Abstract
Objective: To evaluate the degree of zonular weakness based on lens movement at the start of capsulorhexis using extracted porcine eyes. Methods: Zonular dehiscence of 18°, 36°, and 54° was created and alternated with healthy areas into five zones to create a model simulation of weakness of the zonule of Zinn corresponding to dehiscence of 90°, 180°, and 270°. During continuous curvilinear capsulorhexis (CCC), an image displaying the anterior capsule grasped by a cystotome and another displaying the initial tear were captured, and the two images were superimposed to measure the movement distance of the cortical opacities created using a hook. Porcine eyes with no dehiscence were used as the control group. Results: Compared with a distance of 0.44 ± 0.13 mm in the control group, the cortical opacity movement distances in the weakness group with dehiscence corresponding to 90°, 180°, and 270° were 0.68 ± 0.27, 1.01 ± 0.22, and 1.32 ± 0.35 mm, respectively. Significant differences were observed between the control, 90°, 180°, and 270° dehiscence groups (P<0.001). Conclusion: This study revealed numerical data for the degree of weakness of the zonule of Zinn in porcine eyes. Clinical application of this method may be useful for establishing surgical procedures and prognoses for cataract surgery in patients with weakness of the zonule of Zinn.
Highlights
During cataract surgery using phacoemulsification and aspiration (PEA), if the zonule of Zinn is healthy and appropriately supports the lens, fragmentation and emulsification of the lens nucleus using ultrasound followed by in-the-bag intraocular lens (IOL) fixation can be safely performed
During PEA, which is currently the mainstream surgical procedure for cataracts, weakness of the zonule is suspected if puncture of the anterior capsule is difficult due to lens movement when performing continuous curvilinear capsulorhexis (CCC), which often makes subsequent PEA difficult
We report a method of measuring the lens movement distance using zonular weakness models created from extracted porcine eyes
Summary
During cataract surgery using phacoemulsification and aspiration (PEA), if the zonule of Zinn is healthy and appropriately supports the lens, fragmentation and emulsification of the lens nucleus using ultrasound followed by in-the-bag intraocular lens (IOL) fixation can be safely performed. In cases of weakness of the zonule or partial dehiscence, the lens capsule moves along with the lens nucleus, often making it difficult to effectively perform nucleus rotation within the capsule, nucleus division, and removal of nuclear fragments from inside the capsule. Forcing these manipulations can cause zonular dehiscence and posterior capsule rupture, increasing the risk of complications, such as nucleus drop and vitreous loss. In patients with weakness of the zonule, even if PEA and in-the-bag IOL fixation are safely performed to complete the surgery, capsule contraction syndrome (CCS), occluded pupil, and in-the-bag dislocation can occur postoperatively [1-3]. Ascertaining the condition of the zonule is crucial to cataract surgery and is a factor that influences whether the surgery can be conducted safely
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