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Xu S, Zhang Y, Li X, Si W, Tian G, Yang Y, Hu Y, Zhang F. Effect of Implanted Capsular Tension Ring on Postoperative Refractive Shift: A Systematic Review and Meta-Analysis. Semin Ophthalmol 2024:1-7. [PMID: 39039754 DOI: 10.1080/08820538.2024.2381770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND The capsular tension ring is a novel assistant tool for cataract surgery; however, controversy exists in its co-implantation. The potential for hyperopic or myopic shift resulting from the co-implantation of the capsular tension ring and intraocular lens remains unclear. This study aimed to determine the postoperative refractive prediction error and the direction of refractive shift in cataract patients who underwent capsular tension ring co-implantation. METHODS We conducted a systematic review and meta-analysis,searching electronic databases for studies of individuals diagnosed with cataracts receiving surgery with or without capsular tension ring implantation. Systematic searches were performed based on five databases: PubMed, Cochrane Library, Web of Science, Medline, and China National Knowledge Infrastructure. The primary outcome was the mean arithmetic refractive prediction error. Secondary outcomes were mean absolute refractive prediction error and the number of eyes within a certain refractive prediction error range. We applied a fixed-effectsmodel to pool effect sizes across trials using weighted mean differences (WMD) and risk ratios (RR) with their 95% confidence intervals (95% CI). Statistical heterogeneity scores were assessed with the I2statistic. RESULTS A total of 407 affected eyes were included in eight independent clinical studies. Meta-analysis suggested significant differences both in short-term (≤1 month) co-implantation (WMD = 0.16, p < .001, 95% CI: -0.13 ~ 0.19) and long-term (≥3 months) co-implantation between the capsular tension ring co-implantation group and the control group (WMD = 0.19, p < .001, 95% CI: 0.15 ~ 0.23). However, no significant difference was observed in the high myopia subgroup whether capsular tension ring co-implantation (WMD = 0.03, p = .083, 95% CI: -0.27 ~ 0.34). Heterogeneity was not found among the studies. CONCLUSION Compared to simple intraocular lens implantation, capsular tension ring co-implantation is more susceptible to developing hyperopic shifts in non-myopic cataract patients, probably related to anterior chamber depth. It requires careful consideration by clinicians when determining the target diopter preoperatively. However, interpretation is limited, because there is a lack of studies available for analysis. There still needs to be additional studies to expand the evidence base.
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Affiliation(s)
- Su Xu
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yuhang Zhang
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xintong Li
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Wei Si
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Gengqi Tian
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yifan Yang
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yizhuo Hu
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Fengyan Zhang
- The Division of Ophthalmology and Vision Science, Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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Sandhu R, Shankar V, Vasavada V, Vasavada S, Vasavada AR, Vasavada VA. Long-Term Postoperative Outcomes Following Cionni Ring and In-the-Bag Intraocular Lens Implantation in Eyes With Subluxated Lenses. Am J Ophthalmol 2024; 268:136-142. [PMID: 39009238 DOI: 10.1016/j.ajo.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Evaluate long-term outcomes following Cionni modified capsule tension ring (MCTR) and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. DESIGN Retrospective case series. METHODS Forty-one eyes of 31 patients from Raghudeep Eye Hospital, India, with subluxated lenses who had completed a minimum of 5 years' postoperative follow-up were included. Lens extraction, capsular bag fixation with MCTR using 9-0 polypropylene suture, and in-the-bag IOL implantation were performed in all eyes. Corrected distance visual acuity (CDVA), IOL centration, posterior capsule opacification, glaucoma, and retinal complications were documented at final follow-up. RESULTS The mean age of the cohort was 20.48 ± 16.46 (SD) years. Twenty-four eyes (58%) were below 15 years of age at the time of surgery. Marfan syndrome accounted for 37% cases. Mean follow-up was 9.89 ± 3.81 (SD) years. Thirty-two eyes (74%) had a CDVA of ≥0.3 logMAR at final follow-up. IOL decentration was noted in 7 eyes (17%), requiring a secondary surgery. The mean duration from primary surgery to resurgery was 8.79 years. Seventeen eyes (41%) required a laser capsulotomy, 88% of which were pediatric eyes. Retinal detachment occurred in 4 eyes (10%), 3 of which had Marfan syndrome. CONCLUSION Capsular bag fixation with an MCTR using 9-0 polypropylene and in-the-bag IOL implantation had good long-term visual outcomes with an acceptable rate of serious postoperative complications in eyes with subluxated lenses. This approach allows preservation of the natural compartments of the eye and placement of an IOL in its most physiological position. However, considering a 17% rate of IOL decentration requiring surgical intervention, long-term stability with nonbiodegradable suture materials such as polytetrafluoroethylene as well as decentration rates following sutured or sutureless scleral fixation should be compared.
