumar Deb
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry, India
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Zhang K, Dong Y, Zhao M, Nie L, Ding X, Zhu C. The effect of capsule tension ring on posterior capsule opacification: A meta-analysis. PLoS One 2021; 16:e0246316. [PMID: 33720958 PMCID: PMC7959402 DOI: 10.1371/journal.pone.0246316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Kaikai Zhang
- Ophthalmology, The Second Affiliated Hospital of Jilin University, Changchun, China
| | - Yuchen Dong
- Ophthalmology, The Second Affiliated Hospital of Jilin University, Changchun, China
| | - Meisheng Zhao
- Ophthalmology, The Second Affiliated Hospital of Jilin University, Changchun, China
- * E-mail:
| | - Lili Nie
- Ophthalmology, The Second Affiliated Hospital of Jilin University, Changchun, China
| | - Xinfen Ding
- Ophthalmology, The Second Affiliated Hospital of Jilin University, Changchun, China
| | - Chao Zhu
- Ophthalmology, The Second Affiliated Hospital of Jilin University, Changchun, China
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Yaguchi S, Yaguchi S, Bissen-Miyajima H. Evaluation of Lens Capsule Stability Using Capsular Tension Ring, Iris Retractor, and Capsule Expander Using a Porcine Model With Zonular Dehiscence. Invest Ophthalmol Vis Sci 2019; 60:3507-3513. [PMID: 31408113 DOI: 10.1167/iovs.19-27449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We evaluate the efficacy of capsular tension rings (CTRs), iris retractors (IRs), and capsule expanders (CEs) in stabilizing the lens capsule under different degrees of zonular dehiscence using a porcine model. Methods We developed an experimental model that can be used to observe the dynamics of lens capsules with different degrees of zonular dehiscence during phacoemulsification and aspiration (PEA). PEA was performed without any aid (control) and with devices. A CTR was used for a dehiscence of 30°, 45°, 60°, 90°, 120°, 150°, and 180° and one to four IRs or one to three CEs were used for a dehiscence of 90°, 120°, and 180°. The retention rate, calculated as the area of the capsular bag during PEA divided by the area before zonular dissection, and the number of lens fragments dropped into the vitreous cavity during PEA were examined and compared among the control and experimental groups. Results The retention rate increased significantly with the use of devices compared to the control (P < 0.05). The number of dropped lens fragments decreased by one or less with the use of CTR, one IR, or one CE for 90°, two IRs, or one or two CEs for 120°, and three or four IRs, or two or three CEs for 180° of zonular dehiscence. Conclusions The experimental porcine eye model with zonular dehiscence makes it possible to observe the entire configuration of the lens capsule, and demonstrates differences in the efficacy of capsular bag retention with CTR, IR, and CE.
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Affiliation(s)
- Saori Yaguchi
- Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | - Shigeo Yaguchi
- Department of Ophthalmology, Showa University School of Medicine, Tokyo, Japan
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Sethi HS, Naik M. Forceps-assisted, 10-0 monofilament nylon, suture-guided capsular tension ring insertion in subluxated cataracts. Taiwan J Ophthalmol 2019; 10:127-130. [PMID: 32874842 PMCID: PMC7442106 DOI: 10.4103/tjo.tjo_26_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 02/26/2019] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Harinder Singh Sethi
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mayuresh Naik
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Taskapili M, Gulkilik G, Kocabora MS, Ozsutcu M, Yilmazli C, Kaya G, Kucuksahin H. Comparison of Sulcus Implantation of Single-Piece Hydrophilic Foldable Acrylic and Polymethylmethacrylate Intraocular Lenses in Eyes with Posterior Capsule Tear during Phacoemulsification Surgery. Eur J Ophthalmol 2018; 17:595-600. [PMID: 17671936 DOI: 10.1177/112067210701700418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To compare the results of sulcus implantation of acrylic and poly(methylmethacrylate) (PMMA) intraocular lens (IOL) in eyes with posterior capsule tear during phacoemulsification surgery. Methods In all eyes a posterior capsule tear developed during phacoemulsification surgery and an IOL to the ciliary sulcus was implanted primarily. A total of 89 eyes of 88 patients received hydrophilic foldable acrylic IOL (acrylic group). A total of 72 eyes of 72 patients received PMMA IOL (PMMA group). The mean age was 67.1 years and 68.1 years and postoperative follow-up period was 19.2 months and 17.9 months in acrylic and PMMA groups, respectively. Results Temporary corneal edema appeared in 33 eyes and 26 eyes, elevation of intraocular pressure in 17 eyes and 12 eyes, anterior chamber inflammatory reaction in 5 eyes and 5 eyes, clinical cystoid macular edema in 7 eyes and 12 eyes, and decentered IOL in 4 eyes and 3 eyes in acrylic and PMMA groups, respectively. Late postoperative endophthalmitis developed in two eyes of the PMMA group. Rhegmatogenous retinal detachment developed in one eye in each group. Final best-corrected visual acuities were 5/10 and above in 73 eyes (82.02%) in the acrylic group and 5/10 and above in 42 eyes (58.33%) in the PMMA group. Postoperative final induced astigmatism was 0.5±0.5 D (SD) in the acrylic group and 1.11±0.65 D (SD) in the PMMA group (p=0.0001) (independent samples t-test). Conclusions Increased astigmatism is more frequently seen in the PMMA group. The implantation of foldable acrylic IOL in the sulcus after posterior capsule tear maintains the advantages of small incision surgery.
