dr. purendra bhasin gwalior - india ascrs conference, boston 2010 managing subluxated lens with...
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Dr. Purendra Bhasin Gwalior - India
ASCRS Conference, Boston 2010
Managing Subluxated Lens with Phaco using Iris Retractors and Capsular
Tension Ring
DECLARATION No financial assistance is taken from any company for the work done in this study
Present study is done to ascertain the safety of managing 27 cases of subluxated cataract by phacoemulsification using Iris
Retractors and a Capsular Tension Ring (CTR)
Iris Retractors when placed at the capsulorrhexis margin :
Stretches the rim of the Capsular bag Provide stability to the Capsular Bag Counteracts traction forces of aspiration Prevents risk of extension of zonular dialysis Prevents vitreous prolapse in the AC
Aim
Implantation of CTR after PE & cortex aspiration
Helps maintain the shape of capsular bag Prevents late capsular fibrosis syndrome Prevents late IOL decentration Prevents PCO
Capsular Tension Ring
Cause of Subluxation
Post traum 19 Myopia 5 Marfans 2 Homocyst. 1
52
1
19
0
24
6
810
12
14
1618
20
1 2 3 4
Age Group
10-20yr. 5 cs. 20-30yr. 6cs. 50 & above 4 cs.30-40yr. 8 cs. 40-50yr 4cs.
56
8
4 4
0
1
2
3
4
5
6
7
8
9
10-20
20-30 30-40
40-50 50 & above
Surgical Technique
Anaesthesia
Peribulbar Anaesthesia Not the Topical
Incision
Clear corneal incisions Away from the site of zonular dialysis
Capsulorrhexis
Start from the area of intact zonules
Relatively difficult to perform because - Capsular instability/lax capsule Capsular thickening /fibrosis
Surgical technique
Surgical Technique
Iris Retractors
Stab incision is given in the area of subluxation
Iris retractors are then placed at the capsulorhexis margin
Degree of sublux. will determine the no. of retractors to be placed
Hydrodissection/Hydrodelineation
Hydromaneuvers are performed slowly & meticulously to ensure complete freeing of nucleus
Surgical Technique
PhacoemulsificationDone in slow motion with low parameters ;
low vacuum, low flow rate and low power
Avoid radial aspiration of the nucleus & Cx
PE can be done in the bag when nucleus is soft & in the AC if the nucleus is hard
Surgical technique
Capsular Tension Ring
Implanted in the capsular bag through the side port CTR injector Scleral fixation of CTR- in more than
180°subluxation
Large optic IOL is implanted in the bag Haptics placed in the meridian of the zonular disinsertion Check the stability of the IOL & capsular bag at the end
IOL Implantation
Follow up
Follow up >6 mths. To 3 yrs.23 cases Uneventful 4 Post Tr. Cases Developed CME (managed medically)
Results
26 cases with different degree of subluxation were managed successfully by this technique. 1 case with > 280 subluxation was converted and managed separately
Follow Up & Results
Conclusion
• Phaco using Iris retractors at CCC margin makes the technique safe & provides excellent surgical control
• Implanting CTR in the bag ensures long term integrity, shape of bag and centering of IOL