A Comprehensive Approach for Capsular Bag Fixation in Subluxated Crystalline Lens: Preserving the Anterior/Posterior Anatomical Segments Barrier
Adi Porat Rein, Adi Abulafia, Elishai Assayag, Mordechai Goldberg, David Zadok- Sensory Systems
- Ophthalmology
- Surgery
Abstract
Purpose:
To report the intra-operative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTS) and a capsular tension ring (CTR) in patients with a subluxated lens.
Setting:
Ophthalmology Department, Shaare-Zedek Medical Center, Jerusalem, Israel.
Design:
Retrospective, consecutive case series.
Methods:
This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior-chamber-maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with two CTS, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt.
Results:
17 eyes (9 patients) were included, with a mean follow-up of 22.06±14.88 months. There was a significant improvement in mean logMAR CDVA (p<0.001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07±1.10D, with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50D and 1.00D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9±2.6 and 2.6±2.1 degrees, respectively. No complications were observed except for one case of an intraoperative posterior-capsular tear.
Conclusion:
A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, two CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.