Dr. Purendra Bhasin Gwalior - India

ASCRS Conference, Boston 2010

Managing Subluxated Lens with Phaco using Iris Retractors and Capsular

Tension Ring

DECLARATION No financial assistance is taken from any company for the work done in this study

Present study is done to ascertain the safety of managing 27 cases of subluxated cataract by phacoemulsification using Iris

Retractors and a Capsular Tension Ring (CTR)

Iris Retractors when placed at the capsulorrhexis margin :

Stretches the rim of the Capsular bag Provide stability to the Capsular Bag Counteracts traction forces of aspiration Prevents risk of extension of zonular dialysis Prevents vitreous prolapse in the AC

Aim

Implantation of CTR after PE & cortex aspiration

Helps maintain the shape of capsular bag Prevents late capsular fibrosis syndrome Prevents late IOL decentration Prevents PCO

Capsular Tension Ring

Cause of Subluxation

Post traum 19 Myopia 5 Marfans 2 Homocyst. 1

52

1

19

0

24

6

810

12

14

1618

20

1 2 3 4

Age Group

10-20yr. 5 cs. 20-30yr. 6cs. 50 & above 4 cs.30-40yr. 8 cs. 40-50yr 4cs.

56

8

4 4

0

1

2

3

4

5

6

7

8

9

10-20

20-30 30-40

40-50 50 & above

Surgical Technique

Anaesthesia

Peribulbar Anaesthesia Not the Topical

Incision

Clear corneal incisions Away from the site of zonular dialysis

Capsulorrhexis

Start from the area of intact zonules

Relatively difficult to perform because - Capsular instability/lax capsule Capsular thickening /fibrosis

Surgical technique

Surgical Technique

Iris Retractors

Stab incision is given in the area of subluxation

Iris retractors are then placed at the capsulorhexis margin

Degree of sublux. will determine the no. of retractors to be placed

Hydrodissection/Hydrodelineation

Hydromaneuvers are performed slowly & meticulously to ensure complete freeing of nucleus

Surgical Technique

PhacoemulsificationDone in slow motion with low parameters ;

low vacuum, low flow rate and low power

Avoid radial aspiration of the nucleus & Cx

PE can be done in the bag when nucleus is soft & in the AC if the nucleus is hard

Surgical technique

Capsular Tension Ring

Implanted in the capsular bag through the side port CTR injector Scleral fixation of CTR- in more than

180°subluxation

Large optic IOL is implanted in the bag Haptics placed in the meridian of the zonular disinsertion Check the stability of the IOL & capsular bag at the end

IOL Implantation

Follow up

Follow up >6 mths. To 3 yrs.23 cases Uneventful 4 Post Tr. Cases Developed CME (managed medically)

Results

26 cases with different degree of subluxation were managed successfully by this technique. 1 case with > 280 subluxation was converted and managed separately

Follow Up & Results

Conclusion

• Phaco using Iris retractors at CCC margin makes the technique safe & provides excellent surgical control

• Implanting CTR in the bag ensures long term integrity, shape of bag and centering of IOL