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Dr. P urendra Bhasin Gwalior - India ASCRS Conference, Boston 2010

Managing Subluxated Lens with Phaco using Iris Retractors and Capsular Tension Ring . Dr. P urendra Bhasin Gwalior - India ASCRS Conference, Boston 2010. DECLARATION . No financial assistance is taken from any company for the work done in this study. Aim.

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Dr. P urendra Bhasin Gwalior - India ASCRS Conference, Boston 2010

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  1. Managing Subluxated Lens with Phaco using Iris Retractors and Capsular Tension Ring Dr. Purendra Bhasin Gwalior-India ASCRS Conference, Boston 2010 DECLARATION No financial assistance is taken from any company for the work done in this study

  2. Aim Present study is done to ascertain the safety of managing 27 cases of subluxated cataract by phacoemulsification using Iris Retractors and a Capsular Tension Ring (CTR) • Iris Retractors when placed at the capsulorrhexis margin : • Stretches the rim of the Capsular bag • Provide stability to the Capsular Bag • Counteracts traction forces of aspiration • Prevents risk of extension of zonular dialysis • Prevents vitreous prolapse in the AC

  3. Capsular Tension Ring • Implantation of CTR after PE & cortex aspiration • Helps maintain the shape of capsular bag • Prevents late capsular fibrosis syndrome • Prevents late IOL decentration • Prevents PCO

  4. Post traum 19 Myopia 5 Marfans 2 Homocyst. 1 Cause of Subluxation

  5. 10-20 20-30 30-40 40-50 50 & above 10-20yr. 5 cs. 20-30yr. 6cs. 50 & above 4 cs. 30-40yr. 8 cs. 40-50yr 4cs. Age Group

  6. Surgical Technique • Anaesthesia • Peribulbar Anaesthesia • Not the Topical • Incision • Clear corneal incisions • Away from the site of zonular dialysis

  7. Surgical technique • Capsulorrhexis • Start from the area of intact zonules • Relatively difficult to perform because - • Capsular instability/lax capsule • Capsular thickening /fibrosis

  8. Surgical Technique • Iris Retractors • Stab incision is given in the area of subluxation • Iris retractors are then placed at the capsulorhexis margin • Degree of sublux. will determine the no. of retractors to be placed

  9. Surgical Technique Hydrodissection/Hydrodelineation Hydromaneuvers are performed slowly & meticulously to ensure complete freeing of nucleus • Phacoemulsification • Done in slow motion with low parameters ; low vacuum, low flow rate and low power • Avoid radial aspiration of the nucleus & Cx • PE can be done in the bag when nucleus is soft & in the AC if the nucleus is hard

  10. Surgical technique Capsular Tension Ring • Implanted in the capsular bag through the side port • CTR injector • Scleral fixation of CTR- in more than 180°subluxation IOL Implantation • Large optic IOL is implanted in the bag • Haptics placed in the meridian of the zonular disinsertion • Check the stability of the IOL & capsular bag at the end

  11. Follow Up & Results • Follow up • Follow up >6 mths. To 3 yrs. • 23 cases Uneventful • 4 Post Tr. Cases Developed CME (managed medically) • Results • 26 cases with different degree of subluxation were managed successfully by this technique. • 1 case with > 280 subluxation was converted and managed separately

  12. Conclusion • Phaco using Iris retractors at CCC margin makes the • technique safe & provides excellent surgical control • Implanting CTR in the bag ensures long term integrity, • shape of bag and centering of IOL THANK YOU

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