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Affiliation(s)
- M Taskapili
- Vakif Gureba Hospital Eye Clinic, 34260 Fatih, Istanbul, Turkey.
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9
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Kumar DA, Sivangnanam S, Agarwal A, Samiullah SB, Das S. Short-term fluctuation of lens corneal distance and clinical correlation with phacodonesis. Graefes Arch Clin Exp Ophthalmol 2017; 256:567-573. [PMID: 29279994 DOI: 10.1007/s00417-017-3862-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/13/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To analyze the role of short-term lens-corneal distance (LCD) fluctuation in quantifying preoperative phacodonesis and predicting intraoperative zonular weakness. METHODS Patients were divided into control (lens without clinical phacodonesis) and study (lens with suspicious and clinical phacodonesis) groups for evaluation. Slit-lamp examination followed by IOLMaster (Carl Zeiss) for LCD assessment was performed. Five readings were taken at five time points (0 s, 15 s, 30 s, 45 s & 60 s) continuously over a minute (short term) for the LCD fluctuation calculation. RESULTS A total of 135 eyes (82 controls and 53 study) were assessed. Study group included 32 (60.3%) suspicious and 21 (39.6%) moderate to severe phacodonesis. There was difference between the control and study eyes (p = 0.000) in short-term LCD fluctuation. Twenty-one study eyes (39.6%) showed LCD difference > 1 mm, including 11 eyes (52.3%) with > 2 mm. There was a difference in LCD with respect to severity of phacodonesis (p = 0.000). In the study eyes, 13 eyes underwent glued IOL implantation (clinical phacodonesis - ten, suspicious phacodonesis - three), and two eyes (suspicious phacodonesis) had glued capsular hook. Thirteen eyes (clinical phacodonesis - ten, suspicious phacodonesis - three) required intraoperative vitrectomy due to vitreous ingress. Intraoperative zonular weakness in 62.5% of eyes with suspicious donesis and association (Chi-square = 0.000) of weakness with preoperative LCD fluctuation was noted. CONCLUSIONS Short-term lens-corneal distance fluctuation can be used as a parameter for quantifying lens stability and as an aid in assessing the intraoperative risk.
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Affiliation(s)
- Dhivya Ashok Kumar
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
| | - Soundari Sivangnanam
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
| | - Amar Agarwal
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India.
| | - Sumaiya Banu Samiullah
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
| | - Sanjiv Das
- Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai, 600 086, India
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Chronic and Intermittent Angle Closure Caused by In-The-Bag Capsular Tension Ring and Intraocular Lens Dislocation in Patients With Pseudoexfoliation Syndrome. J Glaucoma 2017; 26:1051-1055. [DOI: 10.1097/ijg.0000000000000780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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11
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A novel capsular tension ring as local sustained-release carrier for preventing posterior capsule opacification. Biomaterials 2016; 89:148-56. [DOI: 10.1016/j.biomaterials.2016.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/18/2022]
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Abstract
Pseudoexfoliation (PXF) syndrome is characterized by the deposition of distinctive fibrillar material in the anterior segment of the eye. It is an age-related process that is associated with open and narrow angle glaucomas and the formation of cataracts. Not only is PXF associated with the formation of dense nuclear cataracts, it is also well known that those presenting with PXF are at a higher risk of developing complications during, and even after, cataract surgery. Complications associated with cataract surgery in PXF can occur from poor pupillary dilation, zonular weakness leading to intraoperative or postoperative lens dislocation and vitreous loss, postoperative intraocular pressure (IOP) spikes potentiating glaucomatous damage, capsular phimosis, prolonged inflammation, and postoperative corneal decompensation. The surgeon should be prepared to encounter the various potential intraoperative and postoperative complications in eyes with pseudoexfoliation syndrome during cataract surgery. In this way, the surgeon can plan his/her surgical technique to help avoid surprises during cataract surgery and be prepared to manage the potential postoperative complications that can occur in pseudoexfoliation eyes.
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Affiliation(s)
- Neha Sangal
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary , Boston, Massachusetts , USA
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Abstract
PURPOSE OF REVIEW To discuss capsular tension devices and recent evidence regarding their use. RECENT FINDINGS The capsular tension ring, modified capsular tension ring, and capsular tension segment are well established tools for use during phacoemulsification when zonular instability is present. Recent research has provided additional evidence of their benefits in decreasing intraoperative and postoperative complications. SUMMARY Endocapsular support devices allow for cataract surgery success in the setting of zonular instability.
