Accuracy of intraoperative aberrometry versus modern preoperative methods in post-myopic laser vision correction eyes undergoing cataract surgery with capsular tension ring placement

PURPOSE

To assess the accuracy of intraoperative wavefront aberrometry (IWA) versus modern intraocular lens formulas in post-myopic laser vision correction (LVC) patients undergoing cataract surgery with capsular tension ring placement.

METHODS

This is a retrospective chart review conducted at an academic outpatient center. All post-myopic LVC eyes undergoing cataract surgery with IWA from a single surgeon from 05/2017 to 12/2019 were included. All patients received a capsular tension ring (CTR). Mean numerical error (MNE), median numerical error (MedNE), and percentages of prediction error within 0.50D, 0.75D, and 1.00D were calculated for the above formulas.

RESULTS

Twenty-seven post-myopic LVC eyes from 18 patients were included. In post-myopic LVC, MNE with Optiwave Refractive Analysis (ORA), Barrett True K (BTK), Haigis, Haigis-L, Shammas, SRK/T, Hill-RBF v3.0, and W-K AL-adjusted Holladay 1 were + 0.224, - 0.094, + 0.193, - 0.231, - 0.372, + 1.013, + 0.860, and + 0.630 (F = 8.49, p < 0.001). MedNE were + 0.125, - 0.145, + 0.175, + 0.333, + 0.333, + 1.100, + 0.880, and + 0.765 (F = 7.89, p < 0.001), respectively. BTK provided improved accuracy in both MNE (p < 0.001) and MedNE (p = .033) when compared to ORA in pairwise analysis. If the ORA vs. BTK-suggested IOL power were routinely selected, 30% and 15% of eyes would have projected hyperopic outcomes, respectively (p = 0.09).

CONCLUSIONS

Our study suggests that in post-myopic LVC eyes undergoing cataract surgery with CTRs, BTK performed more accurately than ORA with regard to accuracy and yielded a lower percentage of eyes with hyperopic outcomes. Haigis, Haigis-L, and Shammas yielded similar results to ORA with regard to accuracy and percentage of eyes with hyperopic outcomes. On average, Shammas and Haigis-L suggested IOLs that would yield outcomes more myopic than expected when compared to BTK.

Effect of capsular tension ring on the refractive outcomes of patients with extreme high axial myopia after phacoemulsification

PURPOSE

The aim of the study is to evaluate the effect of capsular tension ring (CTR) implantation following cataract surgery on the refractive outcomes of patients with extreme high axial myopia.

METHODS

Sixty eyes (with an axial length of ≥26 mm) were retrospectively reviewed and classified into two groups: CTR group (n = 30), which underwent CTR implantation following phacoemulsification, and control group (n = 30), which did not undergo CTR implantation. Intraocular lens (IOL) calculation was performed using Barrett Universal II (UII), Haigis, and SRK/T formulas. The refractive prediction error (PE) was calculated by subtracting the postoperative refraction from predicted refraction. The mean PE (MPE), mean absolute error (MAE), and percentages of eyes that had a PE of ±0.25, ±0.50, ±1.00, or ±2.00 diopters (D) were calculated and compared.

RESULTS

No significant differences were observed in PE between the two groups. The Barrett UII formula revealed a lower AE in the CTR group than in the control group (p = 0.015) and a lower AE than the other two formulas (p = 0.0000) in both groups. The Barrett UII formula achieved the highest percentage of eyes with a PE of ±0.25 D (66.67%).

CONCLUSIONS

The refractive outcomes were more accurate in eyes with CTR implantation than in those with routine phacoemulsification based on the Barrett UII formula. The Barrett UII formula was recommended as the appropriate formula when planning CTR implantation in high myopia.

