Phacoemulsification combined with capsular tension ring and intraocular lens implantation in the treatment of high myopia with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the efficacy of phacoemulsification combined with capsular tension ring and intraocular lens implantation in the treatment of high myopia with cataract.METHODS: Retrospective study. A total of 82 cases(82 eyes)of high myopia complicated with cataract who admitted to the cataract department of our hospital from December 2021 to April 2023 were selected as study objects, and they were divided into control group(n=39)and combination group(n=43)according to whether or not the capsular tension ring was used intraoperatively. Patients in the control group were treated with intraocular lens implantation alone, and those in the combination group were treated with phacoemulsification combined with capsular tension ring and intraocular lens implantation. The preoperative and postoperative best corrected visual acuity, central anterior chamber depth, trabecular ciliary process, visual quality and complications were compared.RESULTS: At 1 mo after surgery, the best corrected visual acuity(LogMAR)of both groups increased significantly(combination group: 0.64±0.28 vs 0.12±0.14; control group: 0.62±0.26 vs 0.23±0.25, both P<0.001). Central anterior chamber depth in both groups were higher than those before surgery(combination group: 2.57±0.56 vs 1.97±0.40 mm; control group: 2.22±0.45 vs 1.89±0.37 mm; both P<0.001), and the best corrected visual acuity and central anterior chamber depth of the combination group were significantly better than those of the control group(both P<0.05). The distance of trabecular ciliary process showed no statistical significance(combination group: 0.68±0.22 vs 0.74±0.20 mm; control group: 0.74±0.19 vs 0.78±0.17 mm, both P>0.05). The visual quality scores of the combination group were all higher than the control group at 1 mo after surgery [watching TV: 3.00±0.38 vs 2.22±0.46 points; reading books: 2.85±0.42 vs 2.21±0.44 points; night vision: 2.71±0.34 vs 2.37±0.41 points; fine operation: 2.82±0.38 vs 2.33±0.40 points, all P<0.001]. The incidence of complication in the combination group was significantly lower than that of the control group(33% vs 14%, P<0.05).CONCLUSION: Phacoemulsification combined with capsular tension ring and intraocular lens implantation can effectively promote the recovery of visual function, improve the structure of chamber angle, and reduce the incidence of complications in the treatment of patients with high myopia and cataract.

Management of pediatric subluxated cataract and different methods to face the challenges

Background: Traumatic cataracts present in multiple and different forms. Based on the nature of injury, it necessitates a customized approach for individual case. Capsulorhexis and in the bag intraocular lens (IOL) placement are vital for long term centration of pediatric IOLs. Paediatric lenses having elastic capsule provide more challenges to perform optimum rhexis and the surgery becomes further complicated, when it is subluxated or fibrosed. Here is a pediatric case with such challenges managed using capsular tension ring (CTR) and capsular tension segment (CTS). Purpose: To demonstrate the making of optimum rhexis in a fibrosed capsule in subluxated lens and placing the IOL along with fixation of bag using CTR and CTS. Synopsis: A 13?year?old boy sustained an injury in the right eye from an air pistol, underwent lid tear repair in a local hospital, and presented to us one month post trauma with visual acuity of 6/60 in the right eye and 6/6 in the left eye. On examination, there was more than 180° temporal zonular dialysis with fibrosis of the anterior capsule. In this situation, creating an intact capsulorhexis was a challenge which was solved using micro?scissors and micro?vitreo?retinal forceps, in addition to routine instruments. After removing the lens material, CTS was placed initially in the bag to stabilize it while introducing CTR. The CTS was then fixated to the sclera. Foldable IOL was placed in the bag. Technique and tips to make intact rhexis and easy passage of suture are demonstrated. Highlights: This video shows tips and different methods adopted in each step of the surgery for successful placement of IOL in bag along with fixation of bag using CTR and CTS in a case of traumatic subluxated cataract with shrunken anterior lens capsule.