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Kim EJ, Berg JP, Weikert MP, Kong L, Hamill MB, Koch DD, Yen KG. Scleral-fixated capsular tension rings and segments for ectopia lentis in children. Am J Ophthalmol 2014; 158:899-904. [PMID: 25127699 DOI: 10.1016/j.ajo.2014.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the short-term outcomes and complications of implantation of scleral-fixated capsular tension rings and/or capsular tension segments with intraocular lenses (IOL) in pediatric patients with ectopia lentis. DESIGN Retrospective, observational case series. METHODS Thirteen consecutive pediatric patients (19 eyes) underwent placement of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between January 1, 2009 and March 30, 2013 by 3 anterior segment surgeons at a single academic center. The scleral fixation suture was 9-0 polypropylene in 16 eyes and CV-8 Gore-Tex (expanded polytetrafluoroethylene) in 3 eyes. Outcome measures included change in corrected distance visual acuity (CDVA) and complications. RESULTS The mean age was 10.2 years ± 4.8 (SD) and the median follow-up, 23.4 months. A Cionni modified capsular tension ring was implanted in 5 eyes and a capsular tension segment with an unsutured capsular tension ring was implanted in 12 eyes. In 2 eyes, capsular tension segment alone was placed. The mean CDVA at the final follow-up (0.10 ± 0.11 logMAR, 18 eyes) was significantly better than preoperatively (0.58 ± 0.26 logMAR, 15 eyes) (P < .001). The CDVA at the final follow-up was 20/40 or better in 18 eyes (94.7%). All IOLs were well centered. Posterior capsule opacification developed in 11 eyes (57.9%), 9 eyes (47.4%) required neodymium-yttrium-aluminum-garnet capsulotomy, and 3 eyes (15.8%) required pars plana vitrectomy and posterior capsulotomy. Other complications included broken suture (5.3%) (9-0 polypropylene at CTR eyelet, repaired with CV-8 Gore-Tex), conjunctival dehiscence (5.3%), suture exposure (5.3%) (trans-scleral 9-0 polypropylene), and vitreous strand at inferior paracentesis (5.3%). CONCLUSIONS Implantation of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring appears to be a safe and effective technique for visual rehabilitation in pediatric ectopia lentis.
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Affiliation(s)
- Eric J Kim
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - James P Berg
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Mitchell P Weikert
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Lingkun Kong
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Marshall B Hamill
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Douglas D Koch
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Kimberly G Yen
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
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15
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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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Gimbel HV, Amritanand A. Suture refixation and recentration of a subluxated capsular tension ring-capsular bag-intraocular lens complex. J Cataract Refract Surg 2014; 39:1798-802. [PMID: 24286838 DOI: 10.1016/j.jcrs.2013.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
We describe a 3-point ab externo technique to refixate and recenter a subluxated Cionni capsular tension ring (CTR)-intraocular lens (IOL)-capsular bag complex to the sclera. A 9-0 polypropylene suture on a curved needle is looped through the eyelet of the CTR and back through a Hoffman scleral tunnel. Two other sutures passed in a similar fashion through the fibrotic continuous curvilinear capsulorhexis (CCC) edge are used to complete a tripod fixation, which centers and stabilizes the IOL. This surgical approach avoids the surgical trauma of removing and replacing a subluxated CTR-IOL-capsular bag complex, retains the optimal anatomical position, and ensures centration of the IOL.
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Affiliation(s)
- Howard V Gimbel
- From the Gimbel Eye Centre (Gimbel, Amritanand), Calgary, Alberta, Canada, and Loma Linda University (Gimbel), Loma Linda, California, USA.
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Two-step technique for posterior optic buttonholing of intraocular lens. Optom Vis Sci 2014; 91:S17-9. [PMID: 24584307 DOI: 10.1097/opx.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aims to describe a two-step surgical technique for placement of a posterior chamber intraocular lens (IOL) in cases with crystalline lens subluxation resulting from non-progressive zonular dialysis. METHODS The first stage entails a phacoemulsification with creation of a 4-mm posterior capsular opening using an automated vitrector. The second stage performed 6 weeks later includes an anterior vitrectomy and injection of a foldable three-piece IOL in the sulcus. The haptics of IOL are positioned in the sulcus while the optic is pushed behind the posterior capsular opening therefore "buttonholing" the IOL. RESULTS Seven eyes of seven patients with posttraumatic zonular dialysis were operated using this technique. Follow-up of all cases revealed a well-centered IOL with good postoperative visual acuity (20/20 to 20/80). CONCLUSIONS Our two-stage surgical technique precludes the insertion of capsular tension ring in cases with non-progressive zonular dialysis. The technique is recommended in the presence of less than or equal to 6 clock hours of zonular dialysis with preexisting posterior capsular tear or herniation of vitreous in the anterior chamber.
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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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Abstract
Surgery for traumatic cataracts is a potentially complex procedure. Clinically, traumatic cataracts may be difficult to thoroughly assess due to the presence of other significant ocular damage including corneal scars, posterior synechiae, and vitreous hemorrhage. Frequently, surgery involves surprises regarding the integrity of the posterior capsule and zonular structure. Careful ophthalmic imaging using ultrasound technologies may result in finer pre-operative detail regarding lens support structures, and may therefore give the surgeon the advantage when planning surgery. Imaging techniques most applicable to pre-operative evaluation include B scan ultrasound, 20MHz ultrasound, and ultrasound biomicroscopy. Important modifications to technique that can be made depending on the integrity of lens support structures include adjustment of wound location, adjustment in the technique for cataract removal, and possible use of a capsular tension ring.