"NIR-triggered ROS storage" photodynamic intraocular implant for high-efficient and safe posterior capsular opacification prevention

Posterior capsular opacification (PCO) is the leading cause of vision loss after cataract, mainly caused by the adhesion, proliferation and trans-differentiation of post-operative residual lens epithelial cells (LECs). Effective PCO prevention remains a huge challenge to ophthalmologists and researches for decades. Herein, we developed a "NIR-triggered ROS storage" intraocular implant (CTR-Py-PpIX) based on capsular tension ring (CTR), which is concurrently linked with photosensitizer protophorphyrin IX (PpIX) and energy storage 2-pyridone derivative (Py), to guarantee instantaneous and sustainable ROS generation for LECs killing, aiming to achieve more efficient and safer photodynamic therapy (PDT) to effectively prevent PCO. The silylated PpIX-Si and Py-Si were covalently conjugated to the plasma activated CTR surface to obtain CTR-Py-PpIX. Results demonstrated that CTR-Py-PpIX had dual functions of PDT and battery, in which PpIX could generate ROS extracellularly under irradiation, with one part directly inhibiting LECs by lipid peroxidation (LPO) induction of cell membranes. Meanwhile, the excess ROS stored in Py could be continuously released to amplify LPO levels after the irradiation was removed. Ultimately, the proliferation of LECs in capsular bag was completely inhibited under mild irradiation conditions, achieving a sustainable and controlled PDT effect for effective PCO prevention with good biocompatibility. This NIR-triggered ROS storage intraocular implant would provide a more efficient and safer approach for long-term PCO prevention.

Propensity-matched comparison of postoperative stability and visual outcomes of toric intraocular lens with or without a capsular tension ring and updated meta-analysis

PURPOSE

To assess the contribution of capsular tension ring (CTR) to postoperative stability and visual outcomes of a plate-haptic toric intraocular lens (IOL).

METHODS

This prospective cohort study was performed among patients underwent toric IOL (AT TORBI 709 M) implantation with or without CTR at the Eye and ENT hospital between April 2020 and November 2021. Propensity score matching (PSM) was performed to balance baseline factors. Postoperatively, uncorrected distance visual acuity (UCVA) and residual astigmatism, as well as IOLs' rotation, tilt, and decentration, were analyzed. Grouped multiple linear regression analysis was used to model predictive factors of rotation in each group. Additionally, a meta-analysis of data from 4 publications (284 eyes) and current study was performed to evaluate the effect of CTR co-implantation on toric IOL rotation.

RESULTS

After PSM, 126 eyes from each group were included for further analysis. Postoperatively, UDVA was 0.31 ± 0.38 logMAR and 0.27 ± 0.36 logMAR in the CTR and NCTR groups, respectively (P = 0.441), and residual astigmatism was 0.75 ± 0.52 D and 0.86 ± 0.65 D, respectively (P = 0.139). The rotation of toric IOL was significantly smaller in the CTR group than in the NCTR group (4.63 ± 6.27 vs. 10.93 ± 16.05 degrees, P < 0.001). The regression models of the two groups and the coefficients of LT were significantly different (P < 0.001 and P = 0.001, respectively). Furthermore, the meta-analysis confirmed that CTR co-implantation reduced toric IOL rotation (MD, - 1.59; 95% CI, - 3.10 to - 0.09; P = 0.038).

CONCLUSION

CTR enhances rotational stability of toric IOL by reducing the impact of LT, and CTR co-implantation is recommended in patients with lens thickness (LT) ≥ 4.5 mm, white-to-white (WTW) ≥ 11.6 mm, or high preexisting astigmatism.

Early lens aspiration with posterior chamber intraocular lens and capsular tension ring in microspherophakia to avoid lens-induced complications

PURPOSE

To report the surgical outcome of early lens aspiration, posterior chamber intraocular lens (PC IOL), and capsular tension ring (CTR) in a case series of microspherophakia (MSP) and secondary glaucoma.

METHODS

Case series of 18 eyes of MSP cases presented with lenticular myopia and secondary glaucoma that underwent early lens aspiration, PC IOL and CTR by one ophthalmologist. Baseline, long-term postoperative outcomes and complications were documented.

RESULTS

All cases underwent successful surgery with lens aspiration PC IOL implantation and CTR insertion without intraoperative complications. One of the 18 cases was a delayed referral which had broad anterior synechiae and following lens aspiration developed corneal decompensation. In one eye, CTR implantation was not possible hence, lens aspiration with scleral fixation (SF) of 3 piece IOL was performed (excluded from the analysis). Overall there was an improvement in visual acuity (from 0.3 ± 0.1 to 0.2 ± 0.2 LogMar, P = 0.006), intraocular pressure (IOP), and most notably, deepening of the anterior chamber. Some cases required subsequent glaucoma surgery to control IOP. After a long duration of follow-up, all cases had stable capsular lens complex and no capsular phimosis.

