Clinical applications of capsular tension rings in cataract surgery

BACKGROUND: Although the open capsular tension ring was designed to manage zonular dialysis during cataract surgery, it also lowers the incidence of capsule contraction, stabilizes the capsular bag, and enhances IOL centration. With appendages, it provides a partial solution for those eyes with colobomata and aniridia. MATERIALS AND TECHNIQUES: Subsequent modifications to the capsular tension ring include the Cionni ring, capsular edge ring, coloboma ring, and aniridia ring. A square-edge design may inhibit posterior capsule opacification, and the aniridia and coloboma rings with appendages create an artificial it is in traumatic or congenital colobomata. RESULTS: Designs, functions, indications, and results of different types of capsular tension rings are reviewed, as well as applications in pediatric cases, and considerations for their routine use in adult cataract surgery. CONCLUSIONS: The potential benefits of capsular edge ring implantation in pediatric cataract surgery cases are explored.     

晶状体囊袋张力环脱位的手术治疗

目的 探讨晶状体囊袋张力环（CTR）完全脱位的治疗效果。 设计 回顾性病例系列。 研究对象 2006年3月至2010年2月北京同仁医院治疗的CTR完全脱位患者11例（11眼）。方法 所有患者先行玻璃体切除联合脱位CTR取出,再根据视网膜和视盘情况以及取出的CTR和人工晶状体（IOL）状况,分别选择IOL或CTR缝线固定7眼,虹膜固定型IOL植入1眼,硅油填充3眼。术后随访5~32个月。主要指标 视力、眼压、IOL居中性及并发症。 结果 11眼均顺利取出脱位的CTR和IOL,8眼同时植入IOL,3眼行硅油填充。最后一次随访时最佳矫正视力0.3~0.6者4眼,0.1~0.2者4眼,低于0.1者2眼,1例患者不合作。其中5眼达到或超过CTR脱位前的最好矫正视力。术后高眼压5眼,眼压25~51 mm Hg。4眼经药物治疗,1眼经巩膜睫状体光凝后眼压恢复正常。前房积血1眼,经药物治疗后吸收。未出现IOL或IOL-CTR复合体脱位或偏位现象。结论 玻璃体切除联合脱位CTR取出并睫状沟缝线固定IOL或CTR可以有效地治疗CTR完全脱位。（眼科, 2012, 21: 82-85）     

囊膜拉钩联合可缝合囊袋张力环植入在中重度晶状体半脱位治疗中的初步应用

目的 探讨囊膜拉钩联合可缝合晶状体囊袋张力环在中重度晶状体半脱位治疗中的应用效果及注意问题。设计 回顾性病例系列。研究对象 2009年1月至2011 年1月北京英智眼科医院治疗的15 例（19眼）脱位范围135°~225°的中重度晶状体半脱位患者。方法 患者在囊膜拉钩的辅助下行白内障超声乳化吸出折叠人工晶状体（IOL）植入术中同时植入可缝合囊袋张力环。术前观察晶状体脱位的范围及方位。术后平均随访（16.4±4.8）个月。测量视力、屈光状态、眼压,裂隙灯检查了解IOL位置,有无后发障、玻璃体疝等,UBM检查张力环位置。主要指标 视力、并发症。结果19 眼（100%）均成功植入可缝合囊袋张力环。最后一次随访时视力均有不同程度提高。随访期间未见IOL明显偏位、眼压升高、张力环嵌顿、后发障及玻璃体疝等并发症。结论囊膜拉钩联合可缝合囊袋张力环植入可作为中重度晶状体半脱位者施行原位超声乳化白内障吸出折叠IOL植入术的有效辅助手段,能提高手术安全性及成功率,可维持术后囊袋长期稳定性。（眼科,2012,21：52-55）      

晶状体囊袋张力环在半脱位晶状体超声乳化术中的应用

目的　探讨晶状体囊袋张力环在超声乳化吸出联合后房型囊袋内人工晶体植入术治疗悬韧带断离范围小于 15 0°的半脱位晶状体的临床效果。方法　超声乳化吸出术治疗晶状体半脱位 14例 (14眼 )。悬韧带断离范围小于 90°者 5眼 ,90～ 15 0°者 9眼。造成悬韧带断离的原因为眼外伤 (8眼 )、马凡综合征 (1眼 )、玻璃体视网膜手术后 (2眼 ) ,另有 3眼原因不明。在常规白内障超声乳化吸出术过程中 ,植入晶状体囊袋张力环及囊袋内植入人工晶体。随访 2～ 12个月 (平均 6个月 )。结果　 13眼囊袋张力环及人工晶体植入顺利 ,未见人工晶体移位及晶状体悬韧带断离范围扩大。 1眼术后 2 4h散瞳下发现人工晶体位于囊袋外 ,其余病例随访过程中未见人工晶体偏心及晶状体悬韧带断离范围扩大。结论　晶状体囊袋张力环在手术治疗晶状体半脱位的白内障病例中 ,可有效地防止晶状体悬韧带断离范围扩大、确保术中人工晶体囊袋内植入及防止术后人工晶体移位     