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Affiliation(s)
- Lynn J Poole Perry
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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Rodrigues ACL, Trivedi RH, Wilson ME. Subluxation of the crystalline lens: a no-ring approach. J Pediatr Ophthalmol Strabismus 2012; 49:157-63. [PMID: 21800782 DOI: 10.3928/01913913-20110726-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 06/17/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the surgical technique and outcomes of a no-ring approach to posterior chamber intraocular lens (IOL) implantation in children and young adults with subluxation of the crystalline lens. METHODS A three-piece 5.5-mm hydrophobic acrylic IOL was implanted in which the optic and one haptic were inside the capsular bag and the other haptic was in the ciliary sulcus. The implantations were done in 13 eyes of 10 patients with lens subluxation. One haptic was fixated in the ciliary sulcus by passing it through an operculum-shaped opening in the capsular bag edge, made between 2 and 3 clock hours, clockwise from the middle point of the subluxated area. RESULTS The mean age of the 10 patients was 12.61 ± 8.04 years and the mean follow-up was 21.38 ± 11.29 months. The mean preoperative and postoperative best-corrected visual acuity (BCVA) was 1.15 ± 0.58 and 0.37 ± 0.17 logarithm of the minimum angle of resolution, respectively, in 11 measured eyes. The postoperative BCVA was 20/40 or better in 4 eyes (36.36%), between 20/40 and 20/60 in 6 eyes (54.54%), and between 20/80 and 20/100 in 1 eye (9.09%). The BCVA improved in all eyes. Postoperative IOL decentration between 1.0 and 1.5 mm occurred in 3 of 13 eyes (23.08%). CONCLUSION The results indicate that the no-ring technique allows centration of an IOL implanted into a subluxated capsular bag without using capsule tension rings.
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Affiliation(s)
- Antonio Carlos L Rodrigues
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
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Buttanri IB, Sevim MS, Esen D, Acar BT, Serin D, Acar S. Modified capsular tension ring implantation in eyes with traumatic cataract and loss of zonular support. J Cataract Refract Surg 2012; 38:431-6. [DOI: 10.1016/j.jcrs.2011.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/04/2011] [Indexed: 11/29/2022]
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Werner L, Zaugg B, Neuhann T, Burrow M, Tetz M. In-the-Bag Capsular Tension Ring and Intraocular Lens Subluxation or Dislocation. Ophthalmology 2012; 119:266-71. [DOI: 10.1016/j.ophtha.2011.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 11/26/2022] Open
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Ghaffariyeh A, Honarpisheh N. Magnet-assisted capsular bag fixation to manage limited zonular weakness during phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2010; 41:478-80. [PMID: 20415295 DOI: 10.3928/15428877-20100325-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2009] [Indexed: 11/20/2022]
Abstract
A new technique to manage limited zonular weakness during phacoemulsification is presented in this report. The technique, called magnet-assisted capsular bag fixation, uses the magnetic implant to stretch and fixate the capsular bag over the zonular dehiscence area for patients with limited zonular disruption, which stabilizes the capsular bag and facilitates cataract extraction.
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Das P, Ram J, Brar GS, Dogra MR. Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children. Indian J Ophthalmol 2010; 57:431-6. [PMID: 19861744 PMCID: PMC2812761 DOI: 10.4103/0301-4738.57149] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children. Setting: Tertiary care setting Materials and Methods: We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90° up to 210° after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO). Results: Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL. Conclusions: Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation
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Affiliation(s)
- Pranab Das
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh-160 012, India
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Monteiro TP, Estrela Silva SE, Domingues M, Fernandes AV, Falcão-Reis F. Complete spontaneous posterior luxation of capsular bag-intraocular lens-capsular tension ring complex. J Cataract Refract Surg 2009; 35:2154-6. [PMID: 19969223 DOI: 10.1016/j.jcrs.2009.05.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 05/19/2009] [Accepted: 05/23/2009] [Indexed: 11/30/2022]
Abstract
We describe the case of a monocular 72-year-old man who presented with spontaneous acute visual decrease in the left eye 2 years after uneventful phacoemulsification with intraocular lens (IOL) and standard capsular tension ring (CTR) implantation. Dilated fundoscopy revealed aphakia and complete vitreous luxation of the entire capsular bag-IOL-CTR complex.
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Affiliation(s)
- Tiago P Monteiro
- Ophthalmology Department, Hospital São João, Universidade do Porto, Portugal.
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Koplin RS, Anderson JE, Seedor JA, Ritterband DC. In situ nuclear disassembly: efficient phacoemulsification without nuclear rotation using lateral sweep sculpting and in situ cracking techniques. J Cataract Refract Surg 2009; 35:1487-91. [PMID: 19683141 DOI: 10.1016/j.jcrs.2009.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 04/13/2009] [Accepted: 04/15/2009] [Indexed: 11/17/2022]
Abstract
We describe an in situ nuclear disassembly technique using a simplified form of sculpting and cracking, enhanced by phacoemulsification technology with a Kelman-style tip. The technique does not require mobilization or rotation of the nucleus within the capsular bag, and hydrodissection is optional. The technique requires a Kelman-style curved tip and Kuglen hook and takes advantage of the versatility of the curved phacoemulsification needle for sculpting and cracking. Since in situ nuclear disassembly requires no rotation of the nucleus for extraction, it is useful in cases in which zonules are compromised or the surgeon suspects posterior lenticonus and the potential for loss of integrity of the posterior capsule.
