Capsular Bag Complex Research Articles

Chronic postoperative endophthalmitis after cataract surgery secondary to vancomycin-resistant Ochrobactrum anthropi: case report and literature review.

BackgroundThe aim of this study was to report an unusual case of chronic postoperative endophthalmitis following cataract surgery, secondary to Ochrobactrum anthropi that was found to be resistant to vancomycin.FindingsAnterior chamber paracentesis cultures grew gram negative bacilli Ochrobactrum anthropi. The patient was treated with a series of intracameral injections of moxifloxacin, with adjuvant oral moxifloxacin. Posterior sub-Tenon and oral corticosteroids were used to treat cystoid macular edema. Explantation of the intraocular lens (IOL)-capsular bag complex was avoided.ConclusionsChronic postoperative endophthalmitis is a rare entity, often due to indolent pathogens that sequester in the capsular bag. Aggressive surgical intervention may be avoided with the use of adequate intraocular antibiotic, provided that the offending organism demonstrates appropriate antibiotic susceptibilities.

Axial Length of the Eyeball Is Important in Secondary Dislocation of the Intraocular Lens, Capsular Bag, and Capsular Tension Ring Complex.

Purpose. To analyze the patients with secondary dislocation of CTR and IOL within 5 years from cataract surgery, to determine predisposing factors. Methods. 16 eyes of 15 patients aged 66.2 ± 6.7 (from 49 to 82) with CTR/IOL complex dislocation within 5 years from cataract surgery were compared with 26 patients aged 67.1 ± 7.2 (from 53 to 85), implanted with CTR during cataract surgery to manage zonule dehiscence and did not dislocate for at least 5 years, in respect of cause, axial length and IOL power, refraction, coexistent pathology, and trauma. Results. Axial length of the eyeball was 23.8 ± 1.3 (from 21 to 29) in the group of patients with CTR/IOL dislocation and 20.7 ± 1.2 (from 19 to 24) in patients with no dislocation present (p = 0.008). Crystalline lens dislocation was diagnosed before surgery in 13 of 16 patients with CTR/IOL complex dislocation as opposed to 7 of 26 eyes in the control group (p = 0.01). Pseudoexfoliation was present in 50% and 58% in both groups, respectively. Traumatic dislocation was present in 8 patients, none of them with CTR/IOL dislocation (p = 0.04). Conclusion. Longer axial length may contribute to the failure of the CTR to prevent in-the-bag IOL dislocation. Traumatic dislocation appears to be well fixed with the CTR.

Suture refixation and recentration of a subluxated capsular tension ring–capsular bag–intraocular lens complex

We describe a 3-point ab externo technique to refixate and recenter a subluxated Cionni capsular tension ring (CTR)-intraocular lens (IOL)-capsular bag complex to the sclera. A 9-0 polypropylene suture on a curved needle is looped through the eyelet of the CTR and back through a Hoffman scleral tunnel. Two other sutures passed in a similar fashion through the fibrotic continuous curvilinear capsulorhexis (CCC) edge are used to complete a tripod fixation, which centers and stabilizes the IOL. This surgical approach avoids the surgical trauma of removing and replacing a subluxated CTR-IOL-capsular bag complex, retains the optimal anatomical position, and ensures centration of the IOL.

Repositioning and scleral fixation of subluxated lenses using a T-shaped capsule stabilization hook

We describe a T-shaped capsule stabilization hook (modified capsule expander [M-CE]) used for repositioning and scleral fixation of the lens capsule of subluxated lenses. The 5-0 polypropylene device is flexible and attached to a curved needle. The contact portion is bent at 1.25 mm, and the end bifurcates in a T configuration to form a 3.75 mm footpad from which the capsular bag can be suspended. Modified capsule expanders were implanted in 4 eyes of 4 patients with subluxated cataractous lenses and provided excellent support and centration of the intraocular lens (IOL)-capsular bag complex. The IOLs remained well centered and stable. The corrected distance visual acuity improved to at least 20/20 in all patients after surgery. Thus, M-CEs were effective in fixating the lens capsule to the sclera in patients with significant zonular weakness.

Sliding internal knot technique for late in-the-bag intraocular lens decentration

We describe a technique that uses a sliding (Siepser) internal knot to secure the intraocular lens (IOL) and capsular bag complex to the sclera. The technique is helpful in cases of late dislocation of the IOL-capsular bag complex, which seems to be particularly common in patients with pseudoexfoliation. The technique, which borrows from earlier techniques, has the advantages of an external approach of the suture needle and a sliding knot with an internal tie that does not require a knot to be covered or rotated.