Efficacy of capsular tension ring implantation on high myopia patients with cataract: a meta-analysis / 中华实验眼科杂志

Objective:To systematically evaluate the efficacy of phacoemulsification and intraocular lens (IOL) with and without capsular tension ring (CTR) in patients with high myopia and cataract.Methods:MEDLINE, EMBASE, Cochrane Library, and Chinese databases including CNKI, Wanfang Data, and VIP databases were searched from their establishment to October 2020 to obtain peer-reviewed clinical studies comparing the efficacy of cataract phacoemulsification and IOL implantation combined with CTR implantation (experimental group) and cataract phacoemulsification and IOL implantation (control group) in patients with high myopia and cataract.Literature screening, data extraction and methodological quality assessment were implemented based on inclusion and exclusion criteria.A meta-analysis of postoperative best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution unit, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), retinal detachment (RD) was performed using Revman 5.3 software with mean difference ( MD) and odds ratio ( OR) describing the effect sizes of measurement data and count data, respectively. Results:Eight studies with 2 085 eyes were included in this study, including 1 054 eyes in the experimental group and 1 031 eyes in the control group.Meta-analysis showed that there was no significant difference in BCVA between the two groups at 1 week, 1 month, and 3 months after surgery, but the improvement in BCVA at 6 months after surgery was significantly better in the experimental group than in the control group ( MD: -0.11; 95% CI: -0.15--0.07; P<0.01). The incidence rates of postoperative PCO ( OR: 0.24; 95% CI: 0.15-0.36; P<0.01) and CCS ( OR: 0.08; 95 % CI: 0.01-0.65; P=0.02) and RD ( OR: 0.21; 95% CI: 0.05-0.82; P=0.02) were lower in the experimental group than in the control group, and the differences were statistically significant. Conclusions:The combination of CTR in the treatment of patients with high myopia and cataract can improve the postoperative visual quality and reduce the incidence of postoperative PCO, CCS and RD.

Postoperative changes of anterior chamber depth and lens suspensory ligament in patients with ultra-high myopia and cataract and related influencing factors / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the changes of anterior chamber depth(ACD)and lens suspensory ligament after phacoemulsification and intraocular lens(IOL)implantation in patients with ultra-high myopia cataract and related influencing factors.METHODS: A total of 45 patients(60 eyes)with ultra-high myopia and cataract in our hospital from October 2016 to December 2022 were selected. All patients received phacoemulsification and IOL implantation. The patients were randomly divided into implantation group and non-implantation group. Implantation group was combined with capsular tension ring(CTR)implantation, and non-implantation group did not implant CTR during operation. The changes of ACD and lens suspensory ligament length before and after operation were compared and the correlation was analyzed. To observe the differences of ACD and the length of lens suspensory ligament between the two groups before and after operation.RESULTS: The ACD of patients with ultra-high myopia complicated with cataract at 1 and 3mo after operation was higher than that before operation(all P&#x003C;0.05). The positions of 3:00, 6:00, 9:00, 12:00 and the average length of lens suspensory ligament at 1 and 3mo post-operation were shorter than those pre-operation(all P&#x003C;0.05). There was no significant difference in the positions of 3:00, 6:00, 9:00, 12:00 and average length of suspensory ligament between 1mo and 3mo after operation(all P&#x003E;0.05). The preoperative average length of lens suspensory ligament in patients with ultra-high myopia cataract was positively correlated with the ocular axis and the preoperative ACD(all P&#x003C;0.05). There was no significant difference in ACD between the implantation group and the non-implantation before and at 1 and 3mo after operation(P&#x003E;0.05). There was no significant difference in the length of lens suspensory ligament between implantation group and non-implantation group at the position of 6:00 before operation and 1mo after operation(P&#x003E;0.05), but there was difference in lens suspensory ligament between groups at 3mo after operation and the position of 6:00(P&#x003C;0.05). Furthermore, there was no significant difference at the positions of 3:00, 9:00, 12:00 and the average length of lens suspensory ligament between the implantation group and non-implantation group before and at 1 and 3mo after operation(P&#x003E;0.05).CONCLUSION: The ACD deepen and lens suspensory ligament shortened in patients with ultra-high myopia and cataract after phacoemulsification; the length of lens suspensory ligament was affected by the combined use of CTR.

