Minimally invasive technique for the correction of luxation of the lens into the vitreous and in-the-bag IOL implantation
D.V. Zhmuryk, Cand Sc (Med)
Kyiv Municipal Clinical Eye Hospital “Eye Microsurgery Center”
Background: The availability of a variety of the methods proposed for the removal of luxated lens and implantation of the intraocular lens (IOL) can make us conclude that, currently, there is no unified surgical tactics for this disorder.
Purpose: To develop a minimally invasive technique for the correction of luxation of the lens into the vitreous and in-the-bag IOL implantation.
Materials and Methods: Twenty five patients were operated on for the lens luxation secondary to ocular contusion and followed up for a mean of 3 years during September 2011 to February 2016 at the Kyiv Eye Microsurgery Center. Preoperatively, the mean best-corrected visual acuity (BCVA) was 0.14 ±0.16 (range, light perception with accurate projection to 0.5), and the mean intraocular pressure (IOP) was 19.74 ± 2.64 mmHg (range, 18 to 27 mmHg).
Results: At day 2, month 1, month 3, month 6, and month 12 following surgery, the BCVA was 0.37 ± 0.21, 0.54 ± 0.20, 0.58 ± 0.23, 0.56 ± 0.22 and 0.57 ± 0.19, respectively (Table 1), and surgically induced astigmatism averaged 1.31 ± 0.62 D, 0.95 ± 0.36 D, 0.75 ± 0.31 D, 0.61 ± 0.25 D and 0.56 ± 0.22 D, respectively.
Conclusions: The technique presented allows the surgeon to remove the lens through a small self-sealing incision, with a low incidence of intraoperative and postoperative complications; to implant any soft IOL designs; to restore the normal structure of the eye; and to make an IOL stable and well-centered, with surgically induced astigmatism averaged 0.56±0.22 D and preservation of or improvement in visual acuity to 0.5 or better at the 12 months.
Key words: luxation of the lens into the vitreous, surgical treatment, in-the-bag IOL implantation
1.Pashtaev NP. [Lens dislocation: Classification and modern management strategies].
2.In: [Fedorov SN, editor. Current issues of surgery of the lens, vitreous and retina: A Collection of Works]. Moscow: Eye Microsurgery Research Institute; 1986. p. 34–7. Russian
3.Miroshnikov VV. [Technique for correction of aphakia in the absence of capsular support]. Modern Technologies in Ophthalmic Surgery. 2015;4(8):72–3 Russian
4.Pershin KB. [Pseudophakia surgery]. In: [Proceedings of the 5th Russian National Round Table on Macula]; 2012 May 18-20; Rostov-on-Don (Russia); 2012. p.220–6 Russian
6.Livshitz SA. [Developing optimum ultrasound exposure parameters for phacoemulsification with IOL implantation]. [Abstract of Cand Sc (Med) thesis]. Moscow: Eye Microsurgery Complex; 1997. 20 p. Russian
7.Berger RE. Intraocular lens placement after removal of a subluxated lens. Ophthalmic Surg. 1994 Sep-Oct;25(9):657–8
8.Bessarabov AN, Komatova MG. [Mathematical model for the effect of phaco ultrasound the detached and attached retina]. In: [Proceeding of the 1st Eurasian Conference on Ophthalmic Surgery]. Ekaterinburg, 1998. p.8–9. Russian
9.Chang S, Zimmerman NJ, Iwamoto T et al. Experimental vitreousreplacement with perfluorotributylamine. Am J Ophthalmol. 1987 Jan 15;103(1):29–37
10.Miyamoto K, Refojo MF, Tolentino FI, et al. Perfluoroether liquid as a long-term vitreous substitute: an experimental study. Retina. 1984; 4:264–8
11.Monteiro M, Marinho A, Borges S, et al. Scleral fixation in eyes with loss of capsule or zonule support. J Cataract Refract Surg. 2007 Apr;33(4):573–6
12.Kumar DA, Agarwal A, Prakash G, et al. Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye (Lond). 2010 Jul;24(7):1143–8
13.Chang S, Lincoff H, Zimmerman NJ et al. Giant retinal tears. Surgical techniques and results using perfluorocarbon liquids. Arch Ophthalmol. 1989 May;107(5):761–6
14.Kaiura TL, Seedor JA, Koplin RS, et al. Complications arising from iris-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2005 Dec;31(12):2420–2