The Aravind Pseudoexfoliation Study: 5-Year Postoperative Results. The Effect of Intraocular Lens Choice and Capsular Tension Rings

Haripriya, Aravind; Ramulu, Pradeep Y.; Schehlein, Emily M.; Shekhar, Madhu; Chandrashekharan, Shivkumar; Narendran, Kalpana; Venkatesh, Rengaraj; Sithiq, Mohammed; Ramakrishnan, Rengappa; Ravindran, Ravilla D.; Robin, Alan L.

doi:10.1016/j.ajo.2020.06.031

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…Similarly Hosseini H et al 19 recommended the use of trypan blue in PEX eyes for good staining of the anterior capsule to minimize stress on the zonules during capsulorhexis. For the support of zonular dehiscence and the capsular bag use of capsular tension ring (CTR) has been recommended by Haripriya A et al 20 Limitations of our study was that it was a hospital based study which does not truly represent the whole population. Secondly, the preoperative and postoperative visual acuity was not compared.…”

Section: Discussionmentioning

confidence: 93%

Manual Sutureless Cataract Surgery (MSCS) in Patients with Pseudo-Exfoliation

Iqbal¹,

Khan²,

Zia³

et al. 2020

pak J Ophthalmol

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Purpose: To document the complications of Manual suture-less cataract surgery in eyes with pseudo-exfoliation. Study Design: Interventional case series. Place and Duration of Study: Naseer memorial hospital, Dadyal, Azad Jammu Kashmir, from 4 July 2017 to 3 July 2019. Methods: One hundred and fifty patients with pseudo-exfoliation (PEX) and cataract were selected by convenient sampling. Patients with systemic diseases, history of trauma, intraocular pressure ≥15 mm Hg on Applanation tonometry and any other associated ocular disease for example retinal detachment or retinal disease, previous history of glaucoma or narrow/closed angle on Gonioscopy were excluded from the study. Dark brown cataracts were also excluded. Pseudo-exfoliation was diagnosed on slit lamp on the basis of presence of dandruff like material on the pupil and the anterior lens capsule. The patients underwent manual suture less cataract surgery under local anesthesia Intraoperative and post-operative complications were noted. first day postoperatively. The collected data and analyzed using statistical package for social sciences (SPSS) version 21 for analysis. Results: The study group consisted of 64% males and 36% females with mean age of 65 ± 15.32 years. The most common difficulty encountered was poor pupil dilatation in 37.3% cases followed by Zonular dehiscence in 7.3%. On the first post-operative day, the most common complication was intraocular lens decentration in 2.6% of the cases. Conclusion: Pupils of patients with pseudo-exfoliation dilate poorly and makes surgery difficult. With good pupillary dilatation, careful capsulorhexis and minimal stress on the zonules, MSCS can be safely performed in eyes with cataract and PEX. Key Words: Pseudo-exfoliation, Cataract, Pupil.

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Section: Discussionmentioning

confidence: 93%

Manual Sutureless Cataract Surgery (MSCS) in Patients with Pseudo-Exfoliation

Iqbal¹,

Khan²,

Zia³

et al. 2020

pak J Ophthalmol

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“…reduced posterior capsule opacification [34][35][36][37]. Hence, we gathered the related studies and executed the meta-analysis to define the value of capsule tension ring on PCO.…”

Section: Plos Onementioning

confidence: 99%

“…Despite the fact that the benefit of a capsule tension ring in the reduction of posterior capsule opacification has been reported in a several studies [18][19][20]. There still has not been a meta-analysis on the association between the use of a capsule tension ring and posterior capsule opacification.…”

Section: Introductionmentioning

confidence: 99%

The effect of capsule tension ring on posterior capsule opacification: A meta-analysis