Management of pediatric subluxated cataract and different methods to face the challenges

Background: Traumatic cataracts present in multiple and different forms. Based on the nature of injury, it necessitates a customized approach for individual case. Capsulorhexis and in the bag intraocular lens (IOL) placement are vital for long term centration of pediatric IOLs. Paediatric lenses having elastic capsule provide more challenges to perform optimum rhexis and the surgery becomes further complicated, when it is subluxated or fibrosed. Here is a pediatric case with such challenges managed using capsular tension ring (CTR) and capsular tension segment (CTS). Purpose: To demonstrate the making of optimum rhexis in a fibrosed capsule in subluxated lens and placing the IOL along with fixation of bag using CTR and CTS. Synopsis: A 13?year?old boy sustained an injury in the right eye from an air pistol, underwent lid tear repair in a local hospital, and presented to us one month post trauma with visual acuity of 6/60 in the right eye and 6/6 in the left eye. On examination, there was more than 180° temporal zonular dialysis with fibrosis of the anterior capsule. In this situation, creating an intact capsulorhexis was a challenge which was solved using micro?scissors and micro?vitreo?retinal forceps, in addition to routine instruments. After removing the lens material, CTS was placed initially in the bag to stabilize it while introducing CTR. The CTS was then fixated to the sclera. Foldable IOL was placed in the bag. Technique and tips to make intact rhexis and easy passage of suture are demonstrated. Highlights: This video shows tips and different methods adopted in each step of the surgery for successful placement of IOL in bag along with fixation of bag using CTR and CTS in a case of traumatic subluxated cataract with shrunken anterior lens capsule.

Clinical application of capsular tension ring / 国际眼科杂志(Guoji Yanke Zazhi)

As an in-bag filling device, capsular tension ring(CTR)has played an important role in cataract surgery. Maintaining the circular contour of the capsular bag and improving the safety of surgery is the original intention of CTR design, and then it was found to have better effects in inhibiting posterior capsular opacity and capsular bag shrinkage, and enhancing the stability of intraocular lenses. After nearly 30a of improvement and development, CTR has been derived into a variety of types, and its clinical application has gradually expanded. In particular, CTR can be used in complex cataract surgery to reduce intraoperative risk and improve postoperative outcomes. In the present paper, the implantation timing, indications and complications of CTR were summarized, and the progress in clinical application in recent years was briefly reviewed.

Capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the application effect of iris hooks combined with suture fixation of capsular tension ring(CTR)in the treatment of phacoemulsification with secondary glaucoma associated with lens subluxation.METHODS: Retrospective case series. A total of 18 eyes of patients with serious secondary glaucoma associated with lens subluxation were enrolled in Aier Eye Hospital(Changchun)from October 2017 to May 2020 as the observation group. All the patients had iris hooks inserted to support the capsule during the phacoemulsification combined with intraocular lens(IOL)implantation. Iris hooks were inserted through the incisions and placed in the capsulorhexis to support the capsule, then CTR was implanted and sutured onto the sclera of the dislocation side. A total of 11 eyes of patients had intracapsular cataract extraction combined with IOL suspension were enrolled in Aier Eye Hospital(Changchun)from October 2015 to October 2017 as the control group. The postoperative complications were recorded. The postoperative examinations included visual acuity, intraocular pressure(IOP)and positions of the capsule and IOL.RESULTS: The postoperative follow-up at least 12(12-40)mo, both the IOP of observation group and control group returned to normal, with statistically significant difference compared with pre-operation(t=9.994, 8.790, all P&#x003C;0.001). At 12mo after operation, the best corrected visual acuity of the two groups were significantly improved compared with surgery before(Z=-3.900, P&#x003C;0.001; Z=-3.002, P=0.003). The IOL in the observation group of the 18 eyes were in the expected position without complications such as an obvious tilt or displacement. In the control group with 11 eyes, the position of IOL in 8 eyes were centered, 3 eyes were slightly biased, and 2 eyes with cystoids macular edema.CONCLUSION: The application of suture fixation capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation in patients can be used as an effective auxiliary method, it could effectively control the IOP and maintain long-term stability of the capsule.

