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Peculiarities of surgical technique using a capsule ring for intra-capsular fixation of IOL in children with congenital subluxation of the lens

https://doi.org/10.21516/2072-0076-2019-12-2-26-31

Abstract

The aim of the work is to develop a differentiated method of surgical treatment of children with congenital ectopia of the lens using a capsule ring and intra — capsule fixation of IOL.

Material and methods. 15 children (28 eyes) at the age of 5–8 years with congenital ectopic lens I–III degree with the syndrome of Marfan, Weil — Marchesani, homocystinuria and isolated pathology were operated. The lens was removed after the introduction of the capsular ring by the method of phakoaspiration and aspiration — irrigation using viscoelastics. One-pieces models of the Acrysof IOL SN60AT and Hoya iSert model 251 were implanted. Anterior capsulorhexis was performed manually (сystotomy, needle, collet tools) and/or using an YAG laser. After hydrodissection of the lens masses, the ring was injected in the capsular bag using the injector, and then removed the lens masses and implanted a one-piece IOL.

Results. The technique of performing individual stages was determined by the lens ectopia degree. At I–II degree of ectopia, manual or YAG-laser circular anterior capsulorhexis was performed. Limited anterior vitrectomy was performed in the zone of lens displacement at the III degree of ectopia and the presence of vitreous body. Visual acuity before surgery was from 0.04 to 0.1–0.15, after surgery — 0.1–0.15 — 0.6.

Conclusion. The use of differentiated methods of different stages of surgery and the intra — capsule ring in congenital ectopia of the lens allows intra-capsular IOL implantation with high functional and anatomical results at a low level of intra-and postoperative complications.

About the Authors

L. A. Katargina
Moscow Helmholtz Research Institute of Eye Diseases
Russian Federation

Dr. Med. Sci., Professor, deputy director

14/19, Sadovaya-Chernogryazskaya str., 105062, Moscow




T. B. Kruglova
Moscow Helmholtz Research Institute of Eye Diseases
Russian Federation

Dr. Med. Sci., senior researcher, department of children eye pathology, Professor, chair of continuing medical education

14/19, Sadovaya-Chernogryazskaya str., 105062, Moscow 



N. S. Egyian
Moscow Helmholtz Research Institute of Eye Diseases
Russian Federation

Cand. Med. Sci., department of children eye pathology, head of the surgical unit

14/19, Sadovaya-Chernogryazskaya str., 105062, Moscow 



N. N. Arestova
Moscow Helmholtz Research Institute of Eye Diseases; Moscow Evdokimov State Medical Stomatologic University, Faculty of Postgraduate Education
Russian Federation

Dr. Med. Sci., leading researcher, department of children eye pathology, associate professor, chair of ophthalmology

14/19, Sadovaya-Chernogryazskaya str., 105062, Moscow 

20, bild. 1, Delegatskaya st., 127473, Moscow





References

1. Avetisov S.E., Kovalevskiy E.I., Khvatova A.V. Guidelines for pediatric ophthalmology. Мoscow: Meditsina; 1987 (in Russian).

2. Badalyan L.O., Tabolin V.A., Vel'tishchev Yu.E. Hereditary diseases in children. Мoscow: Meditsina; 1971 (in Russian).

3. Bobrova N.F., Skripnichenko Z.M. Toxic, congenital and secondary cataracts. Odessa: Izdatelskiy tsentr; 2017 (in Russian).

4. Cross H., Jensen A. Ocular manifestation in the Marfan,s syndrome and homocystinuria. Am. J. Ophthalmol. 1973; 75: 405–20.

5. Fuchs J., Rosenberg T. Congenital ectopialentis. Acta Ophthalmologica Scandinavica. 1998; 76: 20–6.

6. Khvatova A.V. Lens diseases in children. Leningrad: Meditsina; 1982 (in Russian).

7. Pashtayev N.P. Surgery of subluxation and luxation lens into the vitreous body. Cheboksary: Izdatel'stvo GOU IUV; 2006 (in Russian).

8. Shilovskikh O.V., Ivanov D.I. Classification and selection of surgical tactics for the treatment of congenital ectopies of the lens. Oftalmokhirurgiya. 2005; 4: 19–23 (in Russian).

9. Zubareva L.N., Ovchinnikova A.V., Korobkova G.V., Marchenkova T.Ye., Gavrilyuk A.S., Khvatov V.N. Clinic and treatment of congenital lens subluxations in children. Rossiyskaya pediatricheskaya oftalmologiya. 2007; 3: 24–7 (in Russian).

10. Bobrova N.F., Khmaruk A.N., Pashengor T.E. Features of the clinic and surgical removal of lens subluxations in Marfan syndrome. Oftal'mologicheskiy zhurnal. 2001; 4: 27–33 (in Russian).

