Abstract

Purpose . To present the results of several technologies for suture fixation in case of IOL-capsular bag complex III–IV-degree dislocation and to estimate their impact on IOP. Patients and Methods. We have analyzed 42 cases of IOL-capsular bag complex dislocation complicated by absence of capsular support which were divided into three groups. Group 1 included 4 cases of complex fixation to the sclera (presence of capsular ring, IOLs with closed loop haptics such as T-26, T-28, single-piece IOLs with massive haptics such as Asphina). Suture fixation was performed in the ciliary sulcus projection with capture of haptics or capsular ring and buried knots in capsular pockets. Group 2 included 27 cases with iris suture fixation with capture of haptics or fibrotic capsular bag on a 30G needle. Reposition and support of dislocated IOL-capsular bag complex was performed with a bent 30G needle inserted through pars plana. Group 3 included 11 cases with iris suture fixation with additional surgical manipulations (anterior vitrectomy, removal of fibrotic anterior and posterior capsules, complete removal of the capsular bag with cortex, surgical dissection of opacified posterior capsule). The specific feature was the use of vitreotome needle for IOL-capsular bag complex centration and fixation as well as for subsequent removal of capsular bag fibrosis, secondary cataract or cortex. Results . Intraoperative complications included 3 cases of slight bleeding during iris perforation. Postoperative complications included 4 cases of inflammatory reaction in the form of fibrin in the pupil. No cases of hemophthalmia associated with the insertion of 30 G needle or port in the eye cavity were marked. Two patients developed pseudoexfoliation glaucoma treated with hypotensive drops. In the early and late postoperative period in all patients of all the groups stable position of IOL-capsular bag complex was marked. Conclusion . Use of discussed techniques gives a possibility to obtain high visual prognosis, low probability of IOP elevation and stable position of IOL-capsular bag complex in all the three groups.

Highlights

  • Поздняя дислокация интраокулярной линзы (ИОЛ) является серьезным ос‐ ложнением, которое может развиться независимо от наличия или отсутствия осложнений в ходе пер‐ вичной хирургии катаракты [1,2,3]

  • 42 cases of IOL-capsular bag complex dislocation complicated by absence of capsular support

  • which were divided into three groups

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Summary

ПАЦИЕНТЫ И МЕТОДЫ

Проведен ретроспективный анализ результатов у па‐ циентов, поступивших в Екатеринбургский центр МНТК «Микрохирургия глаза» в период 2013–2015 гг., с наличием дислокации комплекса «ИОЛ — капсульный мешок», ос‐ ложненной отсутствием капсульной поддержки. Репозицию интраокулярной линзы (ИОЛ), дисло‐ цированной вместе с капсульным мешком, осущест‐ вляли путем шовной фиксации блока «ИОЛ — кап‐ сульный мешок» к радужке со стороны задней камеры. Визуализировали контуры опорных элементов на радужке (рис 3.1), затем наклады‐ вали транскорнеальный шов на один опорный элемент, а во время наложения шва на второй опорный элемент производили временную жесткую фиксацию второго опорного элемента с помощью иглы. При этом через парацен‐ тез осуществляли подачу сбалансированного раствора для поддержания нормотонуса глаза, а завершив уда‐ ление фиброзных тканей мешка, выводили наконечник витреотома, удаляли порт, затем полностью выкалывали из роговицы атравматическую иглу, рассекали нить, проходящую снаружи между швами, и фиксировали каждый опорный элемент к радужке

РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ
СВЕДЕНИЯ ОБ АВТОРАХ
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