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Affiliation(s)
- Rasikpriya Sandhu
- From the Raghudeep Eye Hospital, Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat. India
| | - Vijayvarschini Shankar
- From the Raghudeep Eye Hospital, Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat. India
| | - Vaishali Vasavada
- From the Raghudeep Eye Hospital, Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat. India
| | - Shail Vasavada
- From the Raghudeep Eye Hospital, Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat. India
| | - Abhay R Vasavada
- From the Raghudeep Eye Hospital, Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat. India
| | - Viraj A Vasavada
- From the Raghudeep Eye Hospital, Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat. India..
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Venkataraman P, Haripriya A, Mohan N, Rajendran A. A systematic approach to the management of microspherophakia. Indian J Ophthalmol 2022; 70:2262-2271. [PMID: 35791105 PMCID: PMC9426104 DOI: 10.4103/ijo.ijo_2888_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.
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Affiliation(s)
| | | | - Neethu Mohan
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Venkateswaran N, Henderson BA. Loose zonules in cataract surgery. Curr Opin Ophthalmol 2022; 33:53-57. [PMID: 34783703 DOI: 10.1097/icu.0000000000000826] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review will focus on identifying causes of zonulopathy during cataract surgery and discuss various modalities for treatment. RECENT FINDINGS There are multiple different options for capsular bag support in the setting of zonulopathy, including capsular or iris hooks, capsular tension rings as well as capsular tension segments (CTS). Surgical techniques on how to insert these devices are many and can be customized based upon the surgeon's preference and the patient's eye anatomy. SUMMARY Recognizing zonular weakness is critical to achieve stable postoperative vision and avoid future complications. Depending on the degree of zonulopathy, various treatment options can be pursued, ranging from capsular tension hooks or iris hooks, capsular tension rings or sutured or scleral fixated CTS.
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Affiliation(s)
| | - Bonnie A Henderson
- Ophthalmic Consultants of Boston, Tufts University School of Medicine, Boston, Massachusetts, USA
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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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Reply: Loop-on-suture-guided insertion for easier capsular tension ring insertion and residual cortex removal. J Cataract Refract Surg 2021; 47:1381-1382. [PMID: 34544095 DOI: 10.1097/j.jcrs.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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'S' means stop! Critical examination of capsular tension ring movements with Miyake-Apple video analysis. J Cataract Refract Surg 2021; 47:379-384. [PMID: 33149043 DOI: 10.1097/j.jcrs.0000000000000467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine capsular tension ring (CTR) implantation to establish whether there are predictable movements of the CTR during deployment, indicating complicated vs uneventful implantation. SETTING Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. DESIGN Experimental study. METHODS Nine cadaver eyes were prepared using standard Miyake-Apple protocol with digital video recording. A 4 o'clock-hour zonular dialysis was created, followed by a capsulorhexis and hydrodissection. In 4 eyes, a suture-guided CTR (SGCTR) injector and 8-0 nylon suture through the leading eyelet served as a visible tracer for the CTR. In 5 eyes, a standard CTR was used. The movements of the CTR during implantation were observed. RESULTS In all eyes, SGCTR and CTR movements were predictable during implantation. All CTRs displayed cardinal movements within the injector, initially adjacent to the side of the inner diameter of the CTR. As the CTR made contact with lens or capsule, it shifted first to the center and then to the opposite side of the injector lumen. The appearance of an S-curve in the surgeon's view coincided with an obstruction of the leading eyelet and stress on the zonular fibers, as viewed with Miyake-Apple analysis. CONCLUSIONS Traumatic CTR implantation might be avoided by understanding the characteristics of uneventful insertion vs an insertion complicated by entrapment or entanglement of the CTR. By recognizing the abnormal movements of the CTR associated with an obstruction, a surgeon might avoid iatrogenic complications.