CONCLUSION

Early Lens aspiration with CTR and PCIOL alone in MSP with lens subluxation has a significant impact on the patient's quality of vision, deepening the anterior chamber and preventing complications or poor outcomes. In addition, good capsular-lens complex stability and absence of capsular phimosis or phacodonesis on long-term follow-up were obtained.

Combined phacovitrectomy with capsular tension ring and gas tamponade for chronic cyclodialysis cleft unresponsive to conventional closure

Traumatic cyclodialysis clefts, a rare diagnosis after blunt injury to the eye, are typically amenable to closure with either medical therapy or direct surgical cyclopexy. However, when cyclodialysis clefts cannot be closed through these methods, unorthodox techniques may be required. We describe a method to close a traumatic cyclodialysis cleft involving simultaneous vitrectomy, capsular tension ring placement, and insertion of an intraocular lens.

Effect of capsular tension ring implantation during phacoemulsification on postoperative refraction

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Effect of capsule tension ring on short-term refractive stabilization and visual performance in trifocal intraocular lens implantation

PURPOSE

To provide refractive stability and increase visual performance with the use of a capsular tension ring in trifocal intraocular lens implantation.

METHODS

This prospective randomized study was conducted in the Yeniyüzyıl university ophthalmology department between February 2018 and September 2019. Eighty-six eyes of 43 patients with visual loss due to uncomplicated cataract in both eyes were randomly divided into two groups, A and B. The eyes in both groups underwent refractive lens exchange with implantation of the same design of trifocal IOL (plate haptic design). In group B, a capsular tension ring was inserted into the capsular bag before trifocal IOL implantation. Both groups were examined at 1day, 1week, 1month, and 3months postoperatively. At 3months after surgery, visual acuity, refractive errors and refractive prediction errors were analyzed and compared between groups A and B.

RESULTS

The postoperative values in group A were spherical equivalent (mean±SD), 0.07±0.79 diopters (D); refractive sphere (mean±SD), 0.43±0.84 diopters (D); uncorrected distance acuity, 0.20±0.04 (logMAR); best-corrected distance acuity, 0±0.02 (logMAR). Group B values were 0.14±0.5 diopters (D), 0.61±0.45 diopters (D), 0.25±0.20 (logMAR), 0.01±0.04 (logMAR), respectively. There was no significant difference between the two groups with respect to the postoperative evaluation.

CONCLUSION

The use of CTR in the implantation of the trifocal intraocular lens had no statistically significant impact on refractive stability.

Effect of capsular tension ring on optical and multifunctional lens position outcomes: a systematic review and a meta-analysis

AIM

To evaluate the effect of capsular tension rings with multifunctional lens position and optical outcomes.

METHODS

We defined multifunctional lens as more than improving vision, but also to restore visual quality. PubMed, EMBASE, Cochrane Library and Scopus were searched for English-language articles published up to November 11, 2020. Randomized controlled trials and comparative prospective clinical trials were selected. Data extraction was completed by independent pairs of reviewers. The risk of bias was evaluated using the Cochrane Collaboration's risk-of-bias tool for RCTs and select items from the Newcastle-Ottawa Scale for comparative prospective clinical trials.

