Corneal Tunnel Incision Research Articles

Corneal astigmatism induced by scleral small incision versus corneal tunnel incision in children after cataract surgery

Background The amount of postoperative astigmatism is an important factor in the development of amblyopia in children. Early postoperative astigmatism is of concern since amblyopia treatment is usually initiated as soon as possible after cataract surgery, and precise optical correction of astigmatism is needed to maximize visual improvement. Small-incision cataract surgery is preferred by some pediatric ophthalmologists, as it reduces corneal scarring and this reduces the incidence of irregular astigmatism. Also, it is very useful in cases with micro cornea and cases with low endothelial count. However, it has many disadvantages such as increased risk of bleeding, slower visual recovery, hyphemia from scleral vessels, and postoperative surgically induced astigmatism. Aim To assess corneal astigmatism induced by scleral tunnel small incision versus corneal tunnel incision after cataract surgery in children. Patients and methods The study was a prospective study and included 30 eyes of 30 children with cataract from the outpatient clinic of the ophthalmology department of Tanta University in the period between December 2021 to July 2022. Results There was an insignificant difference between the small incision and corneal tunnel incision as regard K1 and K2 prereadings, after 2 weeks, after 6 weeks, and after 3 months of readings. Conclusion We think that both corneal tunnel and scleral tunnel are stigmatically neutral in pediatric cataract surgery.

Розрахунок параметрів тунельного розрізу при факоемульсифікації у хворих з раніше проведеною передньою радіальною кератотомією

Мета. Вибір типу тунельного розрізу на підставі математичних розрахунків у хворих на катаракту з раніше проведеною передньою радіальною кератотомією. Матеріали та методи. У розрахунках використовувалась формула довжини хорди окружності: L = 2R · sin(α/2), де R — радіус рогівки, α — кут у градусах між двома рогівковими надрізами. Довжину хорди вимірювали на лімбі (верхній край тунельного розрізу) та 2 мм від лімба (ніжній край тунельного розрізу). Більш важливою є хорда 2 мм від лімба, тому що відстань між кератотомічними розрізами в цьому місці є меншою. До ширини леза ножа необхідно додати ще від 0,4 мм до 1,0 мм залежно від типу післяопераційного загоювання рогівки, що і буде запорукою пересічення розрізів. Результати. Найпоширенішими є ножі 2,2 мм та довжиною тунелю 2 мм. Тому проводимо розрахунки на базі цього ножа у пацієнтів з 8 та 12 кератотомічними розрізами та діаметром рогівки 12 мм за вертикаллю та 11 мм за горизонталлю. У пацієнтів з 8 кератотомічними розрізами є можливість використовувати ніж 2,2 мм для рогівкового тунельного розрізу, а у хворих з 16 насічками використання рогівкового тунелю неможливе. Висновки. У пацієнтів, хворих на катаракту, в яких раніше була проведена передня радіальна кератотомія, потрібен особливий підхід щодо вибору тунельного розрізу. Вибір доступу залежить від діаметра рогівки, кількості кератотомічних надрізів та ширини ножа і вираховується за допомогою формули довжини хорди окружності.

Post-Operative Astigmatism Using Clear Corneal Tunnel Incision in Children with Developmental Cataract

Post-Operative Astigmatism Using Clear Corneal Tunnel Incision in Children with Developmental Cataract

Формирование роговичного тоннельного разреза с пересечением кератотомических рубцов у пациентов после радиальной кератотомии при факоэмульсификации

