Technique for Capsular Bag Stabilization in Cases of Zonular Insufficiency Using High-Viscosity OVDs
Narrative Responses:
Purpose
We have developed a novel technique for capsular bag distention and stabilization using highly cohesive/viscoadaptive ophthalmic viscosurgical devices (OVD) with or without early insertion of capsular tension rings (CTR) during cataract extraction and intraocular lens (IOL) implantation in cases of zonular insufficiency.
Methods
Highly retentive OVD is instilled over the area of zonular weakness to prevent vitreous prolapse and over the anterior capsule to flatten the surface and facilitate capsulorhexis. The capsule is stained with trypan blue, capsulorhexis is performed, followed by insufflation of the capsular bag with retentive OVD, which remains distended without capsular hooks. The cataract is removed by phacoemulsification with periodic re-instillation of OVD. A CTR is inserted prior to or following phacoemulsification and a capsular ring segment is secured with polytetrafluoroethylene sutures through a preplaced scleral groove. An IOL may then be placed within the stabilized capsular bag.
Results
Capsule sparing cataract surgery in the setting of zonular weakness (e.g. Marfan’s syndrome, trauma) may result in better outcomes yet presents surgical challenges. One challenge has been early stabilization of the capsular bag prior to CTR insertion and traditionally has employed capsular hooks or similar devices, which can tear the capsule and provide only partial support. This novel technique has resulted in immediate and long term stability of the IOL/zonular/capsular bag complex with excellent visual outcomes and has facilitated the use of multifocal lenses in patients in whom such options may not have been feasible given zonular weakness.
Conclusion
The use of highly retentive OVD to distend and stabilize the capsular bag is a safe and effective method for cataract extraction and in-the-bag IOL implantation in the setting of zonular insufficiency.