Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome

Küchle, Michael; Viestenz, Arne; Martus, Peter; Händel, Alexander; Jünemann, Anselm; Naumann, Gottfried O.H.

doi:10.1016/s0002-9394(99)00365-7

Cited by 124 publications

(104 citation statements)

References 28 publications

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“…Increasing age, the presence of a shallow or hyperdeep anterior chamber, an increased cataract density, significant differences in refraction between eyes, and reduced pupil size may all indicate impaired zonular function [6]. Kuchle et al [10] reported that an axial anterior chamber depth of less than 2.5 mm increased the risk of surgical complications, and concluded that a small anterior chamber depth may indicate zonular instability. Ultrasound biomicroscopy has been used to assess changes associated with pseudoexfoliation syndrome in the zonular apparatus, and a method for quantifying zonular integrity had been utilized [11,12].…”

Section: Discussionmentioning

confidence: 99%

Categorization and Surgical Techniques of Weak Zonule Based on Findings at Capsulorhexis during Cataract Surgery

Yaguchi¹

2015

J Clin Exp Ophthalmol

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Purpose: We categorize weak zonule during capsulorhexis.Design: Retrospective interventional case series. Methods:The study examined 5447 consecutive eyes of 3527 cases that underwent phacoemulsification (PEA) and intraocular lens (IOL) implantation between March 2006 and March 2014 at Showa University Fujigaoka Hospital, Kanagawa, Japan. Weak zonule was categorized based on findings at capsulorhexis and difficulty in performing continuous curvilinear capsulorhexis (CCC). The categorization definitions were as follows: (1) Group N (normal) with no or slight lens movement at the start of the CCC and no difficulty in performing CCC, (2) Group W (weak) with moderate lens movement frequently accompanied by fold formation during CCC and some difficulty in performing CCC, (3) Group VW (very weak) because of severe lens movement and difficulties with the initial puncture, CCC can be performed with the aid of a highly retentive and cohesive ophthalmic viscoelastic device (OVD; Healon 5 ® ), and (4) Group EW (extremely weak) with zonular deficiency in addition to the Group VW criteria and accounted for the cases of severe phacodonesis, lens subluxation, lens luxation into the anterior chamber, and dropped nucleus into the vitreous cavity that could be categorized preoperatively. We examined capsule stabilization device use during PEA, surgical lens removal, and IOL fixation in each group. Results:We defined 5098 eyes as Group N, 251 eyes as Group W, 55 eyes as Group VW, and 43 eyes as Group EW. As the zonule became weak, the use of the capsule stabilization device increased in PEA and intracapsular cataract extraction, and scleral suture fixation of IOL increased. Pars plana vitrectomy for lens removal was performed in 5 eyes (11.63%) categorized as Group EW. Conclusions:The categorization of weak zonule at CCC may be useful for selecting an appropriate capsule stabilization device and procedure during cataract surgery.

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Section: Discussionmentioning

confidence: 99%

Categorization and Surgical Techniques of Weak Zonule Based on Findings at Capsulorhexis during Cataract Surgery

Yaguchi¹

2015

J Clin Exp Ophthalmol

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“…Zonulopathy can cause the lens subluxation, vitreous prolapsus and consequently trigger the complications such as cystoid macular edema, retinal tears and other serious retinal or choroidal complications [3,5,6,10,11].…”

Section: Editorialmentioning

confidence: 99%

“…The common causes of zonulopathy are pseudoexfoliation syndrome, zonulolysis due to ocular trauma, iatrogenic zonulolysis due to previous ocular interventions damaging to the zonules such as lens surgery, pars plana vitrectomy, repeated intravitreal injections, and various ocular disorders including high myopia, spherophakia, retinopathy of prematurity, ultra-brunescent cataracts, retinitis pigmentosa, aniridia, advanced age and intraocular tumor. Additionally, systemic diseases or syndromes that affect the zonules or fibrillin such as porphyria, hyperlysinemia, Marfan syndrome, homocystinuria, scleroderma, Weil-Marchesani syndrome and Ehlers-Danlos syndrome may cause the zonulopathy [4][5][6][7]. If the cause of zonulopathy is a specific disease such as pseudoexfoliation syndrome affecting the strength of the zonular system, the zonular fibers are more fragile and they are four times more likely to break [3,5,[7][8][9].…”

