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Management of Dislocated Crystalline Lens With Vitrectomy, Perfluorocarbon Liquid, and Phacoemulsification, Combined With Modified Capsular Tension Ring and in-the-Bag Intraocular Lens Implantation. Retina 2022; 42:1809-1813. [PMID: 30985552 DOI: 10.1097/iae.0000000000002536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saadet GI, Fatih Ö. Effect of the capsular tension ring on refractive outcome after phacoemulsification. Rom J Ophthalmol 2021; 65:59-63. [PMID: 33817435 PMCID: PMC7995511 DOI: 10.22336/rjo.2021.11] [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] [Indexed: 11/23/2022] Open
Abstract
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
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Affiliation(s)
- Gültekin Irgat Saadet
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kutahya, Turkey
| | - Özcura Fatih
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kutahya, Turkey
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Vanags J, Erts R, Laganovska G. Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support. ACTA ACUST UNITED AC 2021; 57:medicina57010035. [PMID: 33401604 PMCID: PMC7823552 DOI: 10.3390/medicina57010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
Background and Objectives: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. Materials and Methods: For this prospective study, we enlisted cataract surgery patients in our hospital with preoperative diagnoses of weak zonules. All patients received phacoemulsification surgery with implantation of a hydrophobic acrylic IOL and capsular tension ring (CTR). ACO reductions were measured for six months after enrolment. Data on late IOL dislocations were collected five years after enrolment of the last patient. Results: Fifty-three patients were enrolled from 2011 to 2015. Over the six-month active follow-up period, ACO area reduction was 23% in patients receiving CTRs of 11 mm diameter and 8% for patients with CTRs of 12 mm, with an overall mean of 15% reduction. Five years after the last patient was enrolled, seven patients (13%) had experienced late IOL-CTR-capsular bag dislocation. For these patients, the mean ACO reduction in the first six months of follow-up was 33%, including for those who had received neodymium-doped yttrium aluminum garnet (Nd: YAG) anterior capsulotomies. Conclusion: Use of hydrophobic acrylic lenses and CTR reduces ACO contraction, with rates comparable to those after cataract surgery without ocular comorbidity. Our patients experienced a relatively high rate of late IOL-CTR-capsular bag dislocation. However, dislocated complexes were easily repositioned and few patients required IOL exchange. Frequent visits are warranted to promptly detect late complications of cataract surgery in patients with weak zonular support.
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Affiliation(s)
- Juris Vanags
- Clinic of Ophthalmology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
- Department of Ophthalmology, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +37-12-6068-123; Fax: +37-16-7069-549
| | - Renārs Erts
- Faculty of Medicine, University of Latvia, LV-1079 Riga, Latvia;
| | - Guna Laganovska
- Clinic of Ophthalmology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia;
- Department of Ophthalmology, Riga Stradins University, LV-1007 Riga, Latvia
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Modern methods of fixation of rear-camera intraocular lenses after facoemulsification of the cataract complicated by the violation of capsule support of the lumber. КЛИНИЧЕСКАЯ ПРАКТИКА 2018. [DOI: 10.17816/clinpract09139-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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.