Purpose. A clinical study of safety and changes of refraction during intersection of a keratotomy scar while performing the corneal tunnel incision in phacoemulsification with IOL implantation. Material and methods. The clinical study included 11 patients (19 eyes) suffering from cataract and patients with previously performed anterior radial keratotomy. A tunnel incision 2.2 mm wide was performed with the location of the scar in its center. In case of insufficient area of the corneal tissue between the scars to involve only one keratotomy scar into the tunnel incision, the adjacent scar was transected at the final stage of tunnel formation when entering the anterior chamber. The other stages of phacoemulsification were carried out in a standard way. During the operation, the state of the keratotomy scar was assessed. A day, a week and a month later after the operation, the patients underwent biomicroscopy, autorefractokeratometry, visometry with an assessment of the values of subjective and objective cylindrical correction. In order to assess the postoperative state of the keratotomy scar and the incision zone, OCT of the cornea was performed using an RTVue 100 optical coherence tomograph (Optovue, Inc, USA) in Line, Crossline, 3D cornea modes. Results. In all cases, during the operation and also the next day, biomicroscopically the cornea was transparent, there was no keratotomy scar dehiscence. There is a dynamic of the best corrected visual acuity value by 1 month after surgery and the difference between the value for subjective and objective cylinder correction as well. The next day after the operation, in all cases the keratotomy scar on the OCT scans is uniform, comparable in width, the architectonics of the tunnel incision does not differ from that of standard phacoemulsification. Conclusion. Performing a corneal tunnel incision with the beginning of the formation outside the zone of the keratotomy scar and with further intersection of the scar with the plane of the blade so that most of it is in the projection of the center of the tunnel incision, as well as the intersection of the adjacent keratotomy scar at the end of the formation of the tunnel incision when entering the anterior chamber in case of insufficient the area of the corneal tissue between the incisions is safe at all stages of phacoemulsification and in the postoperative period. Changes in the values of best corrected visual acuity over time and the difference between the values of subjective and objective cylinder correction require further study on a larger sample and using various keratometry methods. Key words: radial keratotomy, phacoemulsification, tunnel incision, intersection of the keratotomy scar, cornea optical coherence tomography.

Efficacy of double-incision extracapsular cataract extraction in the treatment of hard-nucleus cataract with low corneal endothelial cell density

Objective: To discuss the efficacy and security of double-incision extracapsular cataract extraction (ECCE) in the treatment of hard-nucleus cataract with low corneal endothelial cell density. Methods: This was a retrospective case series study. Forty-six patients (47 eyes) with hard-nucleus cataract and low corneal endothelial cell density were enrolled at Shandong Eye Hospital from June 2009 to December 2018, including 22 males and 24 females, aged 50 to 74 (63.8±6.3) years. Preoperative corneal endothelial cell density was less than 1 000 cells/mm(2), and the cataract nuclear hardness was equal to or greater than grade IV. According to the surgical methods, the patients were divided into the single-incision ECCE group (24 eyes) and the double-incision ECCE group (23 eyes). The surgical procedures for the double-incision group were as follows. First, a superior scleral pre-incision was made. Then the conventional capsulorhexis was conducted through a 2.6 mm transparent corneal tunnel incision at the temporal or the nasal side, after which the hydro-dissection was performed. Next, the surgeon cut the pre-incision at the sclera, delivered the lens nucleus, sutured the scleral incision and removed the residual cortical materials from the corneal incision. Finally, a foldable intraocular lens was implanted, and the viscoelastic substance was removed. The intraoperative anterior chamber condition and the postoperative corneal edema condition were monitored. During the 6 month follow-up after surgeries, the endothelium cell density, visual acuity and astigmatism in the two groups were compared. The χ(2) test was used to compare the counting data, and the t test was used to compare the measurement data. Results: There was no statistically significant difference (t=1.12, P=0.28) in the preoperative corneal endothelial cell density between the double-incision and single-incision ECCE groups, which was (827±164) cells/mm(2) and (802±121) cells/mm(2), respectively. At 6 months after operation, in the double-incision and single-incision groups, the endothelial cell density was (793±147) cells/mm(2) and (706±101) cells/mm(2), respectively, and the difference was statistically significant (t=4.37, P<0.01). The percentage of corneal endothelial cell loss was 4.16%±3.12% and 11.69%±2.96%, respectively, and the difference was also statistically significant (t=9.52, P<0.01). The hexagon loss rate of corneal endothelial cells was 9.67%±6.11% and 28.33%±8.39%, respectively, and the difference was statistically significant (t=5.52, P<0.05). In the follow-up of 6 months, none of the eyes in the double-incision ECCE group suffered corneal endothelial decompensation compared with 3 eyes in the single-incision ECCE group. There were no statistically significant differences in postoperative astigmatism and surgically induced astigmatism between the two groups (t=-0.71, 0.15; P>0.05). Conclusions: The double-incision ECCE, in which the lens nucleus is delivered through a scleral incision and other procedures are conducted through a corneal tunnel incision, is safe and effective for cataract patients with hard nucleus and low corneal endothelial cell density. (Chin J Ophthalmol, 2020, 56: 126-130).