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confidence: 99%

To know the Indicators and Predictors of Zonulopathy can Prevent the Headache of Eye Surgeon

Turgut¹

2017

J Eye Cataract Surg

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EditorialThe cataract is the opacity in the crystalline lens and it is the leading cause of blindness over the world. Cataract surgery is currently the unique treatment for cataract. Cataract surgery is the most commonly performed type of ocular surgery over the world. Although phacoemulsification is a secure surgical type for cataract removal with a success rate of over 98%, it can result in serious complications [1].The zonule of Zinn (the suspensory ligaments of the lens, Zinn's membrane, ciliary zonule) is a ring of fibrous fibers connecting the ciliary body with the crystalline lens. It originates from the basal laminae of the non-pigmented epithelium of the ciliary body, and adhere the lens capsule at the equatorial region. Zonules provide to remain the holding position of the lens and it plays the critical role in accommodation. Zonules are mainly made of fibrillin, a connective tissue glycoprotein that provides strength and elasticity to the lens fibers. As fibrillin is coded by the FBN1 gene, the mutations in this gene can cause zonulopathy [2].Zonulopathy is a clinical entity describing the deficiency of zonular support of the lenticular capsule. Zonulopathy can occur due to the weakness, dehiscence or dialysis or fragility or instability or laxity of the zonules in congenital, genetic or acquired forms. It has been reported that a percent of approximately 5% of zonulopathy cases is recognizable at the time of surgery and that zonular dehiscence develops commonly at the stage of the removal of the lens nucleus or cortical material in cataract surgery [3]. The common causes of zonulopathy are pseudoexfoliation syndrome, zonulolysis due to ocular trauma, iatrogenic zonulolysis due to previous ocular interventions damaging to the zonules such as lens surgery, pars plana vitrectomy, repeated intravitreal injections, and various ocular disorders including high myopia, spherophakia, retinopathy of prematurity, ultra-brunescent cataracts, retinitis pigmentosa, aniridia, advanced age and intraocular tumor. Additionally, systemic diseases or syndromes that affect the zonules or fibrillin such as porphyria, hyperlysinemia, Marfan syndrome, homocystinuria, scleroderma, Weil-Marchesani syndrome and Ehlers-Danlos syndrome may cause the zonulopathy [4][5][6][7]. If the cause of zonulopathy is a specific disease such as pseudoexfoliation syndrome affecting the strength of the zonular system, the zonular fibers are more fragile and they are four times more likely to break [3,5,[7][8][9].Preoperative signs of zonulopathy are phacodonesis/pseudophacodonesis, iridodonesis, a tilted or subluxated or eccentric lens, the presence of a shallow or hyper deep anterior chamber in an eye, asymmetric axial anterior chamber or angle depth between both eyes, a space between iris and lens (iridolenticular gap) and visible lens equator [8,9].Intraoperative signs of zonulopathy include difficulty in the central perforation of the anterior lenticular capsule with the cystotome, extremely wrinkling and the mobility of the anterior lenti...

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“…3 Considering ACD may be helpful in risk stratification for cataract surgery and can help us to further improve our outcomes. This article has highlighted and quantified another important risk factor for posterior capsular rupture (PCR) that was not analysed as a part of our series of 55 567 cases as ACD is not currently a part of the Cataract National Dataset.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Risk stratification for posterior capsule rupture and vitreous loss during cataract surgery

Goverdhan

Anderson

Lockwood

et al. 2009

Eye

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Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome

Cited by 124 publications

References 28 publications

Categorization and Surgical Techniques of Weak Zonule Based on Findings at Capsulorhexis during Cataract Surgery

Categorization and Surgical Techniques of Weak Zonule Based on Findings at Capsulorhexis during Cataract Surgery

To know the Indicators and Predictors of Zonulopathy can Prevent the Headache of Eye Surgeon

Risk stratification for posterior capsule rupture and vitreous loss during cataract surgery

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