Abstract
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.
Highlights
Standard cataract surgery using phacoemulsification and aspiration (PEA) can be safely performed provided that the zonule of Zinn is healthy and appropriately supports the lens; following the surgery, the in-the-bag intraocular lens (IOL) fixation can be performed
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
An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery
Summary
Standard cataract surgery using phacoemulsification and aspiration (PEA) can be safely performed provided that the zonule of Zinn is healthy and appropriately supports the lens; following the surgery, the in-the-bag intraocular lens (IOL) fixation can be performed. The use of capsule stabilization devices and modification of surgical techniques enable surgeons to perform successful PEA with endocapsular posterior chamber IOL fixation. Appropriate use of an adjunct capsule stabilization device can improve the safety and outcome of procedures performed in patients with zonular instability. Cionni and Osher [2] introduced a modified CTR for use in patients with significant zonular compromise or lens subluxation; subsequently, several types of endocapsular support devices to manage lens subluxation have been reported [3,4,5]. Cases of severe zonular compromise require intracapsular cataract extraction (ICCE), pars plana vitrectomy (PPV), or scleral suture fixation of IOL
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