Purpose: We evaluated phacoemulsification and aspiration (PEA) using a T-shaped capsular hook (capsule expander: CE) and intraocular lens (IOL) fixation in cases with a weak ciliary zonule.
Methods: This study investigated 13 eyes in 11 consecutive cases with ciliary zonular dehiscence, wherein the patients underwent PEA using CE. We evaluated the degree of ciliary zonular dehiscence, the area during PEA not covered with an anterior capsule, complications, and postoperative endothelial cell loss (ECL). To measure the uncovered area, we captured still images from an intraoperative video footage, traced the margins of the capsule edge and ciliary body, and measured the area enclosed by the tracing with image analysis software.
Results: The average degree of ciliary zonular dehiscence was 152.1±40.7°. We use two to five CEs to suspend the lens capsule during PEA. The percentage of uncovered area to the pupil area during the procedure was 2.3±2.8%, which was significantly decreased compared with that during no CE suspension (p＜0.001). There were no intraoperative complications such as nucleus drop or vitreous prolapse. Scleral suture fixation of IOL was performed in ten eyes, in-the-bag IOL fixation with capsular tension ring (CTR) insertion was performed in two eyes, and in-the-bag IOL fixation with CTR and sclera fixation of anterior capsule using modified capsule expander (M-CE) was performed in one eye. ECL 1 year postoperatively was 9.8%.
Conclusions: PEA with the aid of CE is very effective in cases with ciliary zonular dehiscence. It is desirable to select IOL fixation as the surgical procedure, and this may involve either scleral suture fixation of IOL, in-the-bag IOL fixation with CTR insertion, or in-the-bag IOL fixation using M-CE based on the degree of ciliary zonular weakness and strength of the remaining ciliary zonule.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 435-443, 2018.