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Capsule anchor to manage subluxated lenses: Initial clinical experience. J Cataract Refract Surg 2009; 35:1372-9. [DOI: 10.1016/j.jcrs.2009.02.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
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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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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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Vasavada V, Vasavada VA, Hoffman RO, Spencer TS, Kumar RV, Crandall AS. Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes. J Cataract Refract Surg 2008; 34:1499-508. [DOI: 10.1016/j.jcrs.2008.04.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 04/16/2008] [Indexed: 10/21/2022]
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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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Henderson BA, Kim JY. Modified capsular tension ring for cortical removal after implantation. J Cataract Refract Surg 2007; 33:1688-90. [PMID: 17889760 DOI: 10.1016/j.jcrs.2007.05.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 05/30/2007] [Indexed: 11/27/2022]
Abstract
We describe a modification of the original 14C Morcher capsular tension ring. The new ring, the Henderson capsule tension ring (HCTR, Morcher), is an open C-shaped loop made of poly(methyl methacrylate). It has 8 equally spaced indentations of 0.15 mm to improve the ease of removing nuclear and cortical material while maintaining equal expansion of the capsular bag. The HCTR is currently under review by the U.S. Food and Drug Administration.
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Sun R. Advantages and potential benefits of a closed CTR. J Cataract Refract Surg 2007; 33:1144-5. [PMID: 17586364 DOI: 10.1016/j.jcrs.2007.03.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 03/02/2007] [Indexed: 11/17/2022]
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Ton Y, Michaeli A, Assia EI. Repositioning and scleral fixation of the subluxated lens capsule using an intraocular anchoring device in experimental models. J Cataract Refract Surg 2007; 33:692-6. [PMID: 17397745 DOI: 10.1016/j.jcrs.2006.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 12/19/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe a new device for repositioning and scleral fixation of the capsular bag of subluxated lenses in experimental models. SETTING Laboratory for Experimental Microsurgery, Meir Medical Center, Kfar-Saba, Israel. METHODS The capsular anchoring device is a poly(methyl methacrylate) 1-plane implant consisting of 2 handles that grasp the edges of the capsulorhexis and a base for scleral fixation with a single 10-0 or 9-0 polypropylene suture. A temporary safety suture can be used to facilitate manipulations and prevent loss of the device through the zonular defect until it is secured to the scleral wall. The device was implanted in porcine eyes and living rabbit eyes. An animal model of lens subluxation was achieved by tearing about one third of the zonules. Capsule centration, implant stability, and inflammatory reaction were evaluated 2 to 4 weeks after implantation in the living model. RESULTS The device was implanted in 7 porcine eyes and 9 living rabbit eyes. A lens subluxation model was created in 4 porcine eyes and 2 rabbit eyes. The device effectively pulled the capsular bag to the center and remained stable up to 4 weeks thereafter. Very large zonular dialysis (>5 hours) was managed using 2 devices. Successful intraocular lens implantation was done repeatedly in the presence of the device. The implant was well tolerated in all rabbit eyes. Histopathological examination of the enucleated eyes revealed no inflammatory reaction or adhesions. The margin of the anterior capsulorhexis remained intact in all cases. CONCLUSIONS Experimental studies of a capsular anchoring device for subluxated lenses confirmed the safety and efficacy of the new device. A capsular tension ring can also be inserted separately to further stabilize the capsular bag.
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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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Goldman JM, Karp CL. Adjunct devices for managing challenging cases in cataract surgery: pupil expansion and stabilization of the capsular bag. Curr Opin Ophthalmol 2007; 18:44-51. [PMID: 17159447 DOI: 10.1097/icu.0b013e3280121b09] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients anticipate favorable surgical outcomes when having cataract surgery. The modern-day cataract surgeon should employ all necessary means to achieve this result. A working knowledge of adjunct devices for pupil expansion and capsular-bag stabilization can significantly improve surgical outcomes. RECENT FINDINGS Adjunct devices for pupil expansion include the Beehler pupil dilator, nylon iris hooks, and pupillary rings, including the Perfect Pupil, the Graether 2000, and the Morcher pupil dilator. Capsular-bag stabilization can be accomplished with capsular tension rings, capsular tension segments or iris hooks. The recent literature on these devices is reviewed. SUMMARY Impaired visualization through a small pupil and poor tissue stabilization increases the chance of tissue damage, retained nuclear material, and vitreous loss. Fortunately, inadequate mydriasis and instability of the capsular bag can be managed safely with the use of adjunct tools. Preoperative planning, familiarity with available tools, and accessibility of these devices in the operative setting is necessary.
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Berthout A, Turut P, Taboureau E, Denimal F, Milazzo S. Solutions chirurgicales à la luxation du complexe ICP — sac capsulaire — anneau de tension capsulaire. J Fr Ophtalmol 2007; 30:139-44. [PMID: 17318095 DOI: 10.1016/s0181-5512(07)89563-5] [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: 10/22/2022]
Abstract
INTRODUCTION The spontaneous luxation of the intraocular lens-capsular bag-capsular tension ring complex is a serious but fortunately rare complication. The authors report a combined surgical procedure to reposition the complex in a patient who was operated on for bilateral lens subluxation 4 years before and whose enophthalmia made surgery difficult. CASE REPORT Two surgical techniques can be considered to reposition the complex and avoid explantation. The McCannel modified stitch can capture the complex with the help of a transcorneal point and then a transscleral suture on the 12 o'clock meridian, despite the enophthalmia of the patient; the Moreno transscleral stitch. Both techniques suture the complex to the ciliary sulcus. CONCLUSION Moreno's technique is easy and safe for the endothelium and must therefore be attempted first. In case of failure, the McCannel modified stitch remains a useful and satisfying procedure allowing transscleral fixation of the complex to the sulcus at the cost of a minimal corneal trauma.
