John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT 84132, USA.
Ophthalmology. 2012 Feb;119(2):266-71. doi: 10.1016/j.ophtha.2011.08.016. Epub 2011 Dec 9.
To describe clinical and pathologic findings from cases of in-the-bag capsular tension ring (CTR) and intraocular lens (IOL) subluxation or dislocation.
Retrospective case series with clinicopathologic correlation.
Twenty-three explanted subluxated/dislocated capsular bags containing a CTR and an IOL explanted in Europe and submitted in fixative to the Berlin Eye Research Institute.
Standard gross and light microscopy of specimens, complete histopathologic analyses of selected specimens done at the University of Utah, as well as questionnaire sent to explanting surgeons, and patient chart review, when available.
Lens design, material, and abnormalities, capsular bag anomalies, patient demographic data, surgical dates, and presence or absence of known risk factors.
Patients were aged 76.31 ± 8.24 years at explantation, which was performed 81.5 ± 32.2 months after implantation. The IOLs in these cases were 3-piece hydrophobic acrylic (N = 11), 1-piece hydrophobic acrylic (n = 6), 3-piece silicone (n = 4), or 1-piece hydrophilic acrylic (n = 2) designs; all CTRs were made of poly(methyl methacrylate). Available information on associated ocular conditions included pseudoexfoliation (n = 17), glaucoma (n = 4), vitrectomy/retina surgery (n = 3), and trauma (n = 1). Complete histopathologic assessment in 3 specimens showed signs consistent with pseudoexfoliation, without available history related to this condition in one of the cases. Moderate/severe degrees of Soemmering's ring formation and capsulorhexis phimosis were observed or reported in 13 and 11 specimens, respectively. Fourteen eyes were implanted and explanted by the same surgeon, with an interval of 92.7 ± 23.4 months between the procedures. His rate of explantation because of subluxation/dislocation was 0.76% of the CTRs implanted during the time considered.
Explantation because of postoperative subluxation or dislocation of CTR-IOL-capsular bag complexes occurred approximately 6.8 years after implantation in this series, providing further evidence that a fine line exists between zonular insufficiency that can be stabilized with the CTR alone and that requiring further support. Analyses of large series may help to define common factors associated with this complication, as well as surgical planning and employment of various endocapsular support devices to enhance postoperative zonular stabilization.
描述袋内囊张力环（CTR）和人工晶状体（IOL）半脱位或脱位病例的临床和病理发现。
回顾性病例系列，伴有临床病理相关性。
23 个在欧洲取出的半脱位/脱位囊袋，其中包含一个 CTR 和一个 IOL，这些囊袋在固定剂中被送到柏林眼研究所以进行研究。
对标本进行标准的大体和光镜检查，对选定的标本进行完整的组织病理学分析，这些分析是在犹他大学进行的，同时还向取出手术的外科医生发送了调查问卷，并在有条件的情况下对患者的病历进行了审查。
晶状体设计、材料和异常，囊袋异常，患者人口统计学数据，手术日期，以及是否存在已知的危险因素。
在取出时，患者的年龄为 76.31 ± 8.24 岁，植入后 81.5 ± 32.2 个月进行了取出手术。这些病例中的 IOL 为 3 件式疏水性丙烯酸（n = 11）、1 件式疏水性丙烯酸（n = 6）、3 件式硅胶（n = 4）或 1 件式亲水性丙烯酸（n = 2）设计；所有的 CTR 均由聚甲基丙烯酸甲酯制成。与相关眼部疾病有关的信息包括假性剥脱（n = 17）、青光眼（n = 4）、玻璃体切除术/视网膜手术（n = 3）和外伤（n = 1）。在 3 个标本中进行的完整组织病理学评估显示出与假性剥脱一致的迹象，但其中一个病例没有与该疾病相关的可用病史。在 13 个标本中观察到或报告了中度/重度的 Soemmering 环形成，在 11 个标本中观察到或报告了后囊切开术缩窄。14 只眼睛由同一位外科医生进行了植入和取出手术，两次手术之间的间隔为 92.7 ± 23.4 个月。他因半脱位/脱位而进行取出手术的比例为同期植入的 CTR 中的 0.76%。
在本系列中，大约在植入后 6.8 年，因袋内 CTR-IOL-囊袋复合体的术后半脱位或脱位而进行了取出手术，这进一步证明了单独使用 CTR 可以稳定的悬韧带不足与需要进一步支撑的悬韧带不足之间存在细微差别。对大系列的分析可能有助于确定与该并发症相关的常见因素，以及手术计划和使用各种囊内支撑装置来增强术后悬韧带稳定。
