Analysis of sutured-guided capsular tension rings vs standard capsular tension rings using Miyake–Apple video analysis and strategies to avoid capsular tension ring complications

Session Details

Session Title: Cataract Surgery: Special Cases

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 09:30

Venue: Free Paper Forum: Podium 2

First Author: : T.Page USA

Co Author(s): :    L. Werner   N. Ellis   J. Heczko                       

Abstract Details

Purpose:

To critically examine capsular tension ring (CTR) implantation to establish predictable movement patterns of the CTR during deployment and atypical patterns that forewarn the surgeon of CTR entrapment or entanglement with pending complications. To study the interaction of the CTR leading eyelet with the capsular bag using Miyake-Apple video analysis (MAVA) and correlate the interaction with visible signs observed in the pupil. In addition, this study will compare the complication rate and time required to explant a standard CTR from the capsular bag versus suture-guided CTR (SGCTR) explantation.

Setting:

Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, and Moran Eye Center, University of Utah, Salt Lake City, Utah, United States of America

Methods:

Nine cadaver eyes were prepared with standard Miyake-Apple protocol and digital video recording. A four clock-hour zonular dialysis was created followed by continuous curvilinear capsulorhexis and hydrodissection. In five eyes, a standard CTR and injector was modified with 8-0 nylon suture through the leading eyelet and injector port. In four eyes, a standard CTR and injector was used. CTR movements making contact with lens material, capsule, and entrapment were analysed. Time required to remove the CTR and any complications with the CTR, capsule or lens were recorded. A time limit of 180 seconds determined the inability to remove the CTR.

Results:

In all eyes, CTR implantation displayed characteristic movements as the CTR contacts capsule or lens material. An S-curve of the CTR within the pupil coincided with entrapment of the leading eyelet of the CTR as viewed by MAVA. Standard CTR removal attempts had a high rate of complication (100%). Complications included capsule tears (n=2), dialysis extension (n=1), and accidental intracapsular cataract extraction (n=1). The SGCTR group had no complications associated with removal. The time spent in effort to remove the CTR 164.5 seconds in the standard CTR group and 6.9 seconds in the SGCTR group (p = 0.001).

Conclusions:

Complications with CTR implantation may be mitigated by recognising the predictable movements of an uncomplicated insertion versus an insertion complicated by entrapment or entanglement of the CTR. The suture did not alter the predictable movements in the SGCTR group and provided a visible tracer for the position of the leading eyelet. Attempts to explant a standard CTR from the capsular bag had a high complication rate. The SGCTR significantly reduced the time and effort required to explant the CTR and was associated with a significant reduction in complications.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a competing company