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Bao X, Hou M, Qin Y, Luo F, Shang F, Wu M. Effect of an MG132-Sustained Drug Delivery Capsular Ring on the Inhibition of Posterior Capsule Opacification in a Rabbit Model. J Ocul Pharmacol Ther 2017; 33:103-110. [PMID: 28106491 DOI: 10.1089/jop.2016.0163] [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] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To design an MG132-sustained drug delivery capsular ring (SDDCR) and investigate its effect on the inhibition of posterior capsule opacification (PCO) in a rabbit model. METHODS The SDDCRs were prepared by forming a slice of film made by the mixture of poly lactic-co-glycolic acid (PLGA) and MG132 on the surface of capsular tension rings (CTRs). The drug-loading capacity, entrapment efficiency, and in vitro release of the drug-containing film were detected. Eighteen New Zealand white rabbits were operated with phacoemulsification and MG132-SDDCRs/PLGA-CTRs/CTRs implantation in the single eye. The images of the anterior segments were acquired at certain days, and the epithelial-mesenchymal transition (EMT) markers were detected by western blot and immunofluorescence. RESULTS The drug-loading capacity and entrapment efficiency of MG132-SDDCRs were 1.15% ± 0.04% and 66.16% ± 0.027%, respectively, and the drug released well within a month. The PCO degree of the MG132-SDDCR group was significantly lower than the other groups. The expression of alpha-smooth muscle actin, fibronectin, vimentin, and collagen-I was lower, and the expression of E-cadherin (E-cad) was higher in the MG132-SDDCR group than the other groups. CONCLUSIONS MG132-SDDCRs could be established successfully. The PCO process was prevented, and the expression of EMT markers was inhibited by the implantation of MG132-SDDCRs, indicating that this could be a potential treatment against PCO.
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Affiliation(s)
- Xuan Bao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Min Hou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Yingyan Qin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Furong Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Fu Shang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Mingxing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
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Thapa BB, Agarwal A, Singh R, Gupta PC, Ram J. Phacoaspiration with a Cionni ring versus pars plana lensectomy, vitrectomy and sutureless transscleral IOL fixation in pediatric patients with a subluxated lens. Graefes Arch Clin Exp Ophthalmol 2016; 254:901-9. [PMID: 26899898 DOI: 10.1007/s00417-016-3297-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare outcomes of phacoaspiration (PA) with Cionni ring-assisted posterior-chamber intraocular lens implantation (PCIOL) versus pars plana lensectomy (PPL) with anterior vitrectomy (AV) and sutureless transscleral fixation of the IOL (TSFIOL) assisted with fibrin glue in the management of a subluxated lens. METHODS In this prospective and comparative interventional study, one eye of children with a bilateral subluxated lens was randomized to undergo PA with PCIOL using a Cionni ring (group A: n = 14 eyes), and the other eye underwent PPL + AV with glue-assisted TSFIOL (group B: n = 14 eyes). The outcome measures included best-corrected visual acuity (BCVA) in logMAR units and rates of complications at 12-month follow-up visits. RESULTS 28 eyes of 14 children (age: 8.06 ± 4.49 years) were included in the study. BCVA improved from preoperative value of 1.21 to 0.4 (p = 0.001) in group A and from 1.53 to 0.31 (p = 0.001) in group B at month 12. There was no significant difference in the BCVA on comparing the two groups at month 12 (p > 0.411). Postoperative complications in group A included corneal edema (two eyes), Cionni hook capture (one eye), elevated IOP (one eye), and posterior capsular opacification (five eyes). In group B, corneal edema was seen in two eyes, hypotony in one eye, vitreous hemorrhage in one eye and pupillary optic capture in four eyes. CONCLUSION Head-to-head comparison of the two techniques demonstrates no significant difference in the rates of complications at month 12. The decision to choose either technique may be based on the operating surgeon's skill, experience and preference.
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Affiliation(s)
- Bikram Bahadur Thapa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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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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Wang R, Bi CC, Lei CL, Sun WT, Wang SS, Dong XJ. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma. Int J Ophthalmol 2014; 7:264-72. [PMID: 24790868 DOI: 10.3980/j.issn.2222-3959.2014.02.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 03/06/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation. METHODS Non-comparative retrospective observational case series. PARTICIPANTS 30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. MAIN OUTCOME MEASURES visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations. RESULTS The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis. CONCLUSION To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.