RESULTS

A total of 5 randomized controlled trials and 6 prospective comparative clinical trials were included. One thousand nine hundred and ninety-nine eyes of implantation intraocular lens were evaluated. Capsular tension ring was helpful in un-corrected distance visual acuity (SMD: 0.54, 95% CI = 0.15 to 0.94, p = 0.829) in 1st month. Contrary to 1st month, no show positive effect in 3rd month un-corrected distance visual acuity (SMD: - 0.30, 95% CI = - 0.70 to - 0.10, p = 0.311), corrected distance visual acuity (SMD: 0.02, 95% CI = - 0.78 to 0.81, p < 0.001), sphere (SMD: 0.44, 95% CI = - 0.43 to 1.31, p < 0.001), cylinder (SMD: - 0.12, 95% CI = - 0.36 to 0.13, p = 0.262), and spherical equivalent (SMD: 0.41, 95% CI = 0.13 to 0.69, p = 0.084). Our study also revealed low correlation between capsular tension ring and postoperative optical outcome with un-corrected distance visual acuity (SMD: 0.43, 95% CI = - 0.69 to 1.56, p = 0.001), corrected distance visual acuity (SMD: - 0.11, 95%CI = - 0.43 to 0.20, p = 0.56), sphere (SMD: - 0.26, 95%CI = - 1.18 to 0.66, p = 0.005), cylinder (SMD: 0.10, 95% CI = - 0.39 to 0.59, p = 0.075), spherical equivalent (SMD: 0.22, 95%CI = - 0.10 to 0.54, p = 0.849) in 6th month. The position of intraocular lens co-implantation with capsular tension ring has no significant difference in 1st week with lens decentration (SMD: - 0.34, 95% CI = - 1.19 to 0.51, p = 0.038) and tilt (SMD: - 1.00, 95% CI = - 2.19 to 0.19, p = 0.007), but capsular tension ring is helpful to prevent lens tilt in 1st month (SMD: - 0.67, 95%CI = - 1.08 to 0.27, p = 0.323). In 3rd month, there was no significant difference between two groups in lens rotation (SMD: - 0.51, 95%CI = - 1.71 to 0.69, p < 0.001).

CONCLUSION

The correlation is low between capsular tension ring and postoperative optical outcomes and lens position, based on small numbers of studies in a short range of follow-up.

Capsular tension ring assisted phacoemulsification of morgagnian cataract

Purpose:

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

Methods:

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

Results:

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

Conclusion:

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

Can toric IOL rotation be minimized? Toric IOL-Capsular Tension Ring suturing technique and its clinical outcomes

Purpose: In this study, we aimed to evaluate the outcomes of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in patients with cataract and astigmatism. Methods: Group 1 comprised 37 eyes of 36 patients to whom the CTR-toric IOL complex was co-implanted after the CTR was sutured to the toric IOL haptic. Group 2 comprised 35 eyes of 33 patients in whom the toric IOL and CTR were implanted without suturing. Both groups were compared in terms of preoperative and postoperative astigmatism, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and IOL rotation. Results: The mean rotation degree was 0.54° ± 2.29° in group 1 and 4.28° ± 8.84° in group 2 (p = .01). While there was no significant difference between the postoperative residual astigmatism and the estimated residual astigmatism in group 1, the postoperative residual astigmatism was statistically higher than the estimated residual astigmatism in group 2 (p = .47 and 0.000, respectively). The mean postoperative UCVA was 0.02 ± 0.04 (logMAR) in group 1 and 0.08 ± 0.13 (logMAR) in group 2 (p = .01). Conclusion: The toric IOL and CTR suturing technique provides excellent rotational stability and astigmatism correction.

Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules

BACKGROUND

The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia.

METHODS

A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia.

RESULTS

Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed.

CONCLUSION

CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background

To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.

Methods

A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis. Outcome measures included intraocular pressure, best-corrected visual acuity, and postoperative complications.

Results

Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years. The cyclodialysis cleft extended over 2.9 clock hours (range 0.5–6.5). The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes. At the last follow-up, the cyclodialysis cleft was closed in 16/20 (80.0%) eyes. The intraocular lens was stable in all patients postoperatively. Best-corrected visual acuity, in terms of the logarithm of the minimal angle of resolution, improved from 1.3 ± 0.8 before surgery to 0.4 ± 0.3 after surgery (P < 0.001). Intraocular pressure increased significantly from 10.6 ± 3.2 mmHg before surgery to 13.0 ± 4.8 mmHg after surgery (P = 0.040). Postoperative complications included a painful reversible intraocular pressure spike in four patients (20.0%). Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of ≥ 10 mmHg.

Conclusions

The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe, successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

Comparison of phacoemulsification parameters in eyes with and without exfoliation syndrome

OBJECTIVE

To evaluate and to compare the phacoemulsification machine parameters in eyes with and without XFS, requiring cataract surgery.

