Department of Paediatric Ophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India.
Indian J Ophthalmol. 2023 Feb;71(2):673. doi: 10.4103/ijo.IJO_2057_22.
Traumatic cataracts present in multiple and different forms. Based on the nature of injury, it necessitates a customized approach for individual case. Capsulorhexis and in the bag intraocular lens (IOL) placement are vital for long term centration of pediatric IOLs. Paediatric lenses having elastic capsule provide more challenges to perform optimum rhexis and the surgery becomes further complicated, when it is subluxated or fibrosed. Here is a pediatric case with such challenges managed using capsular tension ring (CTR) and capsular tension segment (CTS).
To demonstrate the making of optimum rhexis in a fibrosed capsule in subluxated lens and placing the IOL along with fixation of bag using CTR and CTS.
A 13-year-old boy sustained an injury in the right eye from an air pistol, underwent lid tear repair in a local hospital, and presented to us one month post trauma with visual acuity of 6/60 in the right eye and 6/6 in the left eye. On examination, there was more than 180° temporal zonular dialysis with fibrosis of the anterior capsule. In this situation, creating an intact capsulorhexis was a challenge which was solved using micro-scissors and micro-vitreo-retinal forceps, in addition to routine instruments. After removing the lens material, CTS was placed initially in the bag to stabilize it while introducing CTR. The CTS was then fixated to the sclera. Foldable IOL was placed in the bag. Technique and tips to make intact rhexis and easy passage of suture are demonstrated.
This video shows tips and different methods adopted in each step of the surgery for successful placement of IOL in bag along with fixation of bag using CTR and CTS in a case of traumatic subluxated cataract with shrunken anterior lens capsule.
外伤性白内障有多种不同的形式。根据损伤的性质，需要针对具体病例采用定制化的方法。撕囊和囊袋内人工晶状体（IOL）植入对于儿童 IOL 的长期定位至关重要。具有弹性囊的儿童晶状体在进行最佳撕囊时会带来更多挑战，而当晶状体半脱位或纤维化时，手术会变得更加复杂。这里介绍一个使用囊袋张力环（CTR）和囊袋张力段（CTS）来处理此类挑战的儿童病例。
演示在纤维化的半脱位晶状体囊内进行最佳撕囊，并使用 CTR 和 CTS 将 IOL 与囊袋固定。
一名 13 岁男孩右眼被气枪击中，在当地医院接受了眼睑撕裂修复术，一个月后因右眼视力为 6/60，左眼视力为 6/6 就诊。检查发现，颞侧超过 180°的悬韧带断裂，伴有前囊纤维化。在这种情况下，创建完整的撕囊是一个挑战，我们使用显微剪刀和显微玻璃体视网膜镊，以及常规器械解决了这个问题。在去除晶状体物质后，首先将 CTS 放置在囊袋中以稳定其位置，同时引入 CTR。然后将 CTS 固定在巩膜上。将折叠式 IOL 放置在囊袋中。演示了制作完整撕囊和易于缝线通过的技巧和窍门。
该视频展示了在一个外伤性半脱位白内障伴萎缩前晶状体囊的病例中，使用 CTR 和 CTS 将 IOL 成功固定在囊袋中的手术各个步骤中采用的技巧和不同方法。