Optimal timing of capsular tension ring implantation in pseudoexfoliation syndrome / Momento ideal para implante de anel de tensão capsular na síndrome pseudoesfoliativa

ABSTRACT Purpose: The aim of this study was to evaluate the appropriate timing of capsular tension ring implantation in cases of zonular weakness due to pseudoexfoliation syndrome. Methods: This prospective, comparative study was performed at the Ophthalmology Department of Inonu University, Malatya, Turkey. There were 43 patients included in the study. Group 1 (16 patients) had early capsular tension ring implantation, and group 2 (27 patients) had late capsular tension ring implantation. Patients with pseudoexfoliation syndrome who underwent phacoemulsification surgery, posterior chamber intraocular lens implantation, and capsular tension ring implantation were included in the study. Intraoperative complications and difficulties with either capsular tension ring implantation or cortex removal were evaluated in each eye. Results: There was no significant difference between the groups in the difficulty of capsular tension ring implantation (p=0.124). The difficulty of cortex removal differed significantly between the groups (p=0.003). Intraoperative complications were observed in 3 patients in group 1 and 11 patients in group 2; the difference between the groups was not significant (p=0.18). Posterior capsule fluctuations were observed in 8 patients (29.5%) in group 2, which resulted in posterior capsule rupture in 2 patients. Conclusions: Cortex removal is more difficult with early capsular tension ring implantation, and posterior capsule fluctuations may cause problems with late capsular tension ring implantation. The surgeon must consider the risk-to-benefit ratio of early versus late insertion for the optimal timing of capsular tension ring implantation.

RESUMO Objetivo: Avaliar o momento apropriado para implante de anel de tensão capsular em casos de fraqueza zonular devida à síndrome pseudoesfoliativa. Métodos: Este foi um estudo prospectivo e comparativo realizado no Departamento de Oftalmologia da Universidade İnönü. Foram incluídos 43 pacientes, sendo 16 no grupo 1 e 27 no grupo 2. O grupo 1 era composto de pacientes que se submeteram ao implante precoce do anel de tensão capsular, enquanto no grupo 2 os pacientes tiveram implante tardio. Foram incluídos pacientes com síndrome pseudoesfoliativa submetidos à cirurgia de facoemulsificação e ao implante de lente intraocular na câmara posterior e anel de tensão capsular. Em cada olho, foram avaliadas as complicações intraoperatórias e as dificuldades tanto com a implantação do anel de tensão capsular quanto com a remoção do córtex. Resultados: Não houve diferença significativa entre os grupos quanto à dificuldade de implante do anel de tensão capsular (p=0,124). Ao se comparar as remoções do córtex, observou-se diferença significativa entre os grupos (p=0,003). Complicações intraoperatórias foram observadas em 3 pacientes do grupo 1 e 11 pacientes do grupo 2; porém, não houve diferença significativa entre os grupos (p=0,18). No grupo 2, observaram-se flutuações da cápsula posterior em 8 pacientes (29,5%), com ruptura da cápsula posterior em dois deles. Conclusões: A remoção do córtex é mais difícil no implante precoce do anel de tensão capsular e flutuações da cápsula posterior podem causar problemas no implante tardio do anel de tensão capsular. O cirurgião deve ponderar a relação risco/benefício do implante precoce e tardio ao avaliar o momento ideal para implante de anel de tensão capsular.

