Comparative Analisys of Cataract Phakoemulsification, Complicated with the Zonular Weakness

Purpose: To assess the iridocrystalline complex status in patients with cataract, complicated by zonular weakness, before and after surgical treatment.

Patients and Methods. The study enrolled 28 patients (29 eyes) with cataract, complicated by zonular weakness (8 women, 20 men, 74.13 ± 8.48 years old). All patients undergone phacoemulsification with IOL implantation and a capsular tension ring (CTR) if it was necessary. In each case optical biometry, ultrasound biomicroscopy and applanation tonometry were provided. After 1, 3 and 6 months postoperatively refractometry, visual acuity measurement, optical biometry, ultrasound biomicroscopy and OCT of the anterior segment were carried out.

Results. Patients were divided into 2 groups. In I group (17 eyes) standard phacoemulsification was provided.  In II group (11 eyes) it was necessary to implant CTR. 1 patient was excluded due to the extracapsular cataract extraction. Preoperatively angle of the crystalline lens tilt (3.62 ± 0.34° and 1.78 ± 0.27°, p = 0,00) and IOP were higher in group II. 6 months postoperatively UCVA was significantly higher in group II (0.59 ± 0.09 and 0.39 ± 0.21, p = 0.09), upright angle of IOL tilt (0.28 ± 0.35° and 1.40 ± 1.46°, p = 0.10), total zonnular length (14.28 ± 1.00 and 18.93 ± 0.86 mm, p = 0.00) and the value of IOL decentration (0.80 ± 0.17 and 0.20 ± 0.22 mm, p = 0.04) were significantly less in group II.

Conclusion. The angle of crystalline lens tilt according to ultrasound biomicroscopy could be considered as an important diagnostic criterion for the CTR implantation necessity during phacoemulsification. CTR implantation provided decrease of IOL tilt and decentration due to a more regular distribution of zonular tension that increases the UCVA postoperatively in complicated cases. OCT of the anterior segment of the eye and ultrasound biomicroscopy application after phacoemulsification gives a great capacity in IOL-capsular complex visualization and measurement.

1. Brian G., Taylor H. Cataract blindness — challenges for the 21 century. Bulletin of the World Health Organization. 2001;79:249–256.

2. Kupfer C. The conquest of cataract: A global challenge. Trans. Ophthalmol. Soc. UK. 1985;104:1–10. DOI: 10.1016/0039‑6257(86)90127‑X

3. Murthy G., Gupta S.K., John N., Vashist P. Current status of cataract blindness and Vision 2020: The right to sight initiative in India. Indian J. Ophthalmol. 2008;56:489–494.

4. Pashtaev N.P. Surgery of vitreous subluxation and dislocation of the crystalline lens. Cheboksary: GOU IUV, 2007:11–13 (In Russ.). DOI: 10.25276/9785902655060

5. Crema A.S. Femtosecond laser‑assisted cataract surgery in patients with Marfan syndrome and subluxated lens. Journal of Refractive Surgery. 2015;31(5):338–341. DOI: 10.3928/1081597X‑20150424‑02

6. Jashi B.G., Isakova I.A. Implantation of capsular tension rings during cataract surgery in cases of zonula dystrophy and damage. Modern technologies of cataract and refractive surgery = Sovremennye tekhnologii kataraktal’noi i refraktsionnoi khirurgii. 2013:59–62 (In Russ.).

7. Park H.J., Lee H., Kim Do W. Effect of Co‑Implantation of a Capsular Tension Ring on Clinical Outcomes after Cataract Surgery with Monofocal Intraocular Lens Implantation. Yonsei Med. J. 2016;57(5):42. DOI: 10.3349/ymj.2016.57.5.1236

8. Kulikov A.N., Kokareva E.V., Dzilikhov A.A. Intaocular lens position investigation with optical coherence tomography and induced refraction shift analysis after phacoemulsification. Ophthalmosurgery = Oftal’mokhirurgiya. 2018;2:10–15 (In Russ.). DOI: 10.25276/0235‑4160‑2018‑2‑10‑15

9. Avetisov S.E., Ambartsumian A.R. The method of assessing intraocular lens position. Рatent RU 2332932, 22.12.2006 (In Russ.).