11. Zaydullin I.S., Aznabayev R.A., Absalyamov M.Sh. Intrascleralintracapsular fixation of flexible IOLs in lens subluxation in children. Vestnik oftal'mologii. 2009; 4: 27–9 (in Russian).

12. Malyugin B.E., Pokrovskiy D.F., Semakina A.S. Clinical and functional results of iridocapsular fixation of IOL with defects in the ligamentous apparatus of the lens. Oftal'mokhirurgiya. 2017; 1: 10–15 (in Russian).

13. Senchenko N.Ya. Optimization of lens ectopia surgical treatment methods in children with Marfan syndrome. Oftal'mokhirurgiya. 2014; 3: 26–31 (in Russian).

14. Shilovskikh O.V., Fechin O.B., Deryabin V.V. New technology of intraocular correction in Marfan syndrome. Oftal'mokhirurgiya. 2003; 2: 7–9 (in Russian).

15. Hoffman R.S., Snyder M.E., Devgan U., et al. Management of the subluxated crystalline lens. J. Cataract. Refract. Surg. 2013; 39: 1904–15. http://dx.doi.org/10.1016/j.jcrs.2013.09.005

16. Rodrigo B.J, Paulina L.E, de R.Frances M., Eduardo T.J., Alejandro N. Intraocular lens subluxation in Marfan syndome. The Open Ophthalmol. J. 2014; 8: 48–50. doi: 10.2174/1874364101408010048

17. Katargina L.A., Kruglova T.B., Arestova N.N., Egiyan N.S. Manual and YAG-laser anterior capsulorhexis in surgery of congenital ectopia of the lens in children. Rossiyskaya pediatricheskaya oftalmologiya. 2018; 13 (1): 26–30 (in Russian).

18. Pashtayev N.P., Kulikov I.V. Cataract surgery with lens subluxation. Prakticheskaya meditsina. 2017; 2 (9): 155–8 (in Russian). Avaible at: http://pmarchive.ru/xirurgiya-katarakty-s-podvyvixomxrustalika/19. Chee S.P., Wong M.H., Jap A. Management of severely subluxated cataracts using femtosecond laser-assisted cataract surgery. Am. J. Ophthalmol. 2017; 173 (Jan.): 7–15. doi: 10.1016/j.ajo.2016.09.021

19. Ioshin I.E. Intracapsular ring in cataract surgery for lens subluxation (experience of 15 years implantation). Vestnik oftal'mologii. 2012; 2: 45–9 (in Russian).

20. Malyugin B.E., Golovin A.V., Uzunyan D.G., Isayev M.A. Features of the technique and the results of microinvasive phacoemulsification using the original model of the intracapsular ring in patients with extensive defects in the ligamentous apparatus of the lens. Oftal'mokhirurgiya. 2011; 3: 22–6 (in Russian).

21. Grinev A.G. The use of intracapsular rings of various designs in cataract surgery. Permskij medicinskij zhurnal. 2008; 3: 48–53 (in Russian).

22. Fokin V.P., Dzhashi B.G. Results of the use of capsular rings in surgery for complicated cataracts. Sovremennyye tekhnologii v oftal'mologii. 2014; 3: 103–4 (in Russian).

23. Cionni R.I., Ocber R.H. Management of profound zonular dialysis or weakness with a new endocapsular ring designed for sclera fixation. J. Cataract Refract. Surg. 1998; 24 (10): 1299–306.

24. Jacob S., Agarwal A., Agarwal A., et al. Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis. J. Cataract. Refract. Surg. 2002; 29 (2): 315–21.

25. Arestova N.N., Khvatova A.V. Combined laser-microsurgical method for the treatment of congenital lens subluxation in children. Patent RF 2197927; 2000 (in Russian).

26. Neroev V.V., Arestova N.N. Laser reconstructive surgery for diseases of the eye in children. Moskva: Izdatel'stvo RAS; 2018 (in Russian).

27. Yegorova E.V., Ioshin I.E., Tolchinskaya A.I. Device for expanding the capsular bag. Application for utility model 2000103918/20; 2000 (in Russian).

28. Kruglova T.B., Kononov L.B. Features of the calculation of the optical power of an intraocular lens implanted in children of the first year. Vestnik oftal'mologii. 2013; 4: 66–9 (in Russian).

29. Katargina L.A., Kruglova T.B., Yegiyan N.S., Kononov L.B. Extraction of congenital cataracts with IOL implantation in complicated lens forms. Prakticheskaya meditsina. Oftal'mologiya. 2012; 2 (4): 28–30 (in Russian).


Review

For citations:


Katargina L.A., Kruglova T.B., Egyian N.S., Arestova N.N. Peculiarities of surgical technique using a capsule ring for intra-capsular fixation of IOL in children with congenital subluxation of the lens. Russian Ophthalmological Journal. 2019;12(2):26-31. (In Russ.) https://doi.org/10.21516/2072-0076-2019-12-2-26-31

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ISSN 2072-0076 (Print)
ISSN 2587-5760 (Online)