Phacoemulsification combined with CTR implantation in the treatment of high myopia with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy of phacoemulsification combined with capsular tension ring(CTR)implantation in the treatment of patients with high myopia complicated with cataract, and to analyze its safety. <p>METHODS: A retrospective analysis was performed on the clinical data of 186 patients(186 eyes)with high myopia and cataract who underwent phacoemulsification+ intraocular lens(IOL)implantation treatment in our hospital. Among them, 98 cases(98 eyes)were combined with CTR implantation(combined group)and 88 cases(88 eyes)were not combined with CTR implantation(control group). The best corrected visual acuity(BCVA, LogMAR), visual quality \〖root mean square value(RMS)of higher-order aberration(HOA)\〗 and corneal endothelial cell density were recorded in the two groups before surgery and at 1, 3 and 6mo after surgery, and the area of anterior capsular orifice and inclination angle of IOL were evaluated at 1, 3 and 6mo after surgery, and the occurrence of complications such as postoperative anterior capsule opacification, posterior capsule opacification and capsular contraction syndrome were compared between the two groups.<p>RESULTS: There were interaction effects in the BCVA between the two groups(<i>P</i><0.05). The BCVA of the two groups after surgery was decreased compared with that before surgery(<i>P</i><0.05), and the BCVA of combined group after surgery was lower than that of control group(<i>P</i><0.05). There were interaction effects in the total HOA RMS(<i>P</i><0.05), and the total HOA RMS of the two groups after surgery was increased compared with that before surgery(<i>P</i><0.05), and the total HOA RMS after surgery in combined group was lower than that in control group(<i>P</i><0.05). There were interaction effects in the anterior capsular orifice area after surgery between the two groups(<i>P</i><0.05), and the area in the two groups was decreased with the prolongation of postoperative time(<i>P</i><0.05), and the area in combined group at 3 and 6mo after surgery was higher than that in control group(<i>P</i><0.05). The IOL inclination angle of the two groups had interaction effects between the two groups(<i>P</i><0.05), and the angle of the two groups was increased with the prolongation of postoperative time(<i>P</i><0.05), and the angle of combined group at 3 and 6mo after surgery was lower than that of control group(<i>P</i><0.05). The corneal endothelial cell density in the two groups after surgery was lower than that before surgery(<i>P</i><0.05), but there was no interaction effect(<i>P</i> >0.05).<p>CONCLUSION: Phacoemulsification+ IOL implantation + CTR implantation can improve the visual function of patients with high myopia complicated with cataract, with few postoperative complications and good efficacy and safety.

Retrospective analysis of surgical strategies for lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To analyze the effectiveness and safety of different surgical strategies for cataract combined with subluxated lens. <p>METHODS: This is a retrospective study. Data are acquired from patients who diagnosed with cataract combined with subluxated lens between November 2018 to May 2019 in the ophthalmological center of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine. There are 11 eyes in 11 patients(9 males and 2 females), 10 eyes were caused by trauma and 1 eye was unknown. Cataract combined with subluxated lens were treated with different surgery procedures according to the degree of dislocation. Four eyes with lens dislocation larger than 270° underwent intraocular lens suspension; Four eyes with lens dislocation about 180° underwent IOL and tension ring implant in capsular, at the same time, the iris hook was hooked to the lens capsule bag and fixed to the sclera. Three eyes with lens dislocation less than 180° underwent IOL implantation combined with 5-0 polypropylene suture, iris hook was also hooked to the lens capsule bag and fixed to the sclera. If the anterior chamber has vitreous prolapse, anterior vitrectomy was performed. Best corrected visual acuity(BCVA)and intraocular pressure(IOP)were observed before and after surgery. <p>RESULTS: All eyes were successfully implanted with intraocular lens(IOL). Best corrected visual acuity(LogMAR)increased from 0.77±0.26 to 0.35±0.28. Mean IOP decreased from 24.33±13.55 to 13.85±3.80mmHg. No intraoperative complications occurred in all cases.<p>CONCLUSION: In the treatment of lens dislocation with cataract, individualized surgical plan and flexible treatment measures can make cataract surgery safe and effective.