Stability of neodymium:YAG laser posterior capsulotomy in eyes with capsular tension rings

AIM: To evaluate the stability of neodymium (Nd):YAG laser posterior capsulotomy in eyes with capsular tension rings (CTRs).METHODS: A total of 60 eyes that underwent cataract surgery and laser posterior capsulotomy postoperatively were included in this retrospective cohort study. To evaluate the safety and stability of capsulotomy, changes in the size of posterior capsulotomy and anterior chamber depth (ACD) in three groups: the group without CTR, the group with 12 mm CTRs, and the group with 13 mm CTRs, at 1wk, 3, 12, and 15mo after capsulotomy, were compared.RESULTS: In the group without CTR and the group with 12 mm CTR, there was no significant change in ACD at every post-laser follow-up. In the group with 13 mm CTR, the ACD change was significant until 3mo after capsulotomy. In all groups, there was a significant increase in the area of capsulotomy between 1wk and 3mo post-laser. Between 3 and 12mo post-laser, only the group with 13 mm CTR showed a significant increase in the area of capsulotomy (P<0.01).CONCLUSION: Laser posterior capsulotomy is safe in all three groups. The capsulotomy and ACD become stabilized and have not shown significant changes since 1y post-laser, even with larger CTRs. The maintenance of centrifugal capsular tension can last longer with larger CTRs, and the stability of the capsulotomy site can be reached about 12mo after capsulotomy in pseudophakic eyes with larger CTRs.     

Closed foldable capsular rings

A new foldable capsular tension and bending ring system with a sharp-edged design is described. The closed foldable capsular rings (CFCR) consist of 8 hydrophobic and 8 hydrophilic ring segments. The CFCRs have a 9.2 mm minimum overall diameter. The CFCRs were inserted using various cartridge systems or a two-folded technique with a forceps. The CFCRs were implanted after phacoemulsification through a small (1.6 to 3.2 mm) incision in 104 human adult eyes without intraoperative complications. No postoperative complications such as capsule folds or inward bending were observed over a 6-month follow-up. Posterior capsule opacification was minimal or absent in all eyes.     

囊袋张力环的临床应用研究

囊袋张力环作为一种囊袋内填充装置,在白内障手术中起着重要的作用。囊袋张力环设计的初衷是维持囊袋的圆形轮廓、提高手术安全性,之后发现它在抑制后囊膜混浊与囊袋收缩、增强人工晶状体稳定性等方面亦有较好效果。经过近30a的改良,囊袋张力环衍生出多种类型,临床应用范围逐渐扩展,尤其是应用于复杂白内障手术,可以降低术中风险及提升术后效果。本文总结了囊袋张力环临床应用的植入时机、适应证和并发症,并对近年来囊袋张力环的临床应用进展进行简要综述。     

Dislocation of capsular bag with intraocular lens and capsular tension ring

We report a case in which the capsular bag with an intraocular lens (IOL) and a capsular tension ring (CTR) dislocated into the vitreous. The dislocated foldable posterior chamber IOL and CTR were removed with a pars plana vitrectomy and exchanged with a scleral-fixated IOL. No complications occurred intraoperatively or postoperatively. Although insertion of a CTR decreases the risk for IOL dislocation, spontaneous capsular bag dehiscence can occur.     

Posteriorly dislocated capsular tension ring.

A 69-year-old man who had pseudoexfoliation and significant nuclear cataract underwent cataract surgery in his right eye. At the beginning of the phacoemulsification, inferior zonulolysis was observed and a capsular tension ring was implanted. Anterior vitrectomy was also performed because of vitreous in the anterior chamber at the end of surgery. A tear in the posterior capsule could not be identified. Three days after surgery, the capsular tension ring was observed partially in the anterior vitreous. A 3-port pars plana vitrectomy was performed and the ring was removed. Three weeks later, the eye developed retinal detachment and was successfully repaired. Retinal complications can develop if the capsular tension ring moves into the vitreous.     

Anterior capsular phimosis in eyes with a capsular tension ring.

A 64-year-old woman with zonular weakness in the left eye and a 79-year-old man with bilateral pseudoexfoliation and intraoperative zonular dehiscence had phacoemulsification with in-the-bag implantation of a single-piece poly(methyl methacrylate) intraocular lens (IOL) and a capsular tension ring. Ten to 12 weeks postoperatively, all 3 eyes developed significant visual loss secondary to capsule shrinkage and occlusion of the capsulorhexis opening. All eyes had a neodymium:YAG laser radial anterior capsulotomy, anterior capsulectomy, or both. Visual acuity was restored in all eyes despite slight IOL decentration.