Repositioning and scleral fixation of subluxated lenses using a T-shaped capsule stabilization hook

Yaguchi, Shigeo; Asano, Yasuhiko; Kozawa, Tadahiko; Miyawaki, Takaya; Negishi, Kazuno; Tsubota, Kazuo

doi:10.1016/j.jcrs.2011.06.015

Cited by 23 publications

(17 citation statements)

References 13 publications

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“…IOL fixation included in-the-bag IOL fixation, scleral suture fixation of the IOL, and in-the-bag IOL fixation following scleral fixation of the lens capsule using a M-CE [11]. Fig 5 shows the number of each type of IOL fixation procedure used for each zonular weakness grade.…”

Section: Resultsmentioning

confidence: 99%

“…The contact portion of the CE is bent at 1.25 mm with an end bifurcating to form a 2.0-mm T shape to simultaneously expand the capsular equator and the edge of CCC (Fig 1). If it was determined that the IOL could not be fixed in an unstable capsular bag, a scleral suture fixation of the IOL or in-the-bag IOL fixation following scleral fixation of the lens capsule using a modified capsule expander (M-CE, Handaya) [11] was performed. We have developed an M-CE that permanently fixes the lens capsule to the sclera with the IOL inserted in lens capsules in eyes with extensive or progressive zonular compromise (Fig 1).…”

Section: Methodsmentioning

confidence: 99%

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Objective classification of zonular weakness based on lens movement at the start of capsulorhexis

et al. 2017

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PurposeTo quantify zonular weakness based on lens movement at the start of continuous curvilinear capsulorhexis (CCC) and establish a classification system for it.SettingKozawa Eye Hospital and Diabetes Center, Mito, Japan.DesignRetrospective interventional case series.MethodsWe examined 402 consecutive eyes of 316 patients who underwent CCC, phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. The movement of the lens capsule was measured using images from video recordings of the CCC procedure. Zonular weakness was classified based on the shifted distance: Grade I, less than 0.20 mm; Grade II, 0.20–0.39 mm; and Grade III, greater than 0.40 mm. For each of these grades, we examined the use of the capsule stabilization device during PEA, the surgical procedure for lens removal, and IOL fixation.ResultsWe classified 276 eyes (68.6%) as Grade I, 102 eyes (25.4%) as Grade II, and 24 eyes (6.0%) as Grade III. As the grade increased, the use of the capsule stabilization device in PEA and scleral suture fixation of IOL increased.ConclusionsZonular weakness was quantified by measuring the movement of the lens capsule. An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Objective classification of zonular weakness based on lens movement at the start of capsulorhexis

et al. 2017

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“…This categorization is reliable because it is based on findings from a single surgeon who performed the same CCC procedure for each surgery. In addition, we had previously reported using a CE [5] and M-CE [9] to demonstrate their usefulness in cases with weak zonules.…”

Section: Discussionmentioning

confidence: 99%

“…We have also developed an M-CE that permanently fixates the lens capsule to the sclera in eyes with extensive or progressive zonular compromise [9].…”

Section: Surgical Procedures For Iol Fixationmentioning

confidence: 99%

Categorization and Surgical Techniques of Weak Zonule Based on Findings at Capsulorhexis during Cataract Surgery

Yaguchi¹

2015

J Clin Exp Ophthalmol

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Purpose: We categorize weak zonule during capsulorhexis.Design: Retrospective interventional case series. Methods:The study examined 5447 consecutive eyes of 3527 cases that underwent phacoemulsification (PEA) and intraocular lens (IOL) implantation between March 2006 and March 2014 at Showa University Fujigaoka Hospital, Kanagawa, Japan. Weak zonule was categorized based on findings at capsulorhexis and difficulty in performing continuous curvilinear capsulorhexis (CCC). The categorization definitions were as follows: (1) Group N (normal) with no or slight lens movement at the start of the CCC and no difficulty in performing CCC, (2) Group W (weak) with moderate lens movement frequently accompanied by fold formation during CCC and some difficulty in performing CCC, (3) Group VW (very weak) because of severe lens movement and difficulties with the initial puncture, CCC can be performed with the aid of a highly retentive and cohesive ophthalmic viscoelastic device (OVD; Healon 5 ® ), and (4) Group EW (extremely weak) with zonular deficiency in addition to the Group VW criteria and accounted for the cases of severe phacodonesis, lens subluxation, lens luxation into the anterior chamber, and dropped nucleus into the vitreous cavity that could be categorized preoperatively. We examined capsule stabilization device use during PEA, surgical lens removal, and IOL fixation in each group. Results:We defined 5098 eyes as Group N, 251 eyes as Group W, 55 eyes as Group VW, and 43 eyes as Group EW. As the zonule became weak, the use of the capsule stabilization device increased in PEA and intracapsular cataract extraction, and scleral suture fixation of IOL increased. Pars plana vitrectomy for lens removal was performed in 5 eyes (11.63%) categorized as Group EW. Conclusions:The categorization of weak zonule at CCC may be useful for selecting an appropriate capsule stabilization device and procedure during cataract surgery.

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“…Capsular tension segments such as the Ike segments 15,B and the Assia anchors 16 can be inserted at any time during surgery for intraoperative support and are sutured onto the scleral wall with 9-0 or 10-0 polypropylene (Prolene) sutures for intraoperative and postoperative support and centration of the capsular bag. Yaguchi et al 17 have described T-shaped capsule stabilization hooks, which have a 3.75 mm footpad that engages the capsule and are sutured to the sclera. The hooks are attached to a curved needle.…”

Section: Discussionmentioning

confidence: 99%

Glued endocapsular hemi-ring segment for fibrin glue–assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses

Jacob

Agarwal

Athiya

et al. 2012

Journal of Cataract and Refractive Surgery

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Surgical expertise, prolonged surgical time, suture-related problems, and delayed intraocular lens (IOL) subluxation or dislocation due to broken sutures are limitations of suture fixation of the capsular bag to the scleral wall. We describe a new device made of IOL haptic material (polyvinylidene fluoride) that allows sutureless fibrin glue-assisted transscleral fixation of the capsular bag to address these issues. The device has a hemi-ring portion that lies in the capsular fornix and a double scroll mechanism that engages the capsulorhexis rim. The scroll extends forward as a haptic that is exteriorized through a sclerotomy under a lamellar scleral flap and tucked into a scleral tunnel. The flap is closed with fibrin glue. The device is used for subluxated cataracts and IOLs. It anchors the capsular bag to the sclera, giving vertical and horizontal stability, while providing fornix expansion and allowing stabilization of the bag intraoperatively and postoperatively. The device has been used in 4 patients who had good intraoperative and postoperative courses over a 5-week period.

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Repositioning and scleral fixation of subluxated lenses using a T-shaped capsule stabilization hook

Cited by 23 publications

References 13 publications

Objective classification of zonular weakness based on lens movement at the start of capsulorhexis

Objective classification of zonular weakness based on lens movement at the start of capsulorhexis

Categorization and Surgical Techniques of Weak Zonule Based on Findings at Capsulorhexis during Cataract Surgery

Glued endocapsular hemi-ring segment for fibrin glue–assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses

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