Optimization of phacoemulsification in complicated cataract with lens subluxation

Close metadata

MATERIAL AND METHODS

The patients were divided into two groups: group 1 — the main group — included 29 patients (29 eyes; 47.54%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using the scaffold technique. Group 2 — the comparison group — included 32 patients (32 eyes; 54.46%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using standard technique.

RESULTS

Patients’ visual acuity improved up to 0.53 (0.35; 0.80) in group 1, and up to 0.50 (0.45; 0.80) in group 2 by the time of hospital discharge. At 6 months and 1 year follow-ups, visual functions were equal, in group 1 — 0.70 (0.65; 0.80), in group 2 — 0.70 (0.60; 0.90). The number of intraoperative complications decreased from 8.20% in standard phacoemulsification to 1.64% in scaffold technique. The latter reduces endothelial cell loss by 1.95% in comparison with traditional phacoemulsification over 1 year follow-up. With the scaffold technique, the number of intraoperative complications decreased from 15.63% in group 2 to 3.45% in group 1, the number of postoperative complications — from 43.75% to 31.04%, respectively.

CONCLUSION

The scaffold technique is indicated in pseudoexfoliation syndrome with weakness of zonular apparatus, degree I—II lens subluxation, in hard nucleus with absence of posterior cortical layer, in intumescent cataract, Morgagnian cataract to stabilize the posterior capsule and protect it from rupture.

Keywords:

ophthalmology

lens subluxation

scaffold technique

iris retractors

Authors:

Pirogova E.S.

Tambov branch of S.N. Fedorov National Medical Research Center «Eye Microsurgery»

Fabrikantov O.L.

Tambov branch of S.N. Fedorov National Medical Research Center «Eye Microsurgery»;
Tambov State University named after G.R. Derzhavin

Nikolashin S.I.

Tambov branch of S.N. Fedorov National Medical Research Center «Eye Microsurgery»;
Tambov State University named after G.R. Derzhavin

Received:

05.11.2020

Accepted:

29.01.2021

List of references:

