First Author: S.Nikolashin RUSSIA
Co Author(s): O. Fabrikantov
Purpose:
To define the indications for different types of iris retractors implantation for pupil dilatation, capsular bag supporting and iris trauma reduction
Setting:
The Academician S.N. Fyodorov FSBI IRTC " Eye Microsurgery" Tambov branch, Tambov, Russia
Methods:
Three groups of patients. First group 18 eyes (17 patients) with small pupil and lens subluxation, where the hook-type iris retractors were used. Second group 20 eyes (18 patients) with small pupil and the III-IV grade of nuclear density (Buratto“s classification), where Malyugin“s quadrangular iris retractors were used. Third group 12 eyes (10 patients) with small pupil and the I-III grade of nuclear density (Buratto“s classification), where the closed-type quadrangular iris retractor, that may be implanted by means of an injector, was used.
Four hook-type iris retractors were implanted through four paracenteses. Their advantage is that they can be used to support the capsular bag in lens subluxation.
Malyugin“s iris retractors were implanted into the anterior chamber through a 2.2 mm incision by means of two tying forceps. There were some difficulties while inserting, especially on the eyes with shallow anterior chambers, but it allowed obtaining a hexahedral pupil 5-6 mm in diameter, that was especially convenient in hard cataract phacoemulsification.
The closed-type quadrangular iris retractors, manufactured by Sonus, were implanted into the anterior chamber through a 2.2 mm incision by means of an injector or two forceps.
Results:
The use of the hook-type iris retractors allows forming a pupil of a necessary size. The use of hook-type iris retractors to support the capsular bag in lens subluxation allowed performing cataract phacoemulsification without any complications. In two cases the weakness of ligamentous apparatus required IOL to be sutured to the iris. The drawbacks of the use of iris retractors are the formation of the additional paracenteses for its implantation, pupillary sphincter ruptures in 9 patients, petechia, observed in 6 patients.
The use of Malyugin“s iris retractor allowed performing hard cataract phacoemulsification in all patients without any complications. In that group of patients pupillary sphincter ruptures were observed rarely in 8 patients, petechiae were observed in 2 cases.
The Sonus closed-type quadrangular iris retractor implantation into the anterior chamber by means of an injector or forceps does not cause any difficulties. We obtain a rectangular pupil, approximately 4 mm by 5 mm. Pupil size and shape permit to perform cataract phacoemulsification with the I-III grade of nuclear density. After the use of iris retractors pupillary sphincter ruptures were observed in 3 patients, petechiae were observed in 1 patient with diabetes mellitus.
Conclusions:
1. The use of the hook-type iris retractors allows not only dilating a pupil, but also fixing a capsular bag effectively during cataract phacoemulsification. They are necessary to use in lens subluxation of I-II degree, despite the increase in a number of pupillary sphincter ruptures and petechiae.
2. Malyugin“s iris retractor allows performing hard cataract phacoemulsification effectively with a decrease in a number of pupillary sphincter ruptures and petechiae.
3. Owing to a simple and safe implantation, the Sonus closed-type quadrangular iris retractor, is advisable to use in cataract phacoemulsification on the eyes with a narrow rigid pupil and the I-III grade of nuclear density, because while using it the quantity of pupillary sphincter ruptures and petechiae is minimal. FINANCIAL DISCLOSURE?: No
Please wait while information is loading.