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Affiliation(s)
- Rui Wang
- Department of Ophthalmology, Xi'an No.4 Hospital, Xi'an 710004, Shaanxi Province, China
| | - Chun-Chao Bi
- Department of Ophthalmology, Xi'an No.4 Hospital, Xi'an 710004, Shaanxi Province, China
| | - Chun-Ling Lei
- Department of Ophthalmology, Xi'an No.4 Hospital, Xi'an 710004, Shaanxi Province, China
| | - Wen-Tao Sun
- Department of Ophthalmology, Xi'an No.4 Hospital, Xi'an 710004, Shaanxi Province, China
| | - Shan-Shan Wang
- Department of Ophthalmology, Xi'an No.4 Hospital, Xi'an 710004, Shaanxi Province, China
| | - Xiao-Juan Dong
- Department of Ophthalmology, Xi'an No.4 Hospital, Xi'an 710004, Shaanxi Province, China
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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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Jacob S, Agarwal A. Fibrin glue assisted trans-scleral fixation of an endocapsular device for sutureless trans-scleral capsular bag fixation in traumatic subluxations: the glued endocapsular ring/segment. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2013; 2:3-7. [PMID: 24600633 PMCID: PMC3939766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Subluxated cataracts secondary to blunt injury are a challenge to treat from the construction of rhexis to IOL insertion. For that reason, we designed a new glued endocapsular ring (ECR)/ segment (ECS) for subluxated cataracts and IOLs for sutureless fibrin glue assisted trans-scleral fixation of the capsular bag. The glued ECR/segment stabilizes the capsular bag intra and post-operatively, allowing for sutureless fibrin glue assisted trans-scleral fixation. The segment gives vertical, horizontal and rotational stability as well as forniceal expansion. The advantages to this approach include easier implementation; faster surgery; easy adjustability; sturdier scleral fixation; fewer chances of segment drop into vitreous and lack of suture-related complications. Our hypothesis is that a glued versus sutured ECR/ECS will be more viable and stable on the sclera in the long term. Less pseudophakodonesis will also lead to a more stable capsule-bag complex and reduce the risk of posterior segment complications such as retinal detachment and cystoid macular edema. The nature of the device also makes its removal, if required, much more straightforward than the sutured rings/segments. This device can be used in patients with subluxated cataracts, colobomatous lens or subluxated IOLs.
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Khokhar S, Agarwal T, Kumar G, Kushmesh R, Tejwani LK. Lenticular abnormalities in children. J Pediatr Ophthalmol Strabismus 2012; 49:32-7. [PMID: 21688762 DOI: 10.3928/01913913-20110614-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/10/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the lenticular problems in children presenting at an apex institute. METHODS Retrospective analysis of records (< 14 years) of new lens clinic cases was done. RESULTS Of 1,047 children, 687 were males. Mean age at presentation was 6.35 ± 4.13 years. Developmental cataract was seen in 45.6% and posttraumatic cataract in 29.7% of patients. Other abnormalities were cataract with retinal detachment, persistent hyperplastic primary vitreous, subluxated lens, micro/spherophakia, cataract secondary to uveitis, intraocular lens complications, cataract with choroidal coloboma, and visual axis opacification. CONCLUSION Developmental and posttraumatic cataracts were the most common abnormalities. Delayed presentation is of concern.
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Affiliation(s)
- Sudarshan Khokhar
- Dr R P Centre of Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India.
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Sharma A. Trans-scleral fixation of Cionni - modified capsule tension ring. Indian J Ophthalmol 2010; 58:447; author reply 447-8. [PMID: 20689211 PMCID: PMC2992932 DOI: 10.4103/0301-4738.67049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Das P, Ram J, Brar GS, Dogra MR. Authors’ reply. Indian J Ophthalmol 2010; 58. [PMCID: PMC2992933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pranab Das
- Advanced Eye Center, PGIMER, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Center, PGIMER, Chandigarh, India,Correspondence to: Jagat Ram, Advanced Eye Center, Post Graduate Institute of Medical Education, & Research, Chandigarh-160012, India E-mail:
| | - G S Brar
- Advanced Eye Center, PGIMER, Chandigarh, India
| | - M R Dogra
- Advanced Eye Center, PGIMER, Chandigarh, India
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