Capsular Tension Segments for Dislocated Cataract Extraction by Phacoemulsification
Narrative Responses:
Purpose
Phacoemulsification and in-the-bag IOL placement is the preferred method of cataract surgery. In the event of zonular compromise there is a risk of instability and decentration of the IOL/bag complex. Capsular tension segments sutured to sclera can provide additional support in these cases.
Methods
Retrospective case series (n=82) from a single surgeon. Cases were identified from billing records. Charts were reviewed from the years 2005 to 2013 for outcomes of final BCVA, Refraction, Intraoperative complications (e.g. endophthalmitis) and postoperative complications (retinal detachment, IOL/bag/complex subluxation).
Results
Average LogMAR final BCVA was 0.42 (Snellen approx 20/40). LogMAR BCVA significantly improved from PreOp to PostOp (p<0.001). The Mean Absolute Error was 0.8D (SD +/- 0.7D). Toric IOLs were implanted in 27.7% of cases. Multifocal IOLs were used in 2.4% of cases. There was 1 case of retinal detachment, 1 case of endothelial decompensation and one case of anterior capsular tear. There were no cases of posterior capsular rupture, endophthalmitis, UGH, or CME. 8 cases had suture breakage occurred; involving only prolene sutures at an average of 56 months (SD +/- 27 months) postoperatively.
Conclusion
This study shows capsular tension segments are a reasonably safe method to support the IOL/bag complex in cases of compromised zonules. Preservation of the bag enables placement of iris prosthesis, and advance technology IOLs. Capsular tension segments allow for advanced anterior segment reconstruction in a modular fashion using small incisions.