Scleral fixation of a subluxated intraocular lens–capsular bag complex through a fibrotic continuous curvilinear capsulorhexis

Several strategies have been devised to manage in-the-bag intraocular lens (IOL) subluxation. We describe a method of fixating the IOL-capsular bag complex to the sclera using the fibrotic ring that develops around the continuous curvilinear capsulorhexis (CCC). Two, preferably 3, double-armed 10-0 polypropylene sutures are passed around the fibrotic CCC rim of the capsule and out the Hoffman scleral pockets and then tied in the scleral tunnels to center the IOL-bag complex. This technique provides an alternative approach to repositioning and fixating the IOL-bag complex that is especially useful in cases in which removal and replacement of the IOL would be difficult. It also provides more than 2-point fixation to achieve perfect IOL centration. No author has a financial or proprietary interest in any material or method mentioned.

Acute angle-closure glaucoma due to iris transfixation of a subluxated posterior chamber intraocular lens–capsular bag complex

An 80-year-old woman with pseudoexfoliation syndrome developed subluxation of a posterior chamber intraocular lens (IOL)-capsular bag complex due to zonular rupture. She underwent a limited 25-gauge pars plana vitrectomy and iris transfixation of the subluxated IOL-capsule complex. The postoperative course was uneventful until the patient developed acute angle-closure glaucoma 3 weeks postoperatively. Ultrasound biomicroscopy confirmed pupillary block by the IOL-capsule complex. The patient was treated with intraocular pressure-lowering medications and a vitreous tap before a laser peripheral iridotomy could be performed successfully. The vision returned to normal, and the angle closure resolved. We recommend that a prophylactic surgical iridectomy be performed in patients with iris transfixation of a posterior chamber IOL-capsular bag complex.

Surgical Repositioning of Dislocated Capsular Tension Rings

To present techniques and results of surgical repositioning of subluxed and dislocated capsular tension rings (CTRs). Retrospective interventional case series. Eleven patients with a previously implanted CTR in-the-bag for zonular weakness who presented with CTR-intraocular lens (IOL)-capsular bag decentration who underwent surgical repositioning. Data from 11 patients who underwent surgical repositioning were evaluated retrospectively for underlying diagnosis, interval between initial surgery and decentration, surgical technique, clinical results, and complications. Capsular tension ring-IOL-capsular bag centration, final best-corrected visual acuity (BCVA), and surgical complications. Of the 11 patients with CTR decentration, 3 had it early in the postoperative period, and 8 had it late. Mean (+/- standard deviation) durations from cataract extraction and CTR implantation to surgical repositioning were 6.1+/-7.9 months for those with decentration early and 49.6+/-15.3 months for late decentrations (overall range, 0.7-74.7). Of the 11 patients, 7 had pseudoexfoliation, and 4 of the 7 had associated glaucoma. Nine patients had subluxation of the CTR-IOL-capsular bag complex, which was managed by an anterior segment approach. A pars plana vitrectomy and levitation of the CTR was required in 2 patients due to complete dislocation of the CTR into the posterior vitreous. Surgical techniques for repositioning included single, double, or 3-point scleral suture loop fixation of the CTR through the capsular bag complex (8 eyes); use of the capsular tension segment (CTS) placed within the capsular bag for scleral suture fixation (2); or iris suture fixation of the IOL haptics (1). All patients achieved successful anatomical repositioning of the CTR-IOL-capsular bag complex. Mean preoperative BCVA improved from 20/100 to 20/40 postoperatively. After repositioning surgery, BCVA improved in 7 patients, was maintained in 2, and worsened in 2 (due to advanced glaucoma). Postoperative CTR subluxation or dislocation is a risk for patients with severe or progressive zonulopathy. Decentrations may be effectively managed with scleral suture fixation of the CTR through the capsular bag or the use of the CTS.

Single-piece hydrophobic acrylic intraocular lens explanted within the capsular bag: Case report with clinicopathological correlation

A 74-year-old woman had uneventful phacoemulsification with implantation of a single-piece hydrophobic acrylic intraocular lens (IOL) (SA30AL) in her left eye. Two weeks after the surgery, the patient presented for ophthalmological consultation reporting pseudophakic dysphotopsia, which she had subjectively noted since surgery. Explantation/exchange of the IOL was performed 3 months after the surgery. The IOL was strongly attached to the capsule, which was fibrotic and contracted; explantation of the capsular bag complex in toto was done. To our knowledge, this is the first case of explantation of this IOL design with clinicopathological correlation.