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Comment on: 'S' means stop! Critical examination of capsular tension ring movements with Miyake-Apple video analysis. J Cataract Refract Surg 2021; 47:1105-1106. [PMID: 34292906 DOI: 10.1097/j.jcrs.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chee SP, Ti SE, Chan NSW. Management of the subluxated crystalline lens: A review. Clin Exp Ophthalmol 2021; 49:1091-1101. [PMID: 34264007 DOI: 10.1111/ceo.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Cataract surgery for the subluxated crystalline lens is challenging. A thorough preoperative evaluation is important to determine the appropriate surgical approach for lens removal and the subsequent technique of intraocular lens placement. Important considerations include the extent and location of zonular weakness, and whether the zonular deficiency is caused by a static or progressive disease. The capsular bag should be preserved where possible. Creating a good-sized and centred continuous curvilinear capsulorhexis is crucial to facilitate the use of capsular retractors and capsular tension devices, which provide capsular stability. Nucleus sculpting and rotation should be minimised to reduce zonular stress. Being cognisant of the possible intraoperative complications that may occur at each stage of the surgery and knowing how to reduce the risk of these complications occurring will enable surgeons to perform safe cataract surgery in these complex cases.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
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Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
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Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
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Sella S, Rubowitz A, Sheen-Ophir S, Ferencz JR, Assia EI, Ton Y. Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach. Int Ophthalmol 2020; 41:221-229. [PMID: 32915391 DOI: 10.1007/s10792-020-01570-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/17/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). METHODS A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. RESULTS Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5 years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. CONCLUSION Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.
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Affiliation(s)
- Sara Sella
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
| | - Alexander Rubowitz
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Shira Sheen-Ophir
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Joseph R Ferencz
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Ein-Tal Eye Center, Tel Aviv, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
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Loop-on-suture-guided insertion for easier capsular tension ring insertion and residual cortex removal. J Cataract Refract Surg 2020; 46:1561-1563. [PMID: 32541366 DOI: 10.1097/j.jcrs.0000000000000276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The capsular tension ring (CTR) is a useful aid in cataract surgery involving zonular impairment. In standard implantation with tweezers or injectors, there is limited control of the leading eyelet, and this can cause excessive stress on the zonular fibers and lead to damage of the capsular bag. Several techniques have been investigated with the aim of reducing these risks. In this study, a simple new modification of the suture-guided CTR technique is described. Adding a loop to the suture can facilitate manipulation during implantation and removal of cortex residues at the end of cataract extraction.
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13
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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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Abstract
Cataract extraction in exfoliation syndrome requires careful preoperative assessment and planning. Knowledge of the degree of pupil dilation and zonular integrity are essential for safely perform cataract surgery in these eyes. Capsule rhexis should be 5.5 mm and all intraoperative maneuvers should be designed to minimize zonular stress. The surgeon should be versatile in various nuclear disassembly techniques and consider use of capsular support devices when warranted. Cortical cleanup should proceed via a tangential approach and attempts should be made to removal residual lens epithelial cells so as to minimize postoperative capsular contraction syndrome.
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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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Son HS, Shin KU, Kim D, Merz P, Tandogan T, Khoramnia R, Auffarth GU, Friedmann E, Chae S, Lee KH, Choi CY. Lenticular Imaging: A New Experimental and Quantitative Analysis of Capsular Dynamics, "Choi-Apple View". Transl Vis Sci Technol 2019; 8:22. [PMID: 31149393 PMCID: PMC6528741 DOI: 10.1167/tvst.8.3.22] [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: 09/20/2018] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Development of a means for quantitative estimation of lenticular and zonular dynamics by using real-time imaging of human autopsy eyes during implantation of different intraocular lens (IOL) models. Methods Isolated lenticular structures from human autopsy eyes were prepared in vitro. The following IOLs were implanted: a one-piece C-loop haptic IOL, a three-piece C-loop haptic IOL, and a one-piece plate-type IOL. The amount of deformation of lenticular structures during implantation was calculated and the movements visualized with two cameras. The results were transformed to two-dimensional graphs using a newly developed image-processing algorithm. Results For both one-piece plate-type and one-piece C-loop haptic IOLs, the amount of capsular bag deformation from its initial shape was greater in the direction of posterior center of the capsule, as detected by side camera, than in the direction of the equator (or periphery), as detected by front camera. The mean peak deformation values were 51% and 36% (as measured by side and front cameras, respectively) for one-piece plate-type IOL and 25% and 20% for one-piece C-loop haptic IOL. For three-piece C-loop haptic IOL, the capsular bag distention was almost equal in both posterior and peripheral directions, with mean peak deformation values reaching 39% and 38%. Conclusions The new experimental means of lenticular imaging and quantified dynamics from two different angles allowed three-dimensional understanding of specific behavior of each IOL. Our model not only exposes the capsular bag for recording during implantation, but also objectively compares the individual movement values and reveals different zonular and capsular stress patterns, depending on IOL model. Translational Relevance The novel "Choi-Apple View" allows a three-dimensional quantitative analysis of capsular dynamics and IOL implantation behavior.