Application of capsular tension ring implantation during phacoemulsification for ultra-high myopia complicated with cataract / 中华实验眼科杂志

Objective To investigate the effect of phacoemulsification combined with capsular tension ring implantation in patients with ultra-high myopia and cataract.Methods A randomized-controlled study was performed.The clinical data of 48 eyes of 48 patients with ultra-high myopia and cataract were collected at Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus from October 2016 to December 2018.The patients were randomly divided into a control group and a clinical trial group using a random number table method,with 24.eyes in each group.The eyes in the control group underwent phacoemulsification,and capsular tension ring implantation was performed during the surgery in the trial group.The patients were followed up for 3 months.Best corrected visual acuity (BCVA),intraocular pressure,corneal endothelial cell count,intraocular lens (IOL) decentration,and subjective visual quality were observed and compared preoperatively and 1 week,1 month and 3 months postoperatively,and the postoperative inclination angle of the IOL and surgical complications were compared between the two groups.Written informed consent was obtained from each patient prior to entering the study cohort.This study conformed to the tenets of the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus (No.2016-KY-05).Results The operation procedure was successfully completed,and the IOL was implanted into capsular bag in all the eyes.The postoperative BCVA was higher than that before surgery in both groups,with significant differences between them (all at P＜0.05).There were no significant differences in intraocular pressure and the corneal endothelial cell count between the two groups (F=0.122,P=0.729;F=0.006,P=0.939).The level of IOL horizontal decentration,vertical decentration,or total decentration were not significantly different between the two groups at 1 month and 3 months after operation (all at P＞0.05).At 1 month after operation,the horizontal and total inclination angles of the IOL in the trial group were statistically significantly lower than those in the control group (P＜0.05).At 3 months after operation,the vertical and total inclination angles of the IOL were significantly lower than those in the control group (both at P＜0.05).The total inclination in the trail group was significantly lower than that of the control group (P＜0.05).The subjective visual quality scores of the patients in the trial group at 1 week,1 month,and 3 months after operation were 2.85 t 0.24,3.30± 0.36,and 3.43 ± 0.42,respectively,and those in the control group were 2.34±0.23,2.65 ±0.44,and 2.57 ± 0.39,respectively,both significantly improved over the preoperative 1.31 ± 0.22 and 1.19±0.17 (all at P＜0.01).Conclusions The use of a bag tension ring in phacoemulsification for ultra-high myopia with cataract is safe and effective,and can result in good visual quality.

Application of capsular tension ring implantation during phacoemulsification for ultra-high myopia complicated with cataract / 中华实验眼科杂志

Objective@#To investigate the effect of phacoemulsification combined with capsular tension ring implantation in patients with ultra-high myopia and cataract.@*Methods@#A randomized-controlled study was performed.The clinical data of 48 eyes of 48 patients with ultra-high myopia and cataract were collected at Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus from October 2016 to December 2018.The patients were randomly divided into a control group and a clinical trial group using a random number table method, with 24 eyes in each group.The eyes in the control group underwent phacoemulsification, and capsular tension ring implantation was performed during the surgery in the trial group.The patients were followed up for 3 months.Best corrected visual acuity (BCVA), intraocular pressure, corneal endothelial cell count, intraocular lens (IOL) decentration, and subjective visual quality were observed and compared preoperatively and 1 week, 1 month and 3 months postoperatively, and the postoperative inclination angle of the IOL and surgical complications were compared between the two groups.Written informed consent was obtained from each patient prior to entering the study cohort.This study conformed to the tenets of the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus (No.2016-KY-05).@*Results@#The operation procedure was successfully completed, and the IOL was implanted into capsular bag in all the eyes.The postoperative BCVA was higher than that before surgery in both groups, with significant differences between them (all at P<0.05). There were no significant differences in intraocular pressure and the corneal endothelial cell count between the two groups (F=0.122, P=0.729; F=0.006, P=0.939). The level of IOL horizontal decentration, vertical decentration, or total decentration were not significantly different between the two groups at 1 month and 3 months after operation (all at P>0.05). At 1 month after operation, the horizontal and total inclination angles of the IOL in the trial group were statistically significantly lower than those in the control group (P<0.05). At 3 months after operation, the vertical and total inclination angles of the IOL were significantly lower than those in the control group (both at P<0.05). The total inclination in the trail group was significantly lower than that of the control group (P<0.05). The subjective visual quality scores of the patients in the trial group at 1 week, 1 month, and 3 months after operation were 2.85±0.24, 3.30±0.36, and 3.43±0.42, respectively, and those in the control group were 2.34±0.23, 2.65±0.44, and 2.57±0.39, respectively, both significantly improved over the preoperative 1.31±0.22 and 1.19±0.17 (all at P<0.01).@*Conclusions@#The use of a bag tension ring in phacoemulsification for ultra-high myopia with cataract is safe and effective, and can result in good visual quality.

