Wu Wen-Jie, Zheng Dan-ying, Zheng Ying-feng, Cai Xiao-yu
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Yan Ke Za Zhi. 2007 Feb;43(2):108-11.
To evaluate clinical efficiency and safety of the iris hooks and modified capsular tension ring (MCTR) for the treatment of subluxation lens in patients with Marfan's syndrome.
This study comprised 5 patients (7 eyes) with Marfan's syndrome and subluxation lens. After 3.2 mm clear cornea incision and continuous curvilinear capsulorhexis (CCC), 2 - 4 disposable nylon iris hooks were inserted through the stab incisions and placed in the capsulorhexis to support the capsule and enlarged the CCC. Following irrigation/aspiration, a MCTR with suture in its eyelet was placed in the capsule bag. After tightening and tying the suture of MCTR, the capsular bag was centered and fixed. A foldable AcrySof one-piece intraocular lens (IOL) was then placed in the capsule bag.
Twelve months after the operation, the best corrected visual acuity was >/= 0.8 in six eyes and 0.7 in one eye. The scheimpflug images obtained from the Pentacam demonstrated that the IOL were well centered. UBM showed that all the MCTR and the haptics of the IOL were in the capsule bag, the eyelet of the MCTR was rested stably between the capsulorhexis margin and the iris. The retroillumination photograph indicated that only one eye had obvious posterior capsular opacification. No intraoperative and postoperative complications such as prolapse of vitreous and retina detachment was occurred.
The iris hooks can provide excellent intraoperative capsule-lens stability and facilitate the manipulation during operation. MCTR allows additional suture fixation to the eye wall without damaging the capsular bag and maintains the long-term stability of the intraocular lens. Furthermore, MCTR is helpful for avoiding dislocation of the IOL due to progressive weakening of the zonular fibers in some patients and provides long-term safety.
评估虹膜钩和改良型囊张力环（MCTR）治疗马凡综合征患者晶状体半脱位的临床疗效和安全性。
本研究纳入5例（7只眼）患有马凡综合征且晶状体半脱位的患者。在做3.2mm透明角膜切口及连续环形撕囊（CCC）后，通过穿刺切口插入2 - 4个一次性尼龙虹膜钩，置于撕囊处以支撑囊膜并扩大CCC。在水分离/抽吸后，将带小孔缝线的MCTR放入囊袋内。收紧并系紧MCTR的缝线后，使囊袋居中并固定。然后将一片式可折叠丙烯酸酯人工晶状体（IOL）植入囊袋内。
术后12个月，6只眼的最佳矫正视力≥0.8，1只眼为0.7。Pentacam获取的眼前节分析图像显示IOL居中良好。超声生物显微镜（UBM）显示所有MCTR及IOL的襻均在囊袋内，MCTR的小孔稳定位于撕囊边缘与虹膜之间。后照法照片显示仅1只眼有明显的后囊膜混浊。未发生术中及术后诸如玻璃体脱出和视网膜脱离等并发症。
虹膜钩可在术中提供出色的囊膜 - 晶状体稳定性并便于手术操作。MCTR允许额外缝线固定于眼壁而不损伤囊袋，并维持人工晶状体的长期稳定性。此外，MCTR有助于避免部分患者因悬韧带纤维逐渐松弛导致的IOL脱位，并提供长期安全性。