METHODS

Patients who underwent phacoemulsification and in-the-bag IOL implantation for cataract were included in this retrospective study. All surgeries were performed by the same experienced surgeon using the stop & chop technique with the same phacoemulsification device (Infiniti Vision System, Alcon Laboratories, Inc., USA). Patients were divided into two groups according to the presence of exfoliation material (XFM). Each group consisted of consecutive patients. Their characteristics and intraoperative phacoemulsification parameters were compared.

RESULTS

Sixty-eight eyes of 68 patients [29 in the exfoliation syndrome (XFS) (-) group, 39 in XFS (+)] were enrolled. There were no statistical differences regarding preoperative patient characteristics. There was a statistically significant difference in total U/S time, phaco time, aspiration time and estimated fluid used between the XFS (+) and XFS (-) groups (P=0.021, P=0.017, P=0.009 and P=0.002, respectively). Considering that the use of a CTR (capsule tension ring) might be an important factor potentially affecting surgical parameters, the data were analyzed accordingly. Aspiration time and estimated fluid used remained statistically significant (P=0.046 and P=0.017, respectively); however, although the U/S total and phaco time were found to be longer in XFS (+) group compared to XFS (-) group, the difference did not show statistical significance (P=0.061 and P=0.059, respectively). There were no differences between groups regarding endothelial cell loss or any other postoperative complications.

CONCLUSIONS

The presence of XFS results in longer total U/S time, phaco and aspiration time and more estimated fluid used in phacoemulsification, but this prolongation does not result in additional complications.

Decentration of a toric intraocular lens implant in a patient with simple megalocornea

Purpose

To describe a patient who developed radial displacement of the capsular bag and toric intraocular lens implant within approximately 5 weeks after surgery.

Observations

A patient underwent uncomplicated cataract extraction and implantation of a toric IOL for 2.5 diopters (D) of preoperative corneal astigmatism. Uncorrected visual acuity (UCVA) on postoperative day 1 was 20/20. Blurriness developed 5 weeks after surgery when UCVA was 20/70 but corrected to 20/20 with 2 D of cylinder in a new axis. The IOL was in the proper axis, but it and the capsular bag were radially displaced. Dilated examination revealed posterior capsular opacification superotemporally, outside the visual axis. The patient's biometry revealed axial myopia and megalocornea (white-to-white measurement of 13.44 mm), suggesting a larger than average capsular bag. Surgery was performed at postoperative week 6 to expand the capsular bag using a capsular tension ring and to re-center the IOL keeping the same axis. The patient recovered UCVA of 20/25 after the IOL was recentered.

Conclusions and Importance

It is important to review biometry for large white-to-white measurements. Eyes with megalocornea may require capsular tension rings at time of toric IOL implantation so as to maintain IOL centration and good UCVA.

Combination of capsular tension ring and capsular tension segment for the management of lens coloboma >4 clock hours

Lens colobomas extending more than 4 clock hours and causing visual impairment require lens extraction along with capsular support devices with scleral fixation for adequate centration of the capsular bag and for prevention of capsular fornix aspiration with inadvertent extension of zonular dialysis intraoperatively. In this case series, we describe a technique for the management of isolated lens colobomas involving 4–5 clock hours by clear lens extraction and intraocular lens implantation using a combination of a capsular tension ring with a capsular tension segment (CTS) for the centration and stability of the capsular bag. Hoffman's corneoscleral pocket and half-bow sliding knot technique were used for scleral fixation of the CTS.

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

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

Rotation of a toric intraocular lens with and without capsular tension ring: data from a multicenter non-inferiority randomized clinical trial (RCT)

BACKGROUND

Evaluation of clinical outcome in cohorts with versus without simultaneous implantation of a capsular tension ring (CTR) and a toric lens (Tecnis Toric). Main parameter was rotation referring - in contrast to misalignment - to the IOL axis change from immediately after implantation to the final postoperative position.