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Affiliation(s)
- Hyeck Soo Son
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany
| | - Ko Un Shin
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Donghan Kim
- Department of Electrical Engineering, Kyung Hee University, Seoul, Republic of Korea
| | - Patrick Merz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany
| | - Tamer Tandogan
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany
| | - Gerd U Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany
| | | | - Suehey Chae
- Busan Sungmo Eye Hospital, Busan, Republic of Korea
| | | | - Chul Young Choi
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Germany.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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17
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Teshigawara T, Meguro A, Sanjo S, Hata S, Mizuki N. The advantages of femtosecond laser-assisted cataract surgery for zonulopathy. Int Med Case Rep J 2019; 12:109-116. [PMID: 31114398 PMCID: PMC6489659 DOI: 10.2147/imcrj.s189367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/11/2019] [Indexed: 01/19/2023] Open
Abstract
Zonulopathy is a major concern if found during cataract surgery as it can cause further complications. Such complications may occur during continuous curvilinear capsulorhexis (CCC), lens fragmentation and intraocular lens (IOL) implantation. Femtosecond laser-assisted cataract surgery (FLACS) devices, such as the LenSX (Alcon Laboratories) are advantageous because they can detect the area and largest point of zonulopathy via anterior segment optical coherent tomography (AS-OCT) before the manual part of the procedure. CCC and lens fragmentation can also minimize further zonular stress. A symmetrical CCC is ideal for IOL implantation in the sulcus with optic capture. In the present study, we did not detect significant zonular dehiscence preoperatively in either of the eyes of our 68-year-old patient when using AS-OCT (CASIA2 Tomey). However, LenSx AS-OCT revealed zonular dehiscence in both eyes, perioperatively. We created CCC and lens fragmentation without causing stress to the zonules. In the subsequent manual part of procedure, we found zonular dehiscence in the same area as indicated by LenSx AS-OCT, which extended to approximately 200° in the right eye and 180° in the left. After lens fragmentation by LenSx, we successfully removed the lens without further zonular dialysis. However, zonular dialysis (>180°) in the right eye was too large to insert an IOL, either in the capsule or the sulcus. Therefore, we performed scleral IOL implantation. In the left eye, we avoided using capsular tension ring (CTR) for IOL placement to avoid further iatrogenic damage to the zonule. Instead, an IOL was inserted into the sulcus with optic capture to reduce the possibility of further stress to the zonula and phimosis. Post-surgically, the patient regained good eyesight in both eyes. This case illustrates the advantages of FLACS in addressing zonulopathy. The consistent creation of CCC and lens fragmentation by FLACS may increase success rates, even in unexpectedly challenging cases.
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Affiliation(s)
- Takeshi Teshigawara
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka, Kanagawa, Japan.,Department of Ophthalmology, Tsurumi Chuoh Eye Clinic, Yokohama, Kanagawa, Japan.,Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Akira Meguro
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Sanae Sanjo
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka, Kanagawa, Japan
| | - Seiichiro Hata
- Department of Ophthalmology, Yokohama Sky Eye Clinic, Yokohama, Kanagawa, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
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18
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Management of subluxated capsular bag-fixated intraocular lenses using a capsular anchor. J Cataract Refract Surg 2018; 42:653-8. [PMID: 27255239 DOI: 10.1016/j.jcrs.2016.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED We describe the use of the capsular anchor (AssiAnchor) to manage a subluxated intraocular lens (IOL) in the capsular bag. The anchor comprises 2 prongs that hold the anterior lens capsule and a central rod that is sutured to the scleral wall, enabling centration of the IOL-capsular bag complex. Six pseudophakic patients presenting with subluxated posterior chamber IOLs in the capsular bag were operated on using the device. The anchor was used successfully in all cases, although in 2 cases only 1 prong was placed under the capsulorhexis edge. In 1 eye, 2 anchors were used 1 month apart following repeated traumatic zonular injury. The capsular bag holding the IOL remained centered and stable throughout the follow-up period. The anchoring device, which was originally designed to preserve the lens capsule and stabilize subluxated crystalline lenses, can also be used to treat subluxation of a capsular bag-fixated IOL. FINANCIAL DISCLOSURE Dr. Assia is the inventor of the AssiAnchor, has a licensed patent of the anchor, and is consultant to Hanita Lenses. Dr. Lapid-Gortzak is a consultant to and speaker for Alcon Surgical, Inc., Hanita Lenses, Orca Surgical, and Sanoculis Ltd.; a speaker for Santen; and a consultant to Icon. Drs. Ton and Naftali have no financial or proprietary interest in any material or method mentioned.
