Surgical management of anterior capsule contraction syndrome using plasma ablation and incision technique

Session Details

Session Title: Cataract Surgery Special Cases I

Session Date/Time: Sunday 14/09/2014 | 14:30-16:30

Paper Time: 14:30

Venue: Boulevard G

First Author: : V.Kumar RUSSIA

Co Author(s): :    M. Frolov   E. Bozhok   G. Dushina   A. Bezzabotnov     

Abstract Details

Purpose:

To report a case series of anterior capsule contraction syndrome (ACCS) managed with plasma ablation and incision technique

Setting:

Ophthalmic unit of Skhodnya city hospital, Moscow region; Department of Ophthalmology, People’s Friendship University of Russia, Moscow, Russian Federation

Methods:

In this case series results of ACCS management using ab interno plasma ablation and incision technique were analyzed in 11 patients (male-6, female-5; average age - 68.9+/–6.9yrs.). Three cases had complete closure of continuous curvilinear capsulorhexis (CCC) opening. Out of these in 2 cases there were firm adhesions of iris at pupil margin with IOL-capsular bag complex. In other 8 cases CCC opening was shrinked up to 2-3mm and decentered. There were 3 cases with unstable IOL-capsular bag complex and in another 3 cases there was marked dislocation of the complex. In all cases an ab interno technique to create second CCC using Fugo plasma blade was used. Surgical technique: through a 2.0mm clear corneal incision anterior chamber (AC) was irrigated with cohesive viscoelastic followed by insertion of .1mm thick capsulorhexis tip of the device. The activated tip (cut power - medium, cut intensity -7) was moved in a circular manner over the fibrosed capsule to make CCC of desired diameter. After completion of CCC, AC was irrigated with balanced salt solution to remove all viscoelastic followed by wound hydration. Visual gain, IOL-capsular bag complex stability intra- and postoperatively and complications were evaluated.

Results:

In all cases it was possible to make the CCC of desired diameter in the fibrosed capsule. Visual acuity improved in all cases. Further dislocation of unstable IOL-capsular bag complex was not noticed during CCC reformation. In 3 cases a second instrument (usually a Sinskey hook) was necessary to keep the CCC ring in the centre to cut the fibrosed capsule. One of the relative disadvantage noticed was the need for refilling of AC with viscoelastic device, because of reduced visibility due to cavitation bubbles. Follow-up was uneventful in all cases. In 2 cases there were some superficial scratches noticed on the IOL surface without having any adverse effect on optic quality and on visual gain. In cases with adhesions of iris with IOL-capsular bag complex, it was possible as well to create a pupil of the size as of CCC without any hemorrhagic complication.

Conclusions:

Progressive shrinkage or complete closure of the anterior capsule opening has been termed as capsule contraction syndrome. Most commonly a surgical option is selected in its management where a radial cut is made through the previous CCC opening using intraocular scissors followed by completion of a wider CCC with forceps. But this approach is good only in cases of mild fibrosis, where some elasticity is still left in the capsule to complete the CCC in a regular way. Another commonly used approach is YAG laser radial capsulotomies, which is a non invasive method. But again this approach is good for mild fibrotic anterior capsules. In severely fibrosed capsules, a lot of energy is required to create capsulotomies, which is not friendly with corneal endothelium. Fugo plasma blade is a device which produces and concentrates plasma energy at the end of a stainless steel filament tip (the incising part). When the tip is activated, it gets coated with plasma, which is resonant with the tissues that are touched. The tissue absorbs energy by resonance, the tissue molecules become unstable, therefore they shatter, and they get removed in the form of a plume (tissue ablation). The tissues are treated at the molecular and atomic levels, without causing collateral damage. Hence wherever activated tip touches the fibrosed capsule, it is cut by way of ablation. The unique property of this device allows to cut the tissue by only touching and there is no need for stretching or crushing the tissue. Thanks to this property we were able to perform second CCC even in cases with unstable IOL-capsular bag complex without further dislocating it, which could not have been possible with other modalities. It is concluded that ab interno plasma ablation and incision technique is a safe and effective technique in ACCS management.

Financial Interest:

NONE