IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Eur J Ophthalmol. 2024 Jan;34(1):300-303. doi: 10.1177/11206721231200141. Epub 2023 Sep 20.
To describe a novel surgical approach in the management of subluxated cataracts.
A 70-year-old Caucasian male with a subluxated cataract in the left eye was referred to our clinic at the Azienda Ospedaliero-Universitaria di Bologna- Ophthalmology Unit. The ophthalmic examination revealed a best-corrected visual acuity (BCVA) of 20/200 in the left eye with monocular diplopia and a severely subluxated NO6/NC6 cataract and the fundus examination did not reveal any vitreoretinal abnormalities. The right eye had 20/20 BCVA and was pseudophakic. After a 300° conjunctival peritomy, a single 25-gauge valved trocar 4 mm was inserted from the limbus in the inferotemporal quadrant, where the cataract was mainly dislocated and a corneal paracentesis to reduce the anterior chamber intraocular pressure was performed. Subsequently cohesive viscoelastic was progressively injected in the retrolental space through the trocar, to recenter and elevate the subluxated cataract. Thereafter, a complete centered capsulorhexis was performed, four capsular hooks were inserted to stabilize the bag, and complete phacoemulsification was performed with intact posterior capsular support. In the end, given the lack of capsular support elements such as the Cionni ring or Ahmed segment, a sutureless scleral fixated intraocular lens was implanted.
One week after surgery, the BCVA was 20/25, and the final BCVA at 6 months was 20/20, without any complications.
Retrolental cohesive ophthalmic viscoelastic injection could represent a novel effective surgical approach in recentering and elevating subluxated cataracts, facilitating the capsulorhexis, and reducing the risk of a pars plana approach.
描述一种治疗半脱位白内障的新型手术方法。
一名 70 岁白人男性左眼患有半脱位白内障，被转诊至博洛尼亚大学附属医院眼科诊所。眼科检查显示左眼最佳矫正视力（BCVA）为 20/200，伴有单眼复视，并且白内障严重半脱位至 NO6/NC6，眼底检查未发现任何玻璃体视网膜异常。右眼 BCVA 为 20/20，为人工晶状体眼。在进行 300° 结膜环周切开术后，从颞下象限的角膜缘插入一个 25G 带阀套管针 4mm，该位置是白内障主要脱位的部位，并进行角膜穿刺术以降低前房眼内压。随后，通过套管针将粘性眼前房内黏弹剂逐渐注入后房，以使半脱位的白内障复位和抬高。此后，进行完整的中心性晶状体囊膜环形撕囊术，插入四个囊膜钩以稳定晶状体囊袋，并在完整的后囊膜支持下完成白内障超声乳化吸除术。最后，由于缺乏 Cionni 环或 Ahmed 段等囊袋支撑物，植入了无缝线巩膜固定型人工晶状体。
术后 1 周，BCVA 为 20/25，术后 6 个月最终 BCVA 为 20/20，无任何并发症。
后房内黏弹剂注射可能是一种新型有效的复位和抬高半脱位白内障的手术方法，有助于进行晶状体囊膜环形撕囊术，并降低经睫状体平坦部手术的风险。