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Affiliation(s)
- A Berthout
- Département d'Ophtalmologie, Clinique Ophtalmologique Saint-Victor, CHU d'Amiens, 354, boulevard Beauvillé, 80000 Amiens.
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Sun R. Functions of the capsular tension ring. J Cataract Refract Surg 2007; 33:4. [PMID: 17189776 DOI: 10.1016/j.jcrs.2006.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 08/29/2006] [Indexed: 10/23/2022]
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Kurz S, Krummenauer F, Dumbach C, Pfeiffer N, Dick HB. Effect of a closed foldable equator ring on capsular bag shrinkage in cataract surgery. J Cataract Refract Surg 2006; 32:1615-20. [PMID: 17010856 DOI: 10.1016/j.jcrs.2006.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Accepted: 05/17/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of a closed foldable equator ring (CFER) versus a conventional capsular tension ring (CTR) on capsular bag shrinkage. SETTING Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS In this prospective study, 70 eyes of 70 patients were randomized to 2 groups using a 1:1 block scheme. After uneventful cataract surgery, a capsular measuring ring was implanted in all eyes to measure the capsular bag diameter in vivo. In Group 1, a CTR was implanted in the capsular bag. In Group 2, a CFER was inserted. Biometric characteristics such as axial length and the horizontal and vertical corneal radii were measured preoperatively. The capsular bag diameter and capsulorhexis diameter were measured intraoperatively and 2 or 3 days as well as 1 and 3 months postoperatively. RESULTS There were no statistically significant or clinically relevant between-group differences in covariants such as axial length, vertical and horizontal corneal radii, and capsulorhexis diameter. Eyes with the CTR had slight but statistically significant capsular bag shrinkage from a median of 10.4 to a median of 10.2 mm after 3 months (P<.001). Eyes with the CFER also had slight but statistically significant capsular bag shrinkage from a median of 10.3 to a median of 10.2 mm 3 months postoperatively (P = .021). At baseline, the CTR group had a larger capsular bag diameter, but there were no statistically significant differences between the groups at the 3-month follow-up (P = .669). CONCLUSIONS No clinically relevant capsular bag shrinkage was observed after implantation of a CFER or a CTR. The expected capsular bag shrinkage was the same in both groups.
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Affiliation(s)
- Sabine Kurz
- Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany.
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Sethi HS, Saxena R, Sinha A. Use of the Unfolder Silver/Sapphire system to inject capsular tension ring during phacoemulsification in cases with subluxated cataract. J Cataract Refract Surg 2006; 32:1256-8. [PMID: 16863957 DOI: 10.1016/j.jcrs.2006.01.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Accepted: 01/28/2006] [Indexed: 11/25/2022]
Abstract
Capsular tension rings (CTRs) have proved to be useful devices in cataract surgery in cases of zonular weakness and dialysis. They can be inserted with the help of forceps or commercially available injection systems. We describe use of the Unfolder Silver/Sapphire Series implantation system (Advanced Medical Optics, Inc.) to inject a CTR into the capsular bag during phacoemulsification in cases with subluxated cataract. The implantation system used for CTR insertion can subsequently be used for implantation of a foldable intraocular lens.
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Affiliation(s)
- Harinder Singh Sethi
- R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Roussel B, Billotte C. Intérêt de l’anneau de Cionni à fixation sclérale dans les désinsertions zonulaires traumatiques étendues. J Fr Ophtalmol 2006; 29:564-7. [PMID: 16885833 DOI: 10.1016/s0181-5512(06)73812-8] [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: 10/22/2022]
Abstract
INTRODUCTION Large traumatic zonular dialysis (larger than 140) induces significant surgical problems. CASE REPORT Two cases of large zonular dialysis with vitreous hernia in the anterior chamber, significant hypertonia, and cataract with subluxation of the lens are described. The surgical treatment consisted of ablation of the lens by phacoemulsification after anterior capsular rhexis and insertion of a conventional capsular tension ring. Then a Cionni ring was sutured to the sclera opposite the center of the zonular dialysis zone. The implant was inserted in the bag followed by an anterior vitrectomy. The IOL was centered in a stabilized bag in both patients. Postoperative visual acuity was excellent, with transitory hypertonia controlled with medical treatment. DISCUSSION The conventional capsular tension ring does not allow effective treatment of large zonular dialysis or recentration of the bag. However, the Cionni modified ring stabilizes and recenters the bag, allowing capsular preservation and implantation in the bag. The authors describe the insertion technique for this type of ring. CONCLUSION The Cionni ring seems to provide an effective surgical solution to large traumatic zonular dialysis with subluxation of the lens. However, the insertion technique for the ring is difficult to perform.
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Affiliation(s)
- B Roussel
- Service d'Ophtalmologie, CHU de Brest, Hôpital Morvan, Brest.
