Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: Intermediate-term results

Asano, Yasuhiko; Yaguchi, Shigeo; Nishimura, Eiichi; Soda, Mitsutaka; Kozawa, Tadahiko

doi:10.1016/j.jcrs.2014.06.031

Cited by 13 publications

(12 citation statements)

References 21 publications

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“… 11 Endocapsular support devices which permit scleral-suture fixation, including the modified CTR, the capsular tension segment, and the capsule stabilization hook implantation, have become increasingly important in the management of compromised zonules during cataract surgery. 12 , 13 In the present 92-year-old patient, both eyes had an extremely severe zonulopathy and placement of CTR or regular cortex aspiration would end up in further compromise of the zonular apparatus. It is likely that fast development of posterior capsular opacification would not be a concern.…”

Section: Discussionmentioning

confidence: 67%

“…Alternative procedures in cataract surgery in eyes with severe zonular weakness include extracapsular cataract extraction, intracapsular cataract extraction, or phacoemulsification with placement of the implant in the sulcus (with or without lens optic capture), iris fixation or in-the-bag lens insertion along with placement of a CTR. 10 – 13 Insertion of a CTR before cortex aspiration helps to counteract the traction on the zonules by the standard centripetal cortex aspiration technique and also decreases late posterior capsular opacification. 10 CTR reduces intraoperatively redundant capsule folds, forward trampolining of the posterior capsule, and inward collapsing of the capsular fornices toward the aspirating instrument tip.…”

Section: Discussionmentioning

confidence: 99%

“…However, the CTR does not have an element for scleral fixation and is therefore used in dialysis up to 3–4 clock hours or with mild generalized zonular deficiency. 13 Insertion of a CTR puts some zonules under stress and the weight of the CTR may be an additional cause for the subsequent dislocation of the implant-lens bag complex. 14 However in severe diffuse zonulopathy, CTR could add to the risk of further subluxation of the complex intraocular lens-CTR.…”

Section: Discussionmentioning

confidence: 99%

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Central cortical cleanup and zonular deficiency

Mansour

Antonios

Ahmed

2016

OPTH

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BackgroundComplete removal of the cortex has been advocated to prevent posterior capsular opacification but carries the risk of zonular dehiscence, hence there is a need for a safe maximal cortical cleanup technique in eyes with severe diffuse zonulopathy in subjects above age 90.MethodsWe used bimanual central cortical cleaning by elevating central fibers and aspirating them toward the periphery. Peripheral cortical fibers were removed passively only when they became loose due to copious irrigation. A one-piece foldable implant was inserted without a capsular tension ring. Postoperative corticosteroid drops were used.ResultsThis technique was safely performed in a dozen eyes with severe pseudo-exfoliation or brunescent cataract with weak zonules. Posterior capsular rupture, iritis, vitreous loss, and lens subluxation were not observed. Moderate capsular phimosis occurred but with maintained central vision.ConclusionThe dogma of “complete cortical cleanup” in severe zonulopathy needs to be revisited in favor of a clear visual axis with maximal preservation of the damaged zonules. This technique is ideal in patients above age 90 where posterior capsular opacification and late dislocation of intraocular lens–capsule bag complex are unlikely to occur until several years postoperatively.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Central cortical cleanup and zonular deficiency

Mansour

Antonios

Ahmed

2016

OPTH

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“…14 The number of incisions is also consistent with the increasing number of retractors, modified capsular anchors, 15 and peripheral corneal damage 7 due to factors such as retractor expansion. 16 CTRs have been inadvertently threaded through capsule retractor loops. 17 The substantial tension of the CTR may cause it to snap the zonular region and interfere with the irrigation of the cortex.…”

Section: Discussionmentioning

confidence: 99%

Use of the chop hook to stabilize the capsular bag in patients with crystalline lens dislocations and cataracts

Zeng

Fan

2017

J Int Med Res

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ObjectiveTo observe the treatment effects of chop hook-assisted phacoemulsification surgery in patients with crystalline lens dislocation.MethodsThirty-seven eyes with cataracts and crystalline lens dislocations underwent cataract surgery. An L-shaped chop hook was introduced into the anterior chamber, and the tip was pushed or pulled to the centre of the anterior capsular edge of the zonular dialysis during the cataract operation. Postoperative follow-up was conducted for ≥ 1 month.ResultsAll patients’ postoperative visual abilities improved except one patient with glaucoma. One patient who underwent −5D intraocular lens implantation exhibited vision of 1/50. Visual acuity was less than 6/20 in 6 eyes, 6/20 to 10/20 in 7 eyes, and greater than 10/20 in 22 eyes.Conclusions L-shaped chop hooks can be used to push or pull the anterior capsular edge of the zonular dialysis for protection and avoidance of further zonular damage. This strategy provides satisfactory effects and reduces use of additional instruments.

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“…As 10‐0 polypropylene sutures have been reported to be prone to breakage several years later, 24 there is an increasing trend towards the use of stronger sutures such as 9‐0 25,26 and even 8‐0 polypropylene 27 for scleral‐fixated IOLs (SF‐IOLs). The off‐label use of the more resilient 7‐0 Gore‐Tex 28 (CV‐8; WL Gore, Newark, DE), a nonabsorbable polytetrafluoroethylene monofilament suture, has recently become the preferred suture for many surgeons.…”

Section: Surgical Strategy and Planningmentioning

confidence: 99%

Management of the subluxated crystalline lens: A review

Chan

2021

Clinical Exper Ophthalmology

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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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Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: Intermediate-term results

Abstract: Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.

Cited by 13 publications

References 21 publications

Central cortical cleanup and zonular deficiency

Central cortical cleanup and zonular deficiency

Use of the chop hook to stabilize the capsular bag in patients with crystalline lens dislocations and cataracts

Management of the subluxated crystalline lens: A review

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