Department of Pediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India.
Indian J Ophthalmol. 2022 Feb;70(2):709-710. doi: 10.4103/ijo.IJO_153_22.
Ectopia lentis is a condition that compromises vision in childhood by inducing either double vision or aphakic visual axis. Correction of lens status is of prime importance to prevent amblyopia or sensory strabismus.
Placing an intraocular lens (IOL) in the bag in such cases will maintain aqueous vitreous barrier but it is a difficult task.This video demonstrates the method of placing modified Cionni capsular tension ring (CTR) and placement of IOL in children.
This video shows the management of multiple cases of ectopia lentis with more than 180 degree subluxation. Making intact rhexis is crucial and technically difficult in such cases. The way of making a proper capsulorhexis is shown. After making capsulorhexis, all the cases were managed with single loop Cionni CTR. Cionni CTR has a loop with a anterior offset of 0.4 mm to override the anterior capsule. It has two designs - right and left design, based on the position of islet in the CTR. Since the offset of the hook is tiny, there are high chances to flip the Cionni CTR. If the Cionni CTR is placed in a flipped manner, it would not give effective pull of the bag, when fixated to sclera. And also, it could be traumatic to explant and place in correct manner. Hence it is vital to place the Cionni CTR in correct orientation, so that anterior offset will orient anteriorly. This video gives guidance to the viewers about the correct way of placing different designs of Cionni CTR in different types of subluxation.Timing of passing sutures through sclera may be done either before or after placing the Cionni CTR in the bag. Both the ways are demonstrated in different cases.
Different technique of doing Cionni CTR fixation with IOL placement are demonstrated. Surgeons who wish to try this procedure can choose the option that they feel comfortable with. We conclude that choice of Cionni CTR design and technique of placement depends on surgeon's choice and not based on the type of subluxation.
晶状体异位会导致儿童出现复视或无晶状体性视觉轴，从而影响视力。矫正晶状体的位置对于预防弱视或感觉性斜视至关重要。
在这种情况下，将人工晶状体（IOL）置于囊袋内可维持房水玻璃体屏障，但这是一项艰巨的任务。本视频演示了在儿童中放置改良 Cionni 囊袋张力环（CTR）和 IOL 的方法。
本视频展示了超过 180 度半脱位的多个晶状体异位病例的处理方法。在这种情况下，制作完整的撕囊至关重要且技术难度较大。我们展示了制作适当撕囊的方法。完成撕囊后，所有病例均采用单环 Cionni CTR 进行处理。Cionni CTR 带有一个前向偏移 0.4mm 的环，以覆盖前囊。它有两种设计——右设计和左设计，基于 CTR 中胰岛的位置。由于钩的偏移量很小，Cionni CTR 翻转的可能性很高。如果 Cionni CTR 以翻转的方式放置，则当固定在巩膜上时，它不会有效地牵拉囊袋。此外，将其以正确的方式取出和放置也可能会造成创伤。因此，将 Cionni CTR 正确定向放置至关重要，以便前向偏移指向前方。本视频为观众提供了关于在不同类型半脱位中放置不同设计的 Cionni CTR 的正确方法的指导。通过巩膜穿线的时间可以在将 Cionni CTR 放入囊袋之前或之后进行。在不同的病例中演示了这两种方法。
演示了不同的 Cionni CTR 固定技术和 IOL 放置方法。希望尝试此手术的外科医生可以选择他们感到舒适的方法。我们的结论是，Cionni CTR 设计和放置技术的选择取决于外科医生的选择，而不是半脱位的类型。
