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A modified iris repair technique and capsular tension ring insertion in a patient with coloboma with cataracts.

Kim JH, Kang MH, Kang SM, Song BJ - Korean J Ophthalmol (2006)

Bottom Line: After inserting the long needle into the blunt tipped needle at 7 o'clock, both were passed back through the 7 o'clock paracentesis site.The needles were pulled out again at the 5 o'clock paracentesis site tied.Visual acuity improved to 20/20 in the right eye.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea. joshua115@hanyang.ac.kr

ABSTRACT

Purpose: We describe our successful experience using a capsular tension ring (CTR) and iris repair during cataract surgery in a patient with bilateral coloboma.

Methods: A 67-year-old woman had no history of trauma, but had zonular deficiency and inferonasal iris defects in both eyes. An extracapsular cataract extraction and intraocular lens (IOL) scleral fixation was performed in the left eye. A CTR was implanted in the right eye through a sclerocorneal incision. After the IOL was placed centrally in the capsular bag, two paracenteses were made at the limbus (5 o'clock and 7 o'clock). A long, straight needle was passed through the 7 o'clock paracentesis site into a angled, blunt tipped 27 gauge needle inserted from the 5 o'clock paracentesis. The two needles were pulled out at 5 o'clock. After inserting the long needle into the blunt tipped needle at 7 o'clock, both were passed back through the 7 o'clock paracentesis site. The needles were pulled out again at the 5 o'clock paracentesis site tied. Equal tension was used to tie both sides.

Results: Visual acuity improved to 20/20 in the right eye.

Conclusions: Both capsular tension ring implantation and iris repair was successfully performed at the time of cataract surgery in a coloboma patient, which resulted in improvements in visual function and cosmesis.

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Related in: MedlinePlus

The needle was pulled out through the 5 o'clock limbus to be tied.
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Figure 6: The needle was pulled out through the 5 o'clock limbus to be tied.

Mentions: After two days, the procedures were done in the right eye by the same surgeon (J.H. Kim) according to a standardized protocol. Under retrobulbar anesthesia, a 3 mm sclerocorneal incision, paracentesis at the 2 o'clock position, CCC with a bent 25-gauge needle, and hydrodissection were performed uneventfully. Despite mild phacodonesis, the lens was normally located. Phacoemulsification was done in the bag using a stop and chop technique. Subsequently, high viscosity sodium hyaluronate was injected in order to expand the lens capsule completely. Because zonular weakness can cause lens decentration, a CTR was implanted through a sclerocorneal incision using a Sinskey hook. After the IOL (MA 60BM, Alcon®, USA) was placed centrally in the capsular bag, acetylcholine chloride 1:100 (Miochol®, Novartis®, USA) was injected through a side-port. Two paracenteses at 5 o'clock and 7 o'clock limbus were prepared for the iris repair. A long, straight needle (10-0 prolene Ethicon 1713; Johnson & Johnson®, USA) was introduced into the anterior chamber through the 7 o'clock paracentesis site. The right and left iris borders were picked up by the long, straight needle while the angled, blunt tipped 27 gauge needle, inserted from the 5 o'clock paracentesis, countered the pressure of the long, straight needle (Fig. 2) The straight needle was then inserted into the blunt tipped 27 gauge needle (Fig. 1). Both needles were pulled out through the 5 o'clock paracentesis (Fig. 3). After inserting the long needle into the blunt tipped needle from 7 o'clock, both were passed back through the 7 o'clock paracentesis site (Fig. 4). During this procedure, the blunt end of the long needle must be inserted first into the anterior chamber. If the sharp end of the needle gets into the anterior chamber first, it could go through the limbal tissue around the paracentesis and the thread could get caught on the limbal tissue. A single knot was loosely made (Fig. 5) and slowly tightened. The needles were pulled out again at the 5 o'clock paracentesis site to be tied (Fig. 6). Equal tension was used to tie both sides (Fig. 7). The knot was trimmed using vannas scissors through the sclerocorneal incision. This iris repair procedure was repeated three times.


