18-month results of double-fanged 5-0 polypropylene suture transscleral bag fixation in subluxated cataracts / Resultados de 18 meses da técnica double fanged com sutura de 5-0 polipropileno para fixação transescleral de saco capsular em cataratas subluxadas

ABSTRACT Purpose: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique Methods: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. Results: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. Conclusion: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.

RESUMO Objetivo: Avaliar a estabilidade e eficácia da técnica double-flanged com sutura de 5-0 polipropileno para fixação de cataratas subluxadas aos 18 meses e as possíveis complicações desta nova técnica. Métodos: Esta técnica utiliza um monofilamento de polipropileno 5-0 para criar dois flanges com um termocautério para fixar um Segmento de Tensão Capsular na esclera a fim de estabilizar o saco capsular subluxado. Esta técnica foi implementada em 17 olhos que necessitavam do implante de lente intraocular em casos de diálise zonular devido a trauma, síndrome de Marfan, microesferofacia, subluxação idiopática ou pós-facoemulsificação que provocou subulxação do saco capsular intraoperatória. Resultados: O seguimento dos pacientes foi de 18 meses. A acuidade visual corrigida melhorou significativamente de 0,85 para 0,39 (logMAR), enquanto os erros de refração esféricos e cilíndricos e a pressão intraocular permaneceram estáveis. Nenhuma fotodegradação de sutura ou pseudofacodonese foi encontrada. Conclusão: A técnica double-flanged para fixação transescleral de saco capsular com sutura de 5-0 polipropileno mostrou resultados de estabilidade de longo prazo para o complexo lente/saco capsular. Então, aparenta ser uma opção segura para cirurgia de catarata, sem necessidade pontos, em olhos com fraqueza zonular ou diálise.

Double-flanged polypropylene technique: 5-year results.

PURPOSE: To assess the long-term (5-year) results and complications of the double-flanged polypropylene technique in patients with capsular tension segment fixation, nonfoldable intraocular lens (IOL) scleral fixation, and foldable IOL scleral fixation. SETTING: Santa Casa de Belo Horizonte and Centro Oftalmológico de Minas Gerais. DESIGN: Prospective case series. METHODS: Eyes that underwent treatment using the double-flanged polypropylene technique between September 2016 to September 2021 were included. LogMAR visual acuity was recorded, as well as complications such as long-term polypropylene resistance, conjunctival erosion, conjunctival inflammation, flange exposure, internalization, endophthalmitis, retinal detachment, and cystoid macular edema. RESULTS: 71 eyes of 61 patients were evaluated. The mean follow-up period for these eyes was 28.2 ± 14.3 (min: 4; max: 60; median: 26) months. 173 flanges were performed. 13 cases with sub-Tenon flanges (7.5%) were observed. 5 exposed flanges (2.89%), presented after a mean of 1.8 weeks postoperatively, were observed. 1 patient with large flanges presented with conjunctival inflammation and hyperemia. 2 late internalized flanges (1.1%) and 2 recently internalized flanges (1.1%) were observed. 3 eyes (4.22%) had retinal detachment. Moreover, cystoid macular edema was detected in 3 eyes (4.22%). No cases of endophthalmitis were observed. CONCLUSIONS: The double-flanged technique was proven to be stable when the correct technical procedure was followed. However, complications can be observed, especially with short scleral tunnels and in eyes where the flanges were not buried inside the sclera.

18-month results of double-fanged 5-0 polypropylene suture transscleral bag fixation in subluxated cataracts.

PURPOSE: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique. METHODS: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. RESULTS: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. CONCLUSION: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.

Late internalized double-flanged polypropylene with canabrava technique in patient with marfan syndrome.

INTRODUCTION: This paper reports the first occurrence of a late internalized flange due to capsular contraction syndrome after undergoing the double-flanged surgical technique. CASE DESCRIPTION: A 32-year-old woman with Marfan syndrome underwent phacoemulsification using the double-flanged technique in both eyes. Two years postoperatively, a slit lamp examination revealed a capsular bag with anterior phimosis (capsular contraction syndrome) and the external flange internalized. The patient was submitted for a new surgery to re-fixate the capsular bag. The procedure was successfully accomplished. The intraocular lens was centered by the end of the procedure without areas of traction. The patient presented with best corrected visual acuity of 20/25 in both eyes postoperatively. CONCLUSIONS: This paper recounts a successful re-approach of a late internalized double-flange two years after the first procedure in a patient that developed capsular contraction syndrome.

Scleral fixation of a 4-eyelet foldable intraocular lens in patients with aphakia using a 4-flanged technique.

A 29-gauge model test fine needle is used to create a beveled intrascleral tunnel; with microforceps, a 6-0 polypropylene suture is placed in the bore of the needle, which is used as a guide to pass and externalize the monofilament through the sclera. This maneuver is repeated by passing the suture ends through the intraocular lens (IOL) eyelets. The folded IOL is inserted and centered, the sutures are cut, and the flanges are created by thermocautery and inserted into the scleral tunnel. This technique was performed on 7 patients and visual acuity was recorded. The 4-flanged technique for scleral fixation using a 4-eyelet IOL was an effective and a safe treatment in the setting of aphakia.

The Canabrava Ring, an open ring-shaped pupil expander for cataract surgery associated with iris colobomata: a