Modified technique of endocapsular lens aspiration for severely subluxated lenses

Abstract

PurposeSeverely subluxated crystalline lenses pose a difficult situation to anterior segment surgeons and can only be managed surgically by removal of the lens as well as the capsular bag. Several techniques have been described in literature for the management of such cases. We describe a modified technique of endocapsular lens aspiration by the limbal route for lens extraction through small incisions on the cornea.Patients and methodsThirty-two eyes of 16 consecutive patients with severely subluxated crystalline lenses were recruited in the study. All eyes underwent a modified technique of lens aspiration within the capsular bag using a single instrument, vitrectomy cutter, and irrigation cannula, followed by sacrificing of the capsular bag. The patients were either left aphakic or implanted with an open loop anterior chamber intraocular lens (ACIOL Kelman Multiflex) and prospectively followed up for a period of 3 months.ResultsThe mean age of the patients was 9 years 3 months±3 years (range 5-15 yrs). All eyes underwent complete lens aspiration within the capsular bag with no dislocation of the lens matter. ACIOL was inserted in 22 eyes (68.7%) and 10 eyes (31.2%) were left aphakic. All the surgeries were uneventful. The mean best corrected visual acuity (BCVA) at 3 months post surgery was 0.47±0.11 logMAR which was significantly better than pre-operative BCVA (P=0.001). The percentage endothelial cell loss at 3 months was 7.1%. There was no evidence of glaucoma, corneal decompensation, or retinal detachment. The astigmatism which increased from 1.45D±086 preoperatively to 3.76D±2.02 1 week post-operatively due to sutures reduced to 1.97D±0.81 post suture removal at 3 months.ConclusionThe modified technique of endocapsular lens aspiration proves to be a simple and effective method of removal of the lens-capsular bag complex in severely subluxated lenses.

Intra-lenticular lens aspiration in paediatric cases with anterior dislocation of lens

“…The surgical techniques described in the literature for management of anterior dislocation of the lens include intracapsular cataract extraction (ICCE), lensectomy, and in the bag bimanual lens aspiration [1,2,[4][5][6][7]. Lens aspiration within the capsular bag has been described previously by Vasavada et al, Sinha et al, and Khokhar et al for various indications [1,7,8] (Table 2).…”

“…Recently Khokhar et al [7] described a modified technique of endocapsular lens aspiration for severely subluxated lenses. Our technique differs from this technique in several ways.…”

“…Khokhar et al [7] did not use trypan blue dye, suggesting that the dye could migrate into the vitreous cavity through the area of zonular dehiscence which could reduce the visibility of the lens and capsular bag on retroillumination. In our technique, we injected trypan blue dye directly into the capsulotomy, instead of intracamerally.…”

“…The surgical management involves removal of the lens for which various techniques have been described in the literature [1,2,[4][5][6][7]. Herein we describe a modified technique of microscope integrated optical coherence tomography (MiOCT) guided intra-lenticular lens aspiration (ILLA) for management of anteriorly dislocated lens in paediatric cases along with its surgical outcome in perhaps the most extensive series of such cases reported till date.…”

Pediatric cataract

“…In cases of children presenting with subluxation or anterior dislocation, intralenticular aspiration of a lens with anterior-chamber IOL and peripheral iridectomy is preferred. [ 84 ] Iris and scleral fixations of IOL are emerging as the methods of aphakic correction. [ 85 ] In traumatic cataracts, posterior capsulorhexis with posterior capture of optic is preferred to avoid VAO.…”