A modified iris repair technique and capsular tension ring insertion in a patient with coloboma with cataracts.

Kim JH, Kang MH, Kang SM, Song BJ - Korean J Ophthalmol (2006)

The needle was pulled out through the 5 o'clock limbus to be tied.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908861&req=5

Figure 6: The needle was pulled out through the 5 o'clock limbus to be tied.
Mentions: After two days, the procedures were done in the right eye by the same surgeon (J.H. Kim) according to a standardized protocol. Under retrobulbar anesthesia, a 3 mm sclerocorneal incision, paracentesis at the 2 o'clock position, CCC with a bent 25-gauge needle, and hydrodissection were performed uneventfully. Despite mild phacodonesis, the lens was normally located. Phacoemulsification was done in the bag using a stop and chop technique. Subsequently, high viscosity sodium hyaluronate was injected in order to expand the lens capsule completely. Because zonular weakness can cause lens decentration, a CTR was implanted through a sclerocorneal incision using a Sinskey hook. After the IOL (MA 60BM, Alcon®, USA) was placed centrally in the capsular bag, acetylcholine chloride 1:100 (Miochol®, Novartis®, USA) was injected through a side-port. Two paracenteses at 5 o'clock and 7 o'clock limbus were prepared for the iris repair. A long, straight needle (10-0 prolene Ethicon 1713; Johnson & Johnson®, USA) was introduced into the anterior chamber through the 7 o'clock paracentesis site. The right and left iris borders were picked up by the long, straight needle while the angled, blunt tipped 27 gauge needle, inserted from the 5 o'clock paracentesis, countered the pressure of the long, straight needle (Fig. 2) The straight needle was then inserted into the blunt tipped 27 gauge needle (Fig. 1). Both needles were pulled out through the 5 o'clock paracentesis (Fig. 3). After inserting the long needle into the blunt tipped needle from 7 o'clock, both were passed back through the 7 o'clock paracentesis site (Fig. 4). During this procedure, the blunt end of the long needle must be inserted first into the anterior chamber. If the sharp end of the needle gets into the anterior chamber first, it could go through the limbal tissue around the paracentesis and the thread could get caught on the limbal tissue. A single knot was loosely made (Fig. 5) and slowly tightened. The needles were pulled out again at the 5 o'clock paracentesis site to be tied (Fig. 6). Equal tension was used to tie both sides (Fig. 7). The knot was trimmed using vannas scissors through the sclerocorneal incision. This iris repair procedure was repeated three times.

Bottom Line: After inserting the long needle into the blunt tipped needle at 7 o'clock, both were passed back through the 7 o'clock paracentesis site.The needles were pulled out again at the 5 o'clock paracentesis site tied.Visual acuity improved to 20/20 in the right eye.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea. joshua115@hanyang.ac.kr

ABSTRACT

Purpose: We describe our successful experience using a capsular tension ring (CTR) and iris repair during cataract surgery in a patient with bilateral coloboma.

Methods: A 67-year-old woman had no history of trauma, but had zonular deficiency and inferonasal iris defects in both eyes. An extracapsular cataract extraction and intraocular lens (IOL) scleral fixation was performed in the left eye. A CTR was implanted in the right eye through a sclerocorneal incision. After the IOL was placed centrally in the capsular bag, two paracenteses were made at the limbus (5 o'clock and 7 o'clock). A long, straight needle was passed through the 7 o'clock paracentesis site into a angled, blunt tipped 27 gauge needle inserted from the 5 o'clock paracentesis. The two needles were pulled out at 5 o'clock. After inserting the long needle into the blunt tipped needle at 7 o'clock, both were passed back through the 7 o'clock paracentesis site. The needles were pulled out again at the 5 o'clock paracentesis site tied. Equal tension was used to tie both sides.

Results: Visual acuity improved to 20/20 in the right eye.

Conclusions: Both capsular tension ring implantation and iris repair was successfully performed at the time of cataract surgery in a coloboma patient, which resulted in improvements in visual function and cosmesis.

Show MeSH
Related in: MedlinePlus