CM T – Flex intraocular lens an innovative design for aphakia secondary to postcataract surgery

Here, we report a case of 66-year-old female who came with a history of secondary aphakia due to the complication of cataract surgery in the left eye with a vision of HM + which is improving with pinhole to 6/9 and right eye PCIOL with a vision of 6/6, managed with new foldable acryflex T IOL (CM T FLEX) scleral fixated intraocular lens (IOL). Two partial-thickness limbal-based scleral flaps of 2.5 mm × 2.5 mm were created 180° apart; sclerotomies were made using 23G needle 1.5 mm away from the limbus. The new acryflex T–flex IOL implantation was performed through the 2.8 mm clear corneal tunnel incision, and T-shaped IOL haptics were externalized with the 23G forceps under the scleral flap. Fibrin glue was used to close the scleral flaps and conjunctiva. Postoperative period was uneventful; at the end of 1 month, the patient regained a good visual acuity of 6/6 (P) with a good stable centration of IOL.

Проведение роговичного тоннельного разреза у пациентов после радиальной кератотомии при факоэмульсификации

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

A new histological evaluation method to detect residual ophthalmic viscosurgical devices for cataract surgery

PurposeTo establish a new evaluation method to quantify residual ophthalmic viscosurgical device (OVD) volume and corneal endothelium adhesion properties for phacoemulsification surgery. MethodsWe compared the performance of four OVDs (Viscoat®, Healon5®, Healon® and DisCoVisc®) using porcine eyes. First, OVDs were mixed with fluorescent-conjugated dextrans to render them visible under the microscope. A corneal side port was opened, followed by a continuous curvilinear capsulorhexis, and a corneal tunnel incision was made. OVDs were injected, then the lens was removed using one-handed phacoemulsification. After this procedure, the anterior segment of the eye was isolated via an equatorial incision and the tissue was immediately frozen in shimmering liquid nitrogen. Sagittal slices (20 μm) were cut with a Cryostat from limbus to limbus. Every tenth slide was imaged using a fluorescent microscope with a CCD camera. We evaluated the percentage of the corneal endothelium covered by each OVD as the OVD adhesion to corneal endothelium ratio (OAE ratio) and the volume of residual OVD in the anterior chamber. ResultsViscoat® showed significantly higher endothelium coverage compared with both Healon® and DisCoVisc®. A statistically larger volume of Healon5® remained in the anterior chamber compared with Healon® and DisCoVisc®. ConclusionThe new evaluation methods used here provide precise quantitative analysis of OAE ratio and residual OVD volume. These results show that Viscoat® and Healon5® have a high potential for coating the corneal endothelium during phacoemulsification and aspiration surgery.

Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure

BackgroundTo describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification.MethodsDescription of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification.ResultsPeripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet’s detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy.ConclusionsThis technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

An improved method of silicone oil removal combined with intraocular lens implantation in aphakic eye