Combination of capsular tension ring and capsular tension segment for the management of lens coloboma >4 clock hours

Lens colobomas extending more than 4 clock hours and causing visual impairment require lens extraction along with capsular support devices with scleral fixation for adequate centration of the capsular bag and for prevention of capsular fornix aspiration with inadvertent extension of zonular dialysis intraoperatively. In this case series, we describe a technique for the management of isolated lens colobomas involving 4–5 clock hours by clear lens extraction and intraocular lens implantation using a combination of a capsular tension ring with a capsular tension segment (CTS) for the centration and stability of the capsular bag. Hoffman's corneoscleral pocket and half-bow sliding knot technique were used for scleral fixation of the CTS.

Misplaced capsule tension ring in anterior chamber: A unique way of explantation

We report a patient who presented with endocapsular capsule tension ring (CTR) in iridocorneal angle leading to secondary angle closure glaucoma (ACG) and subsequent removal of the CTR from trabeculectomy ostium. Secondary ACG was diagnosed 2 years and 6 months after cataract surgery in which a CTR was used for zonular instability. CTR removal with trabeculectomy was performed, after which there was the resolution of symptoms. To the best of our knowledge, this is the first case report in which CTR was removed from trabeculectomy ostium. We describe a surgical technique to explant CTR and combining with trabeculectomy.

Surgical technique for management of isolated lenticular coloboma with high corneal astigmatism

We describe a surgical technique for the correction of isolated congenital lenticular coloboma associated with high corneal astigmatism. Transscleral fixation of the capsular bag with a single eyelet Cionni capsular tension ring was followed by in-the-bag implantation of a toric intraocular lens (IOL). This lead to complete correction of the lenticular defect and perfect alignment of the toric lens. In this case, the child attained an unaided distance visual acuity of 20/30 following amblyopia therapy and a well-aligned toric IOL at 12 months of follow-up. This technique can be used in cases with concomitant lenticular coloboma and significant corneal astigmatism.

Application of two capsular Tension ring sclera fixing methods in treatment of moderate and severe lens subluxation / 眼科新进展

Objective To compare the clinical effects of one-stage modified capsular tension ring (MCTR) scleral fixation and second-stage capsular tension ring (CTR) capsular bag complex scleral fixation in the treatment of moderate and severe subluxation of lens.Methods Retrospective study.Thirty cases (43 eyes) of patients with moderate and severe subluxation of lens from January 2012 to December 2015 were collected.Those patients were treated with phacoemulsification cataract extraction and MCTR or CTR and IOL intracapsular implantation under local anesthesia.23 eyes in group A were treated with MCTR combined with IOL implantation and one-stage scleral fixation.20 eyes in group B were treated with one-phase CTR combined with IOL implantation and second-stage of CTR-capsular bag complex scleral fixation after 3 to 6 months.The best corrected visual acuity,location of the postoperative capsular bag complex and complication were observed at 6 months after surgery.Results Postoperative 6-month,the best corrected visual acuity ≥0.6 were in 87％,95％ of the patients m group B,and there was no statistical significance difference (P ＞ 0.05).All CTR and IOL were located in the capsular bag after surgery.Two eyes in group A and 1 eye in group B were observed with moderate contraction and off-center of capsular bag,there was no significant difference (P ＞ 0.05).All groups achieved response after YAG laser anterior capsule relaxing incisions.Early complications of postoperative (1 month):3 eyes in group A and 1 eye in group B were observed with exudative membrane in anterior chamber;5 eyes in group A and 2 eyes in group B were with transient high intraocular pressure,and there was no significant difference (all P ＞ 0.05).Long-term complications of postoperative (6 months):3 eyes in group A and 1 eye in group B were observed with after cataract,and there was no significant difference (P ＞ 0.05).All groups conducted YAG laser posterior capsulotomy.Conclusion The location stability of the capsular complex after one-stage MCTR scleral fixation or secondstage CTR capsular bag sclera fixation is good.And the treatment is effective for moderate and severe lens dislocation.