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19
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Jin GM, Fan M, Cao QZ, Lin JX, Zhang YC, Lin JQ, Wang YY, Young CA, Zheng DY. Trends and characteristics of congenital ectopia lentis in China. Int J Ophthalmol 2018; 11:1545-1549. [PMID: 30225232 DOI: 10.18240/ijo.2018.09.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To elucidate the trends and characteristics of congenital ectopia lentis (CEL) in southern China. METHODS CEL patients from China admitted to Zhongshan Ophthalmic Center (ZOC) from January 2006 to December 2015 were recruited in our study. Residence, gender, hospitalization time, age at surgery, and the presence of other ocular abnormalities and system disease were statistically analyzed in different subgroups. RESULTS Four hundred and thirty-seven hospitalizations (306 in-patients) diagnosed with CEL from a total of 283 308 hospitalizations were identified, which accounted for 0.15% of the total in-patients. Of the identified CEL in-patients, the total ratio of boys to girls was 2.22:1. Based on a subgroup analysis according to age, patients aged 12-18 years old constituted the highest proportion (31.70%) of all hospitalized CEL patients, and those 0-3 year old constituted the lowest proportion (8.82%) of the total number. The number of CEL increased from 18 to 72 and the hospital based prevalence increased from 8.60% to 18.10% from 2006 to 2015, and the average age at surgery decreased from 9 years old in 2006 to 7.6 years old in 2015. CONCLUSION The results reveal upward trends in both the number of CEL hospitalizations and hospital based prevalence of CEL in this 10-year study period, but a reduction in the age at surgery, which may reflect the increase of public awareness of children's eye care in China.
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Affiliation(s)
- Guang-Ming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Min Fan
- The Third Affiliated Hospital of Sun Yat-sen University-Lingnan Hospital General Internal Medicine, Guangzhou 510000, Guangdong Province, China
| | - Qian-Zhong Cao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Jun-Xiong Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yi-Chi Zhang
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Jian-Qiang Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yi-Yao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Charlotte-Aimee Young
- Department of Ophthalmology, University of California, San Francisco, CA 94115, United States
| | - Dan-Ying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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20
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Park HJ, Lee H, Kim DW, Kim EK, Seo KY, Kim TI. Effect of Co-Implantation of a Capsular Tension Ring on Clinical Outcomes after Cataract Surgery with Monofocal Intraocular Lens Implantation. Yonsei Med J 2016; 57:1236-42. [PMID: 27401657 PMCID: PMC4960392 DOI: 10.3349/ymj.2016.57.5.1236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Hyun Ju Park
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Do Wook Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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21
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Koplin RS, Waisbren E, Ritterband DC, Seedor JA. Facilitating cortical aspiration after insertion of a capsular tension ring. J Cataract Refract Surg 2016; 42:810-2. [PMID: 27373385 DOI: 10.1016/j.jcrs.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED We describe a simple, effective technique to prevent the cortical entrapment that can occur after a capsular tension ring (CTR) is implanted during phacoemulsification. Before the epinucleus has been removed, the blunt tip of an ophthalmic viscosurgical device (OVD) cannula is burrowed centrally in the cortical/epinuclear plate and OVD is injected as the cannula is advanced. The cannula is turned superiorly and dissection continued to the lens equator. The cleavage plane is extended for approximately 2 clock hours in the direction of the intended CTR insertion. The CTR is then inserted below the cortical/epinuclear plate. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Richard S Koplin
- From the New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Emily Waisbren
- From the New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.
| | - David C Ritterband
- From the New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - John A Seedor
- From the New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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22
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Trikha S, Agrawal S, Saffari SE, Jayaswal R, Yang YF. Visual outcomes in patients with zonular dialysis following cataract surgery. Eye (Lond) 2016; 30:1331-1335. [PMID: 27285326 DOI: 10.1038/eye.2016.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 04/15/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate the visual outcomes of patients with zonular dialysis following cataract surgery.Patients and methodsMedical records of all patients with documented zonular dialysis, either pre- or peri-operatively, undergoing cataract surgery between 2004-2010 at Queen Alexandra Hospital, Portsmouth, were retrospectively reviewed. Baseline demographics and biometry were analysed, and ocular co-morbidities documented. Intraoperative complications and the use of a capsular tension ring (CTR) were identified. Early and late best-corrected visual acuity (BCVA) post surgery were determined using LogMar values. Univariate and multivariate linear regression analysis was performed to determine associations with BCVA post surgery, and further subgroup analysis performed in groups determined by CTR use.ResultsThe records of 22 312 consecutive eyes undergoing cataract surgery were reviewed. The incidence of zonular dialysis was 0.50% (111 eyes). A CTR was inserted in 46 eyes. Using a multivariate linear regression model, better initial pre-operative BCVA (P=0.019), the use of a CTR (P=0.014), and the absence of vitreous loss during surgery (P=0.008, β 0.45) were associated with improved early postoperative BCVA (mean follow-up 6.6 weeks). Better medium-term postoperative BCVA was significantly associated with preoperative BCVA (P=0.002) and the use of a CTR during surgery (P=0.004, β -0.41).ConclusionsThe overall incidence of zonular dialysis is low. CTR use intra-operatively suggests improved early and medium-term BCVA and should be considered in all cases of zonular dialysis.
