Capsular tension ring implantation in cataract patients with pseudoexfoliation

Yıl 2010, Cilt: 37 Sayı: 1, 35 - 41, 01.03.2010

Banu Torun Acar Suphi Acar

Öz

Purpose: To investigate the influence of capsular tension ring (CTR) on prevention of intraoperative complications due to zonular weakness and increased capsular fragility during phacoemulsification of cataracts with pseudoexfo­liation. Materials and methods: 148 eyes of 148 patients who had cataract with pseudoexfoliation underwent pha­coemulsification surgery included. 74 eyes of the first group (study group) were implanted with CTR after hy­drodissection, while CTR was not performed in 74 eyes of control group (Group 2). In both groups, intraoperative complications such as zonular dialysis, conversion to ex­tracapsular cataract extraction (ECCE) or intracapsular cataract extraction (ICCE), posterior capsular rupture, vitreus loss, and early postoperative complications were recorded and compared between two groups. Results: In group 1, no complication occurred in 64 eyes (86.5%) and intraocular lens (IOL) implanted in the bag. In 10 eyes (13.5%) posterior capsule rupture occurred, in 4 of them converted to ECCE, IOL implanted in four eyes. In other 6 eyes, phacoemulsification completed un­derlay viscoelastic. In group 2, no complication occured in 42 eyes and IOL implanted in the bag. In 10 patients (13.5%) zonular dialysis occurred, in 4 of them IOL im­planted in the bag and in 6 of them converted to ICCE and IOL implanted in anterior chamber. Posterior capsule rup­ture occurred in 20 eyes (27.0%), all of them converted to ECCE and IOL was implanted. In 2 eyes capsullorrhexis occurred and converted to ECCE, IOL was implanted in sulcus. Conclusion: In patients with pseudoexfoliation, CTR im­plantation in phacoemulsification simplified the surgery, increased the rate of IOL implanted in the bag and pre­vented complications like IOL desantralization after sur­gery.

Anahtar Kelimeler

pseudoexfoliation, phacoemulsification, cap­sular tension ring, outcome

Psödoeksfoliasyonlu katarakt hastalarında kapsül germe halkası uygulanması

Öz

Amaç: Psödoeksfolyasyonlu katarakt olgularında, fako­emülsifikasyon sırasında kapsül germe halkası (KGH) implantasyonunun, zonül zayıflığı ve artmış kapsül fraji­litesine bağlı gelişebilecek komplikasyonları önlemedeki başarısını değerlendirmek. Gereç ve Yöntem: Fakoemülsifikasyon cerrahisi yapılan psödoeksfolyasyonlu 148 hastanın 148 gözü çalışmaya alındı. Grup 1\'deki (çalışma grubu) 74 göze hidrodissek­siyonu takiben KGH uygulandı, kontrol grubundaki (Grup 2) 74 göze ise KGH uygulanmadı. Tüm olgularda ame­liyat sırasında gelişen zonül diyalizi, arka kapsül rüptü­rü, ekstrakapsüler katarakt ekstraksiyonu (EKKE) ya da intrakapsüler katarakt ekstraksiyonu (İKKE)\'ye dönme, vitreus kaybı gibi intraoperatif komplikasyonlarla, erken postoperatif komplikasyonlar kaydedilerek, sonuçların gruplar arası karşılaştırılması yapıldı. Bulgular: Grup 1\'de 74 gözün 64\'ünde (%86.5) kompli­kasyon gelişmedi ve kapsül içi göz içi lens (GİL) kondu, 10 gözde (%13.5) arka kapsül perfore oldu, bunların 4\'ünde EKKE\'ye geçilerek 2\'sine sulkus lensi, 2\'sine ön kamara lensi kondu. Diğer 6 gözde (%8.1) ise; fakoemülsifikasyon tamamlanarak 4 GİL sulkusa, 2 GİL ön kameraya kondu. Grup 2\'de ise 74 gözün 42\'sinde (%56.8) komplikasyon gelişmedi ve hepsine kapsül içi GİL kondu, 10 hastada (%13.5) zonül diyalizi oldu, bunların 4\'ünde hafif diyaliz vardı ve fakoemülsifikasyon tamamlanarak kapsül içi GİL kondu, 6 gözde ileri derecede zonül diyalizi görüldü ve hepsinde İKKE\'ye geçilerek, ön kamara GİL kondu. Yirmi gözde (%27) arka kapsül perforasyonu gelişti, hepsinde EKKE\'ye geçildi, EKKE\'ye geçilen 14 gözde (%18.9) sul­kusa, 6 gözde ön kameraya GİL implantasyonu yapıldı, 2 gözde kapsüloreksis perifere kaçtığı için EKKE\'ye geçildi ve GİL kondu. Sonuç: Psödoeksfolyasyonlu hastalarda katarakt cerra­hisinde KGH kullanımının; zonül hasarını engelleyip fako­emülsifikasyonu kolaylaştırdığı, kapsül içi GİL implantas­yonu oranını arttırdığı, cerrahi sonrası GİL desantralizas­yonu oluşumunu önemli ölçüde engellediği görüldü.