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Deka S, Deka A, Bhattacharjee H. Management of posteriorly dislocated endocapsular tension ring and intraocular lens complex. J Cataract Refract Surg 2006; 32:887-9. [PMID: 16765811 DOI: 10.1016/j.jcrs.2006.01.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 10/24/2005] [Indexed: 10/24/2022]
Abstract
We report a case of late posteriorly dislocated endocapsular tension ring (ECR) and intraocular lens (IOL) complex into the vitreous cavity that behaved as a single 13 mm disc. A 3-port pars plana vitrectomy was performed, and perfluorocarbon liquid was used to retrieve the ECR-IOL complex to the retropupillary area. A 3-point scleral fixation was performed to reposition the inseparable ECR-IOL complex.
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Affiliation(s)
- Satyen Deka
- Sri Sankaradeva Nethralaya Beltola, Assam, India.
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Lim MCC, Jap AHE, Wong EYM. Surgical management of late dislocated lens capsular bag with intraocular lens and endocapsular tension ring. J Cataract Refract Surg 2006; 32:533-5. [PMID: 16631072 DOI: 10.1016/j.jcrs.2005.12.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 08/10/2005] [Indexed: 11/24/2022]
Abstract
A case of late spontaneous dislocation of the lens capsular bag (CB) with foldable acrylic intraocular lens (IOL) and endocapsular tension ring (CTR) and its surgical management is reported in a 52-year-old man. The dislocation occurred 2 years 3 months after phacoemulsification cataract surgery in which a CTR was used for zonular instability. A 3-port pars plana vitrectomy was performed. Because it was not possible to grasp the IOL-CTR-CB complex, perfluorocarbon liquid was used to attempt to float it up. This was unsuccessful, so a scleral indenter was used to apply external pressure on the sclera to tilt the IOL-CTR-CB complex into a position where it could be grasped with a forceps and removed through a corneal section. A scleral-fixated IOL was placed, and the patient achieved a best corrected visual acuity of 6/9. The procedure was safe and effective without intraocular complications.
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Abstract
Implantation of intraocular lenses has become the standard of care in the aphakic state. Ideally, the lens is placed in the capsular bag, which affords stable fixation at a position closest to the nodal point of the eye. However, there will always be instances where this will not be possible. Congenital weakness of the lens zonules in various conditions, trauma, and surgical complications of cataract surgery are just some examples. In this article, we review the methods that have been devised to allow intraocular lens implantation in the absence of capsular or zonular support. These include anterior chamber angle and iris-fixated lenses, as well as posterior chamber iris- and scleral-sutured lenses. The various lenses are described, and the techniques involved, advantages and disadvantages, complications, and results of each method are discussed. It is hoped that this article will provide a comprehensive overview of ways to deal with a problem that can still result in a very good visual outcome for the patient. This is particularly relevant given the many recent developments and refinements of methods in implanting intraocular lenses.
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Affiliation(s)
- Y M Por
- Singapore National Eye Centre, Singapore
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Taskapili M, Engin G, Kaya G, Kucuksahin H, Kocabora MS, Yilmazli C. Single-piece foldable acrylic intraocular lens implantation in the sulcus in eyes with posterior capsule tear during phacoemulsification. J Cataract Refract Surg 2005; 31:1593-7. [PMID: 16129297 DOI: 10.1016/j.jcrs.2005.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2005] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate early and late period results of the implantation of single-piece foldable acrylic intraocular lens (IOL) in the sulcus in eyes developing a posterior capsule tear (PCT) during phacoemulsification (PE). SETTING S.S.K. Vakif Gureba Training Hospital Eye Clinic, Istanbul, Turkey. METHODS This prospective and noncomparative study consisted of 89 eyes of 88 patients in which PCT developed, with or without vitreous loss, and that were followed up for at least 1 year. The IOL was implanted in the sulcus in all eyes with sufficient capsule support. Postoperative best corrected visual acuity (BCVA), anterior segment biomicroscopy, intraocular pressure (IOP), IOL centralization, and fundus were analyzed. RESULTS Temporary corneal edema, the most frequently observed cause of reduced vision in the early period, appeared in 33 eyes; high IOP in 17 eyes; anterior chamber inflammatory reaction in 5 eyes; clinical cystoid macular edema in 7 eyes; and retinal detachment in 1 eye. The IOL was decentered in 4 eyes and dislocated in 1 eye. Repositioning was performed in 2 eyes. No IOL was removed. In the early period, BCVA was 5/10 and above in 41 eyes; the final BCVA was 4/10 and below in 16 eyes and of 5/10 and above in 73 eyes. CONCLUSIONS The implantation of foldable acrylic IOL in the sulcus in eyes developing posterior capsule tear during phacoemulsification surgery maintains the advantages of a small incision. Postoperative visual results were good, complications were few, and IOLs were centered.