Objective To observe the clinical effect of improved method of silicone oil removal combined with intraocular lens implantation in aphakic eyes. Methods A total of 89 aphakic eyes of 89 cases with silicone oil filling were enrolled. All cases had accepted lensectomy combined with vitrectomy and silicon oil tamponade for complicated retinal detachment and lens opacity, before surgery the corrected visual acuity were≥0.02. The laser photocoagulation on peripheral retina was done before operation. During operation, intraocular lens was implanted after silicone oil removal through a corneal limbus tunnel incision, and fixed in the ciliary sulcus by the suture was guided to the fornix with a circuitous way in the scleral layer. The patients were followed up for 3-6 months. The visual acuity, intraocular pressure, intraocular lens position and the condition of retinal redetachment were observed. Results In all 89 eyes, silicone oil removing and intraocular lens implantation were operated successfully. During operation, a small amount bleeding at the puncture site occurred in 2 eyes. Slight deviation of intraocular lens after operation occurred in 1 eyes and no diplopia, glare or other clinical symptoms.The postoperative uncorrected visual acuity was significantly improved (P<0.05). Conclusion Silicone oil removal through the corneal limbus tunnel incision combined with the lamellar scleral suture to fix intraocular lens is a safe, effective and easy surgical method for aphakic eye with silicone oil filling. The preoperative laser photocoagulation on peripheral retina may reduce the rate of recurrent retinal detachment. Key words: Aphakic eye; Silicone oil removal; Lens, intraocular; Retinal detachment

DIFFERENCES IN MORPHOLOGY OF CORNEAL TUNNEL INCISIONS CREATED WITH A FEMTOSECOND LASER OR A KERATOME

Based on optical coherence tomography, we compared the character and extent of structural changes occurring postoperatively in the corneal incision created with a femtosecond laser (Victus, Bausch &amp; Lomb, TPV, USA) or a keratome (2.2 mm, Mani, Japan). Our findings showed that a corneal tunnel incision created with a femtosecond laser was more beneficial because it was more accurate and allowed reproducibility of the specified profile and size parameters as well as the choice of the width, length, angle and profile parameters. The corneal tunnel incision created with a femtosecond laser caused minimal structural changes in the corneal incision postoperatively.

Clinical evaluation of surgery-induced astigmatism in cataract surgery using 2.2 mm or 1.8 mm clear corneal micro-incisions.

To evaluate corneal astigmatism after phacoemulsification using 2.2 mm or 1.8 mm clear corneal micro-incisions and its effects on visual function. Sixty cases (60 eyes) with cataract were randomly divided into groups A (n=30) and B (n=30) respectively underwent 2.2 mm and 1.8 mm clear corneal tunnel incision phacoemulsification combined with folding intraocular lens implantation from the time direction of 11:00. On day 1 and at 1, 4, and 6wk after operation, patients' vision was measured and both the corneal curvature and corneal thickness (CT) were recorded using Pentacam. The measured surgery-induced astigmatism (SIA) in both groups A and B peaked on day 1 after operation, and then gradually decreased and eventually stabilized in week 4. No statistically significant difference was found in corneal astigmatism between two groups (P>0.05). The measured corneal astigmatism at 4wk and 6wk postoperatively were 0.28±0.09 D and 0.27±0.10 D for groups A and 0.27±0.09 D and 0.25±0.10 D for groups B without statistically significant difference (P>0.05). In addition, no significant differences in visual acuity and CT were found between groups A and B before or after operation. Both 2.2 mm and 1.8 mm micro-incision cataract surgeries result in relatively small SIA with no difference in visual function and corneal astigmatism between two surgery approaches. Thus, the two types of surgical systems are safe and efficient for cataract treatment, by which satisfactory uncorrected visual acuity can be regained early postoperatively.

25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body.

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.

Comparison of the influence on tear film between scleral tunnel incision and clear corneal tunnel incision in phacoemulsification

Comparison of the influence on tear film between scleral tunnel incision and clear corneal tunnel incision in phacoemulsification

Comparison between Clear Corneal Incision and Scleral Tunnel Incision in Phacoemulsification on basis of post-surgical outcomes

To compare post-surgical astigmatism induced by phacoemulsification through 2.8mm clear corneal incision at steep axis versus superior scleral tunnel incision. This study was performed on 200 eyes of 198 patients of cataract reporting at Eye Department, SRMSIMS, Bareilly from July 2015 to December 2015. They were randomly assigned to two groups: Group A, 2.8mm clear corneal incision at steep axis group and Group B, the superior scleral tunnel incision group. Induced refractive change caused by corneal incision at steep axis showed an overall improvement in pre-operative astigmatism with minimum level of significance while post-surgical astigmatism induced by scleral tunnel incision was found out to be minimal with a good visual rehabilitation. Corneal incision at steep axis is an effective technique to reduce pre-operative astigmatism while scleral tunnel technique is suitable in cases where minimal change in pre-operative astigmatism is targeted.