Observation of artificial lens implantation suture fixation into capsular bag when cataract suspensory ligament rupture without capsular tension ring / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.

Choice of operative time and method for pseudoexfoliation syndrome combined cataract with zonular defect / 中华实验眼科杂志

Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.

Safety and effect of femtosecond laser-assisted cataract surgery combined with Cionni capsular tension ring implantation in the management of traumatic lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the safety and effect of femtosecond laser-assisted cataract surgery with Cionni modified capsular tension ring (MCTR) implantation in the management of traumatic lens subluxation.METHODS: Totally 11 patients (11 eyes) with traumatic lens subluxation were divided into three groups according to the severity of lens dislocation, ranging from 90° to 120° (4 eyes), 120° to 180° (5 eyes) and 180° to 270° (2 eyes).The contact LenSx femtosecond laser cataract surgery platform was applied to create the capsulotomy, prepare nuclear fragmentation and make corneal wound creation.Anterior vitrectomy was performed in some patients during the surgery.After capsular retractors insertion and phacoemulsification, the MCTR was inserted to the capsular bag and fixed to the sclera.Finally, the IOL was implanted into the capsular bag.Postoperative visual acuity, intra-and post-operative complications, anterior capsular opening, IOL and MCTR position and intraocular pressure (IOP) were assessed.RESULTS:The duration of follow-up was 2mo.All the operations were completed successfully.Five eyes underwent cataract surgery combined with anterior vitrectomy.Four eyes had been inserted with 2-eyelet MCTR and seven eyes with 1-eyelet MCTR.The best corrected visual acuity (BCVA) after operation was better than 0.5 in 4 eyes, between 0.3 and 0.5 in 3 eyes, between 0.1 and 0.3 in 3 eyes, and less than 0.1 in 1 eye.Compared with preoperative BCVA, the difference was statistically significant (P<0.05).All the IOLs were stably centered and the eyelet of MCTR was fixated steadily between the iris and the anterior capsule.The common intra-and post-operative complications were subconjunctival hemorrhage, incomplete capsulotomy, residual cortex, secondary glaucoma and posterior capsular opacification.CONCLUSION:Femtosecond laser-assisted cataract surgery can improve the success rate of capsulorhexis, and reduce the difficulty of nuclear fragmentation.Femtosecond laser-assisted cataract surgery combined with MCTR implantation is an ideal surgical method for traumatic lens subluxation.

Clinical observation of capsular tension ring implantation in congenital lens subluxation treating by phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical results of capsular tension ring (CTR) implantation in phacoemulsification for eyes with congenital lens subluxation.METHODS: This study comprised 18 patients (31 eyes) with congenital ectopia lentis.All patients received phacoemulsification with CTR and intraocular lens (IOL) implantation.Visual acuity before and after surgery were examined.IOL decentration were measured with Image-Pro Plus image processing software.The complications were also recorded preoperatively and postoperatively.RESULTS: Uncorrected vision of all eyes increased after surgery, and all cases had different degree of IOL decentration after surgery.Two eyes received CTR scleral fixation 3mo after surgery because the IOL decentration aggravated during the follow-up period.CONCLUSION: Phacoemulsification with CTR and IOL implantation is effective and safe for congenital lens subluxation.The implantation of CTR increase the stability of the capsular bag, improve the safety of surgery, and maintain the right position of IOL.CTR scleral fixation is a effective supplement for progressive cases.