METHODS

Lens position was measured at baseline with the patient still in recumbent position, postoperative rotation was calculated by software. Postoperative evaluation included measurement three months after surgery or prior to an indicated revision surgery. Explorative re-evaluation of the underlying RCT's intent-to-treat population was performed for the entire sample and stratified for cohorts by 95% confidence intervals for binary endpoints' incidences (primary endpoint: absolute postoperative rotation ≤5 degrees; secondary endpoints: absolute deviation between achieved cylinder and target cylinder ≤0.5 dpt, postoperative corrected distance visual acuity (CDVA) ≥ 0.8). Data exploration was based on medians and quartiles.

SETTING

Outpatient study sites.

DESIGN

Re-evaluation based on data from a multicenter non-inferiority randomized clinical trial (RCT).

RESULTS

Sub cohorts (without CTR 89, with CTR 90 patients) did not present clinically relevant differences in preoperative characteristics: revision surgery was performed in 7 cases (3 without and 4 with CTR). Primary endpoint incidences for the total sample, without and with CTR were 90%/89%/90%; cylinder endpoint incidences were 46%/45%/46% and CDVA endpoint incidences 90%/92%/88%. Median absolute rotations were 1.74°/1.79°/1.72°, median absolute cylinder deviations 0.55/0.52/0.55 dpt and median visual acuity 1.0/1.0/1.0.

CONCLUSION

No clinically relevant differences between CTR subgroups were found; a satisfying three months rotational stability was achieved.

TRIAL REGISTRATION

The trial was registered retrospectively in the trial registry DRKS, trial registration number DRKS00015316 , date of registration 27. August 2018.

One-step management of post-traumatic triple dialysis using two rings

PURPOSE

To report a case that presented with post blunt trauma cataract, zonular dialysis, cyclodialysis and iridodialysis and its successful single-sitting management.

METHODS

After lens aspiration, a capsular tension ring and multipiece intraocular lens were placed in the bag to support the zonules, a single eyelet Cionni ring was fixed in the sulcus to provide endocyclotamponade, and iridodialysis repair was done using the 'stroke and dock technique'.

RESULT

Successful centration of the intraocular lens, closure of the cleft and apposition of the iris root to its base were achieved at the end of the surgery.

CONCLUSION

A single-sitting surgery correcting all the three dialysis can curtail the burden of repeated surgeries and their complications, providing early visual recovery and cost-effectivity.

Congenital aniridia with cataract: case series

Background

This study evaluates patients with congenital aniridia and cataract who underwent phacoemulsification, capsular tension ring placement, and foldable intraocular lens implantation.

Methods

In this prospective case series, 10 patients (17 eyes) underwent cataract surgery via a 3.2 mm clear corneal incision. A continuous circular capsulorhexis with <6 mm diameter was employed. A capsular tension ring and HOYA yellow foldable posterior chamber intraocular lens was implanted. All patients wore color contact lenses postoperatively. Paired t test was used to compare visual acuity, intraocular pressure, and corneal endothelial changes before and after surgery.

Results

A single surgeon performed all surgeries. The best-corrected visual acuity improved from value 1.03 ± 0.27LogMAR preoperatively to value 0.78 ± 0.26LogMAR postoperatively (p = 0.000). The photophobic symptoms improved significantly after surgery. The mean corneal endothelial cell density before and after surgery was 3280 ± 473 cells/mm2 and 2669 ± 850 cells/mm2, respectively (p = 0.006). None of the patients developed corneal endothelial decompensation or secondary glaucoma after surgery.

Conclusions

Treatment of congenital aniridia and coexistent cataract by phacoemulsification, posterior chamber foldable lens implantation, capsular tension ring placement was safe and effective. Use of colored contact lenses in the postoperative period can reduce photophobic symptoms in this group of patients.

Trial registration

ChiCTR-OOC-17011638 (retrospectively registered at 12,June,2017)

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

PURPOSE

The objective was to evaluate the effect of co-implantation of a preloaded capsular tension ring (CTR) and aberration-free monofocal intraocular lens (IOL) on clinical outcomes and visual quality after cataract surgery.

MATERIALS AND METHODS

Patients who underwent cataract surgery were randomized into two groups that were implanted with a CTR and IOL (group 1, 26 eyes) or an IOL only (group 2, 26 eyes). At 1 and 3 months after surgery, visual acuity, refractive errors, refractive prediction errors, ocular aberrations, and modulation transfer function (MTF) were analyzed. At 3 months postoperatively, anterior chamber depth (ACD) and contrast sensitivity were evaluated.