Clear Corneal Phacovitrectomy with Posterior Capsulorhexis and IOL Implantation in Management of Selective Vitreoretinal Cases.

Purpose. To describe our technique, clear corneal phacovitrectomy with posterior capsulorhexis (CCPV), for the management of selected posterior segment intraocular foreign body (IOFB), posteriorly dislocated lens fragments (PDLF), and proliferative diabetic retinopathy (PDR) cases. Methods. This was a single-center retrospective interventional case series. In 21 patients (21 eyes) we performed phacovitrectomy through three clear corneal tunnel incisions (CCTI) and posterior capsulorhexis to remove IOFB (n = 8), PDLF from the vitreous cavity after complicated phacoemulsification (n = 6), and vitreous hemorrhage and epiretinal membranes in PDR (n = 7). The procedure was completed with implantation of a hydrophobic acrylic IOL through the CCTI. Results. The mean visual acuity (logMAR) was 0.90 preoperative and improved to 0.26 over a mean follow-up of 8.7 months (range, 6–12 months). The intraocular lens was implanted into the capsular bag (n = 12) or onto the anterior capsule (n = 9). One PDR patient experienced an intraprocedural complication, hemorrhage from isolated fibrovascular adhesions. One IOFB patient developed apparent anterior proliferative vitreoretinopathy and required a repeat intervention. Conclusion. Selected vitreoretinal IOFB, PDLF, and PDR cases can be successfully managed by a combined surgical approach involving clear corneal phacovitrectomy with posterior capsulorhexis and implantation of an IOL, with good visual outcome and a low complication rate.

Modified Scleral Suture Fixation Technique for Foldable IOL with Fenestrations in the Proximal Part of the Haptics

To present a modified surgical technique for scleral suture fixation of a new foldable intraocular lens (IOL) design with fenestrations in the proximal part of the haptics. An experimental model of a double continuous-loop 4-point scleral suture fixation of IOL with fenestrations in the proximal part of the haptics showed that with conventional techniques, the lens is located in a horizontal plane 90° to the expected iris plane. To achieve proper IOL positioning, we modified the technique so as to perform 2 needle passes through the sclera for each haptic in the same meridian, resulting in the external part of the suture being radial to the limbus. The technique was performed in 14 eyes. Mean follow-up time was 9.8 months. In all cases, the lens was successfully implanted through clear corneal tunnel incision and the scleral fixation, as mentioned above, was performed with the use of Hoffman scleral pockets. Good centration of the IOLs without signs of tilt was achieved. It is possible to decrease the risk of tilt of the IOL with fenestrations in the proximal part of the haptics by modifying the technique so that the 2 needle passes through the sclera for each haptic are done in the same meridian, resulting in a layout of the external part of the suture being radial to the limbus.

Aspergillus terreus Infection in a Sutureless Self-sealing Incision Made During Cataract Surgery

Here, we describe a case of keratitis caused by Aspergillus terreus in an 80-year-old immunocompetent woman 1 month after uneventful cataract surgery. The patient presented with decreased visual acuity (20/50) and severe pain in her right eye. Examination revealed a 3.5 × 4.5 mm white-colored deep stromal infiltration located on the temporal corneal tunnel incision. Corneal scraping samples were obtained for cytological and culture examinations. The cinnamon-brown colonies consisting of a dense felt of conidiophores were identified as A. terreus using molecular data. Using CLSI M38-A2 microdilution method, minimum inhibitory concentration values of amphotericin B, itraconazole, voriconazole, and posaconazole were determined to be 2, 1, 0.25, and 1 μg/ml, respectively, and minimum effective concentration values of caspofungin and anidulafungin were ≤0.03 and ≤0.03, respectively, at 48 h for the A. terreus strain. Antifungal therapy was started as topical 1 % voriconazole drops hourly and 5 % natamycin ointment five times a day; however, corneal infection and melting progressed despite the ongoing intensive treatment and visual acuity dropped to the 20/200 level at the end of the first week. Amniotic membrane transplantation was performed to promote corneal healing. Topical medication was tapered and discontinued within 2 months based on the clinical features. The ulcer healed with scarring and vascularization, and visual acuity improved to 20/50. In conclusion, A. terreus is a very uncommon cause of mycotic keratitis and is especially rare after cataract surgery. We suggest that early and accurate diagnosis and appropriate treatment of A. terreus keratitis may have a major impact on preventing severe disease complications.