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Affiliation(s)
- S Trikha
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - S Agrawal
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK
| | - S-E Saffari
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - R Jayaswal
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK
| | - Y F Yang
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK
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23
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Stabilizing the capsular bag and expanding the pupil with a pupil expansion device. J Cataract Refract Surg 2015; 41:1801-3. [PMID: 26471052 DOI: 10.1016/j.jcrs.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/22/2022]
Abstract
UNLABELLED We describe a surgical technique for management of zonular instability and pupillary miosis using a pupil expansion device (Malyugin ring) in patients who need cataract surgery. In this technique, the pupil expansion device is first used in the usual fashion. After a capsulorhexis has been created, lateral scrolls of the pupil expansion device are released and repositioned to entrap both the anterior capsulorhexis and the pupil margin at the against-the-wound meridian (3 o'clock and 9 o'clock position) to fixate the unstable capsular bag to the iris. Phacoemulsification is performed, and the ring is removed after intraocular lens implantation. With this method, capsular stabilization and pupil expansion are achieved simultaneously with the same instrument. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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24
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Suture-guided capsular tension ring insertion to reduce risk for iatrogenic zonular damage. J Cataract Refract Surg 2015; 41:1564-7. [DOI: 10.1016/j.jcrs.2015.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/15/2015] [Accepted: 03/18/2015] [Indexed: 11/22/2022]
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25
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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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26
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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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27
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Wilkie DA, Stone Hoy S, Gemensky-Metzler A, Colitz CMH. Safety study of capsular tension ring use in canine phacoemulsification and IOL implantation. Vet Ophthalmol 2014; 18:409-15. [DOI: 10.1111/vop.12232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David A. Wilkie
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus OH 43017 USA
| | | | - Anne Gemensky-Metzler
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus OH 43017 USA
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28
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Hoffman RS, Snyder ME, Devgan U, Allen QB, Yeoh R, Braga-Mele R. Management of the subluxated crystalline lens. J Cataract Refract Surg 2013; 39:1904-15. [DOI: 10.1016/j.jcrs.2013.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/14/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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29
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Ma KT, Kim JH, Kim NR, Jang DS, Seong GJ, Kim CY. Scleral Fixation of Standard Capsular Tension Ring and In-the-Bag Intraocular Lens Implantation in Patients With Severe Lens Subluxation. Ophthalmic Surg Lasers Imaging Retina 2012; 43:504-7. [DOI: 10.3928/15428877-20120920-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/08/2012] [Indexed: 11/20/2022]
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30
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Menapace R. [Pseudoexfoliation syndrome and cataract surgery. Avoidance and treatment of complications]. Ophthalmologe 2012; 109:976-89. [PMID: 23053332 DOI: 10.1007/s00347-012-2533-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Eyes with pseudoexfoliation syndrome often exhibit insufficient mydriasis, zonular weakness and pronounced fibrotic capsular shrinkage. This may make cataract surgery as such difficult but also leads to postoperative complications, such as rhexis ovalization or phimosis (capsule contraction syndrome) or progressive zonular weakening with final spontaneous dislocation of the capsule-implant complex (CIC). To avoid or correct for this special techniques and implants may be used: as prophylaxis, intracameral adrenalin and retroiridal capsulorhexis, iris retractors or dilators, various models of capsular tension and bending rings, bimanual capsule ring implantation, capsular bag stabilization with iris retractors or segments and secondary capsulorhexis may be used. Rhexis phimosis may be excised by a special diathermic probe, a subluxated CIC may be sutured to the sclera either in toto or the lens only after removal from the capsule bag, the latter also to the posterior iris surface. When luxated into the vitreous cavity, the CIC may be lifted to the iris plane and refixed as described or exchanged for a new lens sutured into the sulcus or an angle or iris-supported anterior chamber lens.
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Affiliation(s)
- R Menapace
- Universitätsklinik für Augenheilkunde und Optometrie, Allgemeines Krankenhaus - Universitätskliniken Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich.