RESULTS

Group 1 showed greater hyperopic shift, which caused the refractive prediction error at 3 months after surgery to be significantly different between the two groups (p=0.049). Differences in ACD between the preoperative and postoperative periods tended to be greater in group 1 than in group 2. At 3 months postoperatively, internal MTF values at 20, 25, and 30 cycles per degree were significantly better in group 1 than in group 2 (p=0.034, 0.017, and 0.017, respectively). Contrast sensitivity showed comparable results at almost all spatial frequencies between the groups.

CONCLUSION

Regarding visual acuity and quality, both groups showed comparable results. Co-implantation of a CTR and aberration-free monofocal IOL was associated with hyperopic refractive outcomes. Surgeons should consider the position of the IOL when planning co-implantation of a CTR and IOL.

Crystalline coloboma

CASE REPORT

We present a seventy-three year-old female diagnosed with lens coloboma when she was going to be operated on for cataracts.

DISCUSSION

The incidence of congenital coloboma of the eye is estimated to be 0.5 per 10000 newborns in Spain, 1.4 in France, 2.6 in United States, and 7.5 in China. The diagnosis is clinical by observing the defect. The visual prognosis depends on the extent and severity of the coloboma. The treatment of the cataract was by phacoemulsification with an intraocular lens using a capsular tension ring.

Intraocular lens subluxation in marfan syndrome

PURPOSE

Ectopia lentis (EL) is a major criteria for the diagnosis of Marfan syndrome, it may vary from an asymptomatic mild displacement to a significant subluxation that places the equator of the lens in the pupillary axis. The purpose of this work is to present the case of a patient with Marfan syndrome who received treatment for subluxation at our institution.

CASE REPORT

A 51-year-old female diagnosed with Marfan syndrome presented to the emergency department with bilateral eye redness, foreign body sensation and crusting around the eyes on awakening. She had the following history of cardiac and ophthalmologic complications, including: 1. Lens subluxation 2. High myopia 3. Aortic root dilation, 4. Mitral valve prolapse and 5. Tricuspid insufficiency.

CONCLUSION

The ophthalmological management of Marfan patients is challenging and periodical follow-up is needed. Surgical versus conservative management is controversial, each case needs to be evaluated individually to analyze the risks and benefits of the procedures.

Surgical management and scheimpflug analysis of an atypical lens coloboma

A lens coloboma is not a true coloboma; it is just a zonular absence that causes a defect in the lens equator and hence a more spherical lens. It can be isolated or in association with iris, choroid or retinal colobomas. Typically the defect is present at the site of the embryonic fissure, but it can be present elsewhere. This congenital defect can cause amblyopia, especially when it is associated with cataract. We describe a case of a 39-year-old male with an atypical coloboma that was managed successfully with phacoemulsification, capsular tension ring and intraocular lens implantation. Scheimpflug image analysis and full ophthalmological assessment were performed. Scheimpflug images demonstrated a notching of the lens equator and an absence of zonulae. During the surgical procedure an ophthalmic viscosurgical device was used to tamponade the vitreous, and after continuous curvilinear capsulorhexis the capsular tension ring was inserted to allow the surgeon to perform a safe phacoemulsification.

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

BACKGROUND

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

METHOD

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

RESULT

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

CONCLUSION

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

An unexpected delayed complication of cataract surgery: retinal detachment secondary to capsular tension ring dislocation

We aim to present a case of retinal detachment secondary to capsular tension ring dislocation following cataract surgery. A 45-year-old man who underwent cataract surgery 2 years previously presented with decreased vision in his left eye. The patient's posterior capsule was intact with a well-located posterior chamber intraocular lens. Fundus examination revealed retinal detachment with retinal tears, and a capsular tension ring located around the tear was noticed during pars plana vitrectomy; it was removed through the sclerotomy site. In conclusion, dislocation of the capsular tension ring is a rare and unexpected complication of cataract surgery. Although the integrity of the posterior lens capsule is partially preserved, the ring may shift through a small tear in the bag even during its placement, and may cause retinal tears, retinal detachment or just remain silently suspended in the vitreous.