Anahtar Kelimeler

Psödoeksfolyasyon, fakoemülsifikas­yon, kapsül germe halkası, sonuç

Kaynakça

• Linebarger EJ, Hardten DR, Shah GK, Lindstrom LR. Pha- coemulsification and modern cataract surgery. Surv Oph- thalmol 1999;44:123-147.
• Kelman CD. The history and development of phacoemulsifi- cation. Int Ophthalmol Clin 1994;34:1-12.
• Fine IH, Hoffman RS: Phacoemulsification in the presence of pseudoexfoliation: challenges and options. J Cataract Re- fract Surgery 1997;23:160-165.
• Skuta LG, Parrish KR. Zonular dialysis during extracapsu- lar cataract extraction in pseudoexfoliation syndrome. Arch Ophthalmol 1987;105:1318-1319.
• Hara T, Hara T, Yamada Y: ”Equator ring” for maintenance of the completely circular contour of the capsular bag equator after cataract removal. Ophthalmic Surg 1991;22:358-359.
• Hara T, Hara T, Sakanishi K, Yamada Y: Efficacy of equa- tor rings in an experimental rabbit study. Arch Ophthalmol 1995;113:1060-1065.
• Cionni RJ, Osher RH: Management of profound zonular di- alysis or weakness with a new endocapsular ring designed for scleral fixation. J Cataract Refract Surg 1998;24:1299- 1306.
• Legler UFC, Witschel BM: The capsular ring: a new device for complicated cataract surgery. German J ophthalmol 1994;20:417-420.
• Menapace R, Findl O, Georgopoulos M, Rainer G, Vass C; Schmettere K. The capsular ring: Designs; applications and techniques. J Cataract Surg 2000;26:898-912 .
• Cionni RJ, Osher RH, Marques DM, Marques FF, Synder ME, Shapiro S. Modified capsular tension ring for patients with congenital loss of zonular support. J Cataract Surg 2003;29:1668-1673.
• Gimbel HV, Sun R, Heston JP; Management of zonular dialysis in phacoemulsification and IOL implantation us- ing the capsular tension ring. Ophthalmic Surg Lasers 1997;28:273-281.
• Freyler H, Radax U. pseudoexfoliation syndrome –a risk factor in modern cataract surgery? Klin Monatsbl Augen- heilkd 1994;205:275-279.
• Schlötzer SU, Naumann OG. A histopatholologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol 1994;118:730-733.
• Wirbelauer C, Anders N, Pham DT, Wollensek J, Corneal endothelial cell changes in pseudoexfoliation syndrome af- ter cataract surgery. Arch Ophthalmol 1998;116:145-149.
• Bayraktar S, Atlan T, Küçüksümer Y, Yılmaz ÖF. Capsular tension ring implantation after capsulorhexis in phacoemül- sification of cataracts associated with pseudoexfoliation syndrome: intraoperative complications and early postoper- ative findings. J Cataract Refract Surg 2001;27:1620-1628.
• Fine IH. Cortical cleaving hydrodissection. J Cataract Re- fract Surg 1992;18:508-512.
• Yüksel N, Karabaş VL, Arslan A, Demirci A, ÇağlarY. Ocu- lar hemodynamics in pseudoexfoliation syndrome and pseu- doexfoliation glaucoma. Ophthalmology 2001;108:1043- 1049.
• Puska P, Tarkanken A. Exfoliation Syndrome as a risk fac- tor for cataract development: five-year follow-up of lens opacities in exfoliation syndrome. J Cataract Refract Surg 2001;27:1992-1998.
• Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001;45:265-315.
• Lumme P, Laatikainen L. Exfoliation syndrome and cata- ract extraction. Am J Ophthalmol 1993;116:51-55.
• Scorolli L, Campo EC, Bassien L, Meduri RA. Pseudo- exfoliation syndrome: a cohort study on intraoperative complications in cataract surgery. Ophthalmologica 1998; 212:278-280.
• Guzek JP, Holm M, Cotter JB, et al. Risk factors for intraop- erative complications: 1000 extracapsular cases. Ophthal- mology 1987;94:461-466.
• Ermiş SS, İnan ÜÜ, Öztürk F: The Effect of Pseudoexfolia- tion syndrome in phacoemulsification cataract surgery and small anterior chamber depth as a risk factor. MN Oftal- moloji Dergisi 2002;4:319-323.
• Aslan BS, Altıparmak UE, Duman S. Psödoeksfolyatif sendromlu gözlerde fakoemülsifikasyon sırasında kapsül germe halkası uygulanımının cerrahi komplikasyonlara et- kisi. Türk Oftalmoloji Gazetesi 2003;33:596-599.
• Köz ÖG, Yarangümeli A, Akyol S, Kural G. Kapsül germe halkası ile fakoemülsifikasyon cerrahisi uygulanan psödo- eksfolyasyonlu olgularda glokom ve postoperatif sonuçla- rın ilişkisi. MN Oftalmoloji Dergisi 2004;11:114-117.
• Fries UK, Ohrloff. C. Ultrasound biomicroscopy image of the capsula supporting ring in pseudophakia. Klin Monatsbl Augenheilkd 1996;209:211-214.
• Drolsum L, Haaskjold E, Sandvig K. Phacoemulsification in eyes with pseudoexfoliation J Cataract Refract Surg 1998;24:787-792.