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Ahmed IIK, Chen SH, Kranemann C, Wong DT. Surgical Repositioning of Dislocated Capsular Tension Rings. Ophthalmology 2005; 112:1725-33. [PMID: 16199268 DOI: 10.1016/j.ophtha.2005.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 05/09/2005] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To present techniques and results of surgical repositioning of subluxed and dislocated capsular tension rings (CTRs). DESIGN Retrospective interventional case series. PARTICIPANTS Eleven patients with a previously implanted CTR in-the-bag for zonular weakness who presented with CTR-intraocular lens (IOL)-capsular bag decentration who underwent surgical repositioning. METHODS Data from 11 patients who underwent surgical repositioning were evaluated retrospectively for underlying diagnosis, interval between initial surgery and decentration, surgical technique, clinical results, and complications. MAIN OUTCOME MEASURES Capsular tension ring-IOL-capsular bag centration, final best-corrected visual acuity (BCVA), and surgical complications. RESULTS Of the 11 patients with CTR decentration, 3 had it early in the postoperative period, and 8 had it late. Mean (+/- standard deviation) durations from cataract extraction and CTR implantation to surgical repositioning were 6.1+/-7.9 months for those with decentration early and 49.6+/-15.3 months for late decentrations (overall range, 0.7-74.7). Of the 11 patients, 7 had pseudoexfoliation, and 4 of the 7 had associated glaucoma. Nine patients had subluxation of the CTR-IOL-capsular bag complex, which was managed by an anterior segment approach. A pars plana vitrectomy and levitation of the CTR was required in 2 patients due to complete dislocation of the CTR into the posterior vitreous. Surgical techniques for repositioning included single, double, or 3-point scleral suture loop fixation of the CTR through the capsular bag complex (8 eyes); use of the capsular tension segment (CTS) placed within the capsular bag for scleral suture fixation (2); or iris suture fixation of the IOL haptics (1). All patients achieved successful anatomical repositioning of the CTR-IOL-capsular bag complex. Mean preoperative BCVA improved from 20/100 to 20/40 postoperatively. After repositioning surgery, BCVA improved in 7 patients, was maintained in 2, and worsened in 2 (due to advanced glaucoma). CONCLUSION Postoperative CTR subluxation or dislocation is a risk for patients with severe or progressive zonulopathy. Decentrations may be effectively managed with scleral suture fixation of the CTR through the capsular bag or the use of the CTS.
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Kurz S, Krummenauer F, Hacker P, Pfeiffer N, Dick HB. Capsular bag shrinkage after implantation of a capsular bending or capsular tension ring. J Cataract Refract Surg 2005; 31:1915-20. [PMID: 16338560 DOI: 10.1016/j.jcrs.2005.06.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2005] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the influence of a capsular bending ring (CBR) or tension ring (CTR) on capsular bag shrinkage. SETTING Department of Ophthalmology, Johannes Gutenberg-University, and Department of Medical Biometry, Epidemiology and Informatics, University of Mainz, Mainz, Germany. METHODS In 92 eyes of 92 patients, a capsular measuring ring (CMR) was implanted after phacoemulsification to measure capsular bag size in vivo. Patients were randomized into 3 groups: The first received a CMR and CBR, the second received a CMR and CTR, and the third received a CMR alone. Measurements were performed preoperatively, intraoperatively, during the first 3 postoperative days, and after 1 and 3 months. Preoperative biometric characteristics such as axial length (AL) and anterior chamber depth were determined. Primary clinical end points were capsular bag size and capsulorhexis diameter measured intraoperatively and by means of slitlamp biomicroscopy and retroillumination photography postoperatively. RESULTS There were no clinically relevant group differences in AL, anterior chamber depth, or capsulorhexis diameter. Eyes implanted with the CBR showed shrinkage of the capsular bag from 10.6 to 10.4 mm after a median of 3 months (sign test; P = .023); eyes with a CTR showed comparable median capsular bag shrinkage from 10.5 to 10.2 mm (P<.001), whereas eyes without a CTR showed a median shrinkage from 10.5 to 10.0 mm (P<.001). Intraindividual shrinkage was of a similar, although significantly different, order among these groups (median shrinkage 0.15 versus 0.23 and 0.38 mm, respectively; all pairwise Wilcoxon test; P = .050, P = .020, P<.001, respectively). CONCLUSIONS Capsular shrinkage can be inhibited by a CBR and, to lesser extent, a CTR; the gain in shrinkage prevention is limited when compared with a CMR, however. This conclusion can be drawn only for the specific CBR or CTR and hydrophobic acrylic intraocular lens (IOL) used in this study. Reduction of capsular bag shrinkage after CTR implantation may reduce IOL dislocation and tilt and help to maintain postoperative visual acuity.
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Affiliation(s)
- Sabine Kurz
- Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany
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Sinha R, Sharma N, Vajpayee RB. Intralenticular bimanual irrigation: aspiration for subluxated lens in Marfan's syndrome. J Cataract Refract Surg 2005; 31:1283-6. [PMID: 16105595 DOI: 10.1016/j.jcrs.2004.11.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2004] [Indexed: 10/25/2022]
Abstract
We describe a new technique of aspiration of subluxated lens in young patients with Marfan's syndrome. Two small circular anterior capsulorhexis (1.5 mm to 2.0 mm) openings were created, and bimanual irrigation/aspiration was performed by introducing the irrigation cannula through 1 capsular opening and the aspiration cannula through the other. The irrigation cannula served the dual purpose of hydrating the lens matter and holding the lens in central position to ensure complete aspiration of the lens matter. The lens capsule was later removed and anterior vitrectomy performed by a vitrectomy cutter. This new technique of intralenticular irrigation/aspiration is effective and safe in performing lens aspiration in extensively dislocated crystalline lens in Marfan's syndrome.
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Affiliation(s)
- Rajesh Sinha
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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