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31
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Vasavada AR, Praveen MR, Vasavada VA, Yeh RY, Srivastava S, Koul A, Trivedi RH. Cionni ring and in-the-bag intraocular lens implantation for subluxated lenses: a prospective case series. Am J Ophthalmol 2012; 153:1144-53.e1. [PMID: 22317913 DOI: 10.1016/j.ajo.2011.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 11/02/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the intraoperative performance and postoperative outcomes of the Cionni-modified capsule tension ring (CTR) implantation in eyes with subluxated lenses. DESIGN Prospective, observational case series. METHODS This study was carried out at Iladevi Cataract & IOL Research Centre, Ahmedabad, India. The study population comprised 41 eyes with subluxated lenses that underwent lens extraction, capsular bag fixation with modified CTR, and in-the-bag single-piece AcrySof intraocular lens (IOL) implantation. Main outcome measures were intraoperative performance and postoperative best-corrected visual acuity (BCVA), IOL centration, and complications. RESULTS The mean age was 29.46 ± 16.16 years (3-68 years). Mean extent of subluxation was 6.1 ± 1.0 clock hours. Preoperatively, vitreous was detected in the anterior chambers of 5 eyes (12.2%). Two-port anterior chamber vitrectomy was performed in 2 eyes. Mean follow-up was 45.8 ± 2.9 months. Mean preoperative BCVA was 0.66 ± 0.22 logMAR (35 eyes). Mean postoperative BCVA at final follow-up was 0.33 ± 0.21 logMAR (41 eyes) (P < .001). BCVA improved in 35 eyes (85.4%) at the last follow-up. In 3 eyes (7.3%) IOL decentration was noted and repositioning was required in 2 eyes. Posterior capsule opacification developed in 14 eyes (34.2%); 12 eyes (29.3%) required Nd:YAG capsulotomy. Other complications included cystoid macular edema in 1 eye (2.4%), posterior synechiae in 1 eye (2.4%), and retinal detachment in 1 eye (2.4%). CONCLUSION In-the-bag implantation of a Cionni-modified CTR with IOL appears to be a safe option in eyes with subluxated cataract, ensuring a stable IOL with few complications.
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32
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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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Inoue M, Ota I, Taniuchi S, Nagamoto T, Miyake K, Hirakata A. Miyake-Apple view of inner side of sclerotomy during microincision vitrectomy surgery. Acta Ophthalmol 2011; 89:e412-6. [PMID: 21401906 DOI: 10.1111/j.1755-3768.2011.02126.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the inner surface of the sclerotomy during microincision vitrectomy surgery by Miyake-Apple view. METHODS The anterior half of porcine eyes was attached to a transparent acrylic plate with cyanoacrylate glue. Then, either a 23-gauge or a 25-gauge trocar-cannula was inserted through the sclera obliquely. The inner surface of the entrance site was observed posteriorly by Miyake-Apple view. These images were compared with the endoscopic view of two patients who underwent vitreous surgery for an epiretinal membrane. RESULTS When the trocar-cannula was inserted obliquely, the Miyake-Apple view showed that the ciliary epithelium at the sclerotomy site was stretched. When the trocar-cannula was inserted vertically, the ciliary epithelium was folded, and the folds remained even after the trocar was removed. Vitreous strands were seen incarcerated into the sclerotomy site. In human eyes, a folding of the ciliary epithelium was not clearly seen with the endoscopic view but the incarcerated vitreous was seen. CONCLUSION The Miyake-Apple view provided a precise, in vivo, observation of the inner surface of the entry site. It disclosed the morphological stress on the ciliary epithelium by the sclerotomy.
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Affiliation(s)
- Makoto Inoue
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
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Chee SP, Jap A. Management of traumatic severely subluxated cataracts. Am J Ophthalmol 2011; 151:866-871.e1. [PMID: 21310378 DOI: 10.1016/j.ajo.2010.10.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/23/2010] [Accepted: 10/26/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine outcome of cataract surgery in severely subluxated traumatic cataracts. DESIGN Noncomparative case series. METHODS Retrospective review of cataract surgery in all consecutive eyes with at least 6 clock hours of zonulysis, for patient demographics, presenting best-corrected visual acuity (BCVA) and postoperative BCVA at various time points, extent of zonulysis, and type and timing of insertion of capsular tension device. Main outcome measures were retention of the capsular bag and BCVA at last visit. Secondary outcome measures included IOL stability and centration, and perioperative complications. RESULTS There were 41 eyes (41 patients). Mean age at time of surgery was 57 years and the mean duration of follow-up was 21.4 months. The capsular bag was preserved with aid of a Cionni modified capsular tension ring (CTR) in 36 eyes (87.8%) and a combination of a capsular tension segment (CTS) and CTR in 2 eyes. In 3 eyes with total zonulysis, the bag could not be preserved despite the use of a CTS in 2 eyes. Preoperatively only 9 of the 41 eyes (22.0%) had a BCVA of 20/40 or better, as compared to 38 eyes at the last visit (92.7%, P < .001, χ(2) test). Posterior capsule rupture occurred in 3 eyes, 2 of which occurred during fixation of the CTR. CONCLUSIONS The capsular bag can be successfully preserved even in severely subluxated traumatic cataracts with the aid of fixated capsular tension devices.
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Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases. J Cataract Refract Surg 2010; 36:1270-82. [DOI: 10.1016/j.jcrs.2010.01.035] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 01/18/2010] [Accepted: 01/27/2010] [Indexed: 11/22/2022]
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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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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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Kim DB. Cross chop: Modified rotationless horizonal chop technique for weak zonules. J Cataract Refract Surg 2009; 35:1335-7. [PMID: 19631116 DOI: 10.1016/j.jcrs.2009.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 03/20/2009] [Accepted: 03/23/2009] [Indexed: 11/29/2022]
Abstract
Cross chop is a modified horizontal chop technique that enables safe and efficient lens disassembly without torquing the lens within the capsular bag.
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Shingleton BJ, Crandall AS, Ahmed IIK. Pseudoexfoliation and the cataract surgeon: Preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg 2009; 35:1101-20. [DOI: 10.1016/j.jcrs.2009.03.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/17/2009] [Indexed: 01/25/2023]
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Pereira FA, Werner L, Milverton JE, Coroneo MT. Miyake-Apple posterior video analysis/photographic technique. J Cataract Refract Surg 2009; 35:577-87. [DOI: 10.1016/j.jcrs.2008.11.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/17/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
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Sergienko NM, Kondratenko YN, Yakimov AK. Capsule fixation device for cataract surgery. Eur J Ophthalmol 2009; 19:143-6. [PMID: 19123164 DOI: 10.1177/112067210901900123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The authors present a patient with Marfan syndrome who underwent cataract surgery using a novel device for fixation of capsular bag. METHODS The capsule fixation device (CFD) is poly(methyl methacrylate) arch with double-armed bent hook that can be introduced into the anterior chamber through the clear corneal incision, placed with a rest on the capsule equator, and sutured to the sclera without injury of the capsular bag. A 16-year-old patient with Marfan syndrome underwent consecutive phacoemulsification with in-the-bag intraocular lens and CFD implantation on both eyes. RESULTS During the surgery handling the CFD was technically simple with good visualization. The preoperative best-corrected visual acuity was 0.3 and 0.1 and postoperatively 0.6 and 0.8 in the right and left eyes, respectively. The postoperative follow-up was over 9 months. CONCLUSIONS Use of the CFD was successful in a case of lens subluxation with no complications observed during the period of follow-up.
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Affiliation(s)
- N M Sergienko
- Department of Ophthalmology, National Medical Academy of Postgraduate Education, Kiev, Ukraine
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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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Kranemann C. February Consultation #2. J Cataract Refract Surg 2008. [DOI: 10.1016/j.jcrs.2007.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wilkie DA, Gemensky-Metzler AJ, Stone SG, Basham CR, Norris KN. A modified ab externo approach for suture fixation of an intraocular lens implant in the dog. Vet Ophthalmol 2008; 11:43-8. [PMID: 18190352 DOI: 10.1111/j.1463-5224.2007.00600.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goals of canine cataract and lens instability surgery should be to ensure a small incision, minimal tissue trauma, shortened surgical time, maintenance of the anterior chamber, and restoration of emmetropia through the use of a stable intraocular lens specifically designed for the canine eye. While this is usually the case with routine phacoemulsification and in-the-bag intraocular lens implantation, it is often not the case with lens instability, lens luxation or large posterior capsular ruptures. In such cases the incisions are often larger, surgical time and tissue trauma are excessive, and the patient is often left aphakic. The goal of this paper is to present a modified ab externo technique designed to allow removal of the lens and placement of a ciliary sulcus sutured IOL through a small incision, with minimal trauma and shortened surgical time. Use of this technique may allow more canine patients to be emmetropic postoperatively. In addition, the ease of this procedure may encourage earlier removal of an unstable lens and decrease the risk of secondary glaucoma and retinal detachment that occur in association with lens luxation.
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Affiliation(s)
- D A Wilkie
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA.
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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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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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