Agarwal A, Kumar DA, Jacob S, et al. Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg. 2008;34(9):1433-1438. https://doi.org/10.1016/j.jcrs.2008.04.040
Assia EL, Ton Y, Michaeli A. Capsule anchor to manage subluxated lenses initial clinical experience. J Cataract Refract Surg. 2009;35(8):1372-1379. https://doi.org/10.1016/j.jcrs.2009.02.046
Belonozhenko YaV, Sorokin EL. Approaches strategy to diagnosis and surgical intervention choice in age-related cataract with initial lens subluxation. Sovremennye tekhnologii v oftal’mologii. 2015;(2):36-39 (In Russ.).
Malyugin BE, Golovin AV, Uzunyan DG, et al. Microincisional phacoemulsification with the modified capsular tension ring in patients with zonular dialysis. Oftal’mokhirurgiya. 2011;(3):22-26 (In Russ.).
Malyugin B. Managing Zonular Deficiency. J Cataract Refract Surg Today Europe. 2013;(2):61-65.
Mikhina IV, Fabrikantov OL. Contemporary aspects of pseudoexfoliation syndrome. Prakticheskaya meditsina. 2012;59(4-2):229-232. (In Russ.).
Nikolashin SI. Phacoemulsification of cataract with hard nuclei based on vertical chop technology with horizontal nucleus fragmentation. Oftal’mokhirurgiya. 2010;(3):10-14. (In Russ.).
Pashtaev NP. Classification of lens subluxations, modern treatment technique. In: Aktual’nyye problemy khirurgii khrustalika, steklovidnogo tela i setchatki [Urgent problems of surgery of lens, vitreous body and retina]: Collected papers. M. 1986;34-37. (In Russ.).
Shilovskikh OV. Phacoemulsification Technique in Patients with Severe Zonular Defects. Accessed October 16, 2020. https://ascrs2016.conferencefilms.com/atables.wcs?entryid=0098
Yusef N, Yusef YuN, Ivanov MN. Some features of phacoemulsification of lens subluxation. Vestnik oftal’mologii. 2013;129(3):12-15. (In Russ.).
Bat’kov EN, Pashtaev NP. Tactical approaches to surgical management of lens subluxation. Oftal’mokhirurgiya. 2018;(3):80-87. (In Russ.). https://doi.org/10.25276/0235-4160-2018-3-80-87
Cionni RJ, Osher RH, Marques MV, et al. Modified capsular tension ring for patients with congenital loss of zonular support. J Cataract Refract Surg. 2003;29(9):1668-1673. https://doi.org/10.1016/s0886-3350(03)00238-4
Jacob S, Agarwal A, Agarwal A, et al. Glued endocapsular hemi-ring segment for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses. J Cataract Refract Surg. 2012;38(2):193-201. https://doi.org/10.1016/j.jcrs.2011.12.001
Malyugin BE, Pokrovskiy DF, Semakina AS. Clinical outcomes of the bi-planar intraocular lens with iridocapsular fixation in eyes with severe zonular defects. Oftal’mokhirurgiya. 2017;(1):10-15. (In Russ.).
Fabrikantov OL, Nikolashin SI, Pirogova ES. The symptom of the posterior capsule pathological mobility. Oftal’mokhirurgiya. 2018;(3):13-18. (In Russ.). https://doi.org/10.25276/0235-4160-2018-3-13-18
Agarwal A, Jacob S, Agarwal A, et al. Glued intraocular lens scaffolding to create an artificial posterior capsule for nucleus removal in eyes with posterior capsule tear and insufficient iris and sulcus support. J Cataract Refract Surg. 2013;39(3):326-333. https://doi.org/10.1016/j.jcrs.2013.01.018
Kumar DA, Agarwal A, Prakash G, Jacob S, et al. IOL Scaffold technique for posterior capsule rupture. J Refract Surg. 2012;28(5):314-315. https://doi.org/10.3928/1081597x-20120413-01
Parkash RO, Mahajan S, Parkash TO, Nayak V. Intraocular lens scaffold technique to prevent posterior capsule rupture in cases of Morgagnian cataract. J Cataract Refract Surg. 2017;43(1):8-11. https://doi.org/10.1016/j.jcrs.2016.12.008
Om Parkash R, Mahajan S, Om Parkash T, Om Parkash T, Rai M. Nuclear scaffold: Tree-dimensional indigenous capsular bad support combined with IOL scaffold and capsular tension ring to prevent posterior capsule rupture in zonulopathy. J Cataract Refract Surg. 2019;45(12):1696-1700. https://doi.org/10.1016/j.jcrs.2019.08.046
Kurle RW, O’Day DM. A microcomputer system for measuring and analysing corneal endothelium. Am Intraocul Soc J. 1984;10(3):369-371. https://doi.org/10.1016/s0146-2776(84)80031-2
Matsuda M, Miyake K, Inaba M. Long-term corneal endothelial changes after intraocular lens implantation. Am J Ophthalmol. 1988;105(3):248-252. https://doi.org/10.1016/0002-9394(88)90004-9
Shultz RO, Glasser DB, Matsuda M, et al. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol. 1986;104(8):1164-1169.
Takasc Agnes I, Kovacs I, Mihaltz K, et al. Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg. 2012; 28(6):387-392. https://doi.org/10.3928/1081597x-20120508-02
Belonozhenko YaV, Sorokin EL. Zonular weakness in age-related cataract, its negative role in the formation of phacoemulsification complications and possibilities of its preoperative detection. Sovremennye tekhnologii v oftal’mologii. 2016;(3):182-184. (In Russ.).
Malyugin BE, Golovin AV. Features and technique of phacoemulsification in patients with the extensive defects of zonular apparatus of the lens. In: Sovremennyye tekhnologii kataraktal’noy i refraktsionnoy khirurgii [Modern technologies of cataract and refractive surgery]: Collected papers. M. 2009; 160-165. (In Russ.).
Pashtaev NP. Khirurgiya podvyvikhnutogo i vyvikhnutogo v steklovidnoe telo khrustalika [Surgery of the subluxated and dislocated lens into the vitreous body]. Cheboksary: GOU IUV; 2007. (In Russ.).

Close metadata