et al. 2021

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Background Posterior capsule opacification is one of the most common complications after cataract surgery. Studies have suggested that the introduction of a capsule tension ring might play a critical role in the prevention of capsule opacification, yet quantitative evidence is still lacking. This work consists of a meta-analysis on available data in order to explore the influence of a capsule tension ring on posterior capsule opacification. Methods A comprehensive review of the literature on capsule tension ring and posterior capsule opacification was carried out using the Embase, Pubmed, Web of Science, and Cochrane electronic databases. The selected studies included randomized controlled trials, retrospective studies and prospective studies published before June 2020. The studies of interest were selected by two reviewers independently from the included studies. Odds ratios (ORs) and standardized mean differences (SMD) were used in order to assess the association. A fixed-effects model or a random-effects model was applied to combine data according to heterogeneities. Sensitivity analysis was used to assess the heterogeneity of the studies. Publication bias was estimated using the Egger test. Statistical analysis was performed using the stata15.1 software. Results The meta-analysis included in total 8 studies involving 379 cases and 333 controls. There was a statistically significant difference of Nd:YAG laser capsulotomy rate (OR=0.241, 95% CI: 0.145, 0.400 I2=42.1%) between the capsule tension ring group and the control group, indicating that the tension ring reduced the Nd:YAG laser capsulotomy rate. Further studies with continuous data also revealed that the use of capsule tension ring was associated with a lower posterior capsule opacification score (SMD = -1.402, 95% CI: -2.448, -0.355 I2=95.0%). The sensitivity analysis suggested that the result of the re-combined analysis did not change notably, indicating that the result was reliable and stable. Both pooled analysis showed no evidence of publication bias. Conclusion The findings of this meta-analysis confirmed that capsule tension ring might reduce capsule opacification. Further studies should be made to validate the result.

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“…Recently, late in-the-bag IOL subluxation or dislocation due to zonulolysis has been reported with increasing frequency and has been reported as 0.2% to 3% [1,[3][4][5][6][7][8][9][10] . Risk factors for postoperative IOL dislocation include pseudoexfoliation syndrome, prior vitreoretinal surgery, history of trauma, long axial length, uveitis, retinitis pigmentosa, and connective tissue disorders, such as Marfan syndrome [11][12][13][14] . Certain measures to prevent IOL-bag complex luxation have been proposed in these predisposing eyes: postoperative relaxing cuts of anterior capsulorhexis margin with Nd:YAG laser, intraoperatively, aspiration of cortex directed in a tangential fashion, and preference of a 3-piece hydrophobic acrylic IOL which may reduce continuous curvilinear capsulotomy (CCC) shrinkage through a combination of decreased anterior capsule fibrosis and greater haptic rigidity than a single piece IOL [3][4][5][6][7][8][9][10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability: a comparison of three insertion methods

Cho¹,

Ambati²

2022

Int J Ophthalmol

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AIM: To evaluate the efficacy and stability of haptic sutured in-the-bag intraocular lens (IOL) in eyes with zonular instability. METHODS: A total 60 eyes of 60 patients were included in this retrospective cohort study. Postoperative stability in three groups [haptic sutured IOL in the bag, IOL in the bag insertion with haptics oriented toward areas of zonulysis, IOL with capsular tension ring (CTR) in the bag insertion] were compared according to the IOL insertion methods. To evaluate the IOL stability, the changes of anterior chamber depth (ACD), refraction, contraction of anterior continuous curvilinear capsulotomy (CCC) area, and tilt of IOL were compared. RESULTS: There was no significant difference in change of ACD (-0.04±0.01 mm in group of haptic sutured IOL, -0.07±0.01 mm in group of CTR insertion) and refraction (0.05±0.05 D in group of haptic sutured IOL, 0.37±015 D in group of CTR insertion) between the group of haptic sutured IOL in the bag and CTR insertion group. But in comparison of CCC contraction and IOL tilt, CTR insertion group showed less contraction (1.00%±0.52%) and less IOL tilt (2.66°±0.11°) than the group of haptic sutured IOL in the bag (6.32%±1.36%, 3.47°±0.11°, respectively). The CTR insertion group showed the least CCC contraction and the least tilt. CONCLUSION: In eyes with zonular instability, the method of haptic sutured IOL in-the-bag shows comparable stability in ACD and refraction in comparison with IOL with CTR in the bag insertion. The method of IOL only in-the-bag insertion shows the largest contraction of CCC and the largest tilt of IOL.

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The Aravind Pseudoexfoliation Study: 5-Year Postoperative Results. The Effect of Intraocular Lens Choice and Capsular Tension Rings

Cited by 8 publications

References 30 publications

Manual Sutureless Cataract Surgery (MSCS) in Patients with Pseudo-Exfoliation

Manual Sutureless Cataract Surgery (MSCS) in Patients with Pseudo-Exfoliation

The effect of capsule tension ring on posterior capsule opacification: A meta-analysis

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability: a comparison of three insertion methods

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