In vitro immunohistochemical and morphological observations of penetrating corneal incisions created by a femtosecond laser used for assisted intraocular lens surgery

To compare inflammatory cell response and morphological aspects of femtosecond laser-created corneal incisions. Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. Experimental study. In 16 of 22 human corneoscleral buttons, clear corneal tunnel incisions were created using a femtosecond laser (Lensx) with 7 μJ laser pulse energy on the outer periphery and manually using a phaco knife on the respective opposite side (180 degrees). In 6 corneas, no treatment was performed (controls). Corneas were then kept in organ culture for 12 or 48 hours, and the inflammatory reaction was evaluated using standard immunofluorescence analyses for monocytes (CD11b) and for dendritic cells (HLA-DR). For morphological analyses and apoptosis, van Gieson staining and terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling was performed. There were no statistically significant differences in inflammatory cell response between femtosecond laser corneal incisions and manually performed incisions. Apoptosis was significantly more pronounced in the femtosecond incisions. The ratio of dendritic cells between femtosecond incisions and manual incisions was 1:2 (12 hours and 48 hours; P=.07), the ratio of monocytes was 1:2 (12 hours and 48 hours; P=.08), and the ratio of apoptotic cells was 1:5 (12 hours) and 1:6 (48 hours) (P=.02). Femtosecond laser incisions showed a more sawtooth-like cutting edge than manual incisions. Femtosecond laser-created corneal incisions in human corneas showed no differences in inflammatory cell response but a significantly higher cell death rate than manually performed incisions, indicating an upregulated postoperative wound-healing response. Proprietary or commercial disclosures are listed after the references.

Technology of phacoemulsification in extensive zonular defects of zinn ligament fibers

Aim. To describe the technique and to assess the results of phacoemulsification in eyes with extensive zonular defects of Zinn ligament fibers. Methods. Phacoemulsification was performed through a 2.2- mm corneal tunnel incision on adhesive viscoelastic bed. The lens was stabilized with a capsular tension ring. The operation was finished with intraocular implantation and its suturing to the iris. The study included 36 patients [42 eyes, 23 males (63.9%), 13 females (36.1%)] in whom phacoemulsification has been performed. Visual acuity before surgery ranged from 0.01 to 0.7 (mean 0.2±0.18). Intraocular pressure ranged from 15 to 25 mm Hg (mean 19.2±4.5 mm Hg). Corneal astigmatism value before surgery ranged from 0 to 2.25 D (mean 0.87±0.63 D). Results. Postoperatively the following complications were observed: an inflammatory reaction in 3 eyes (7.1%), inflammation of Descemet’s membrane in 3 (7.1%) cases, ocular hypertension in 9 (21.4%) eyes. All the complications were drug treated within 3-5 days. On the second day mean visual acuity was assessed as 0.56±0.12,1 month after surgery - 0.70±0.16,6 months after surgery - 0.75±0.21, and 1 year after surgery - 0.74±0.19. Corneal induced astigmatism 1 year after the surgery ranged from 0.0 to 1.5 D (mean 0.39±0.16 D). Conclusion. The presented technology of phacoemulsification is relatively safe, effective and provides a possibility to rehabilitate patients with cataract combined with extensive zonular defects of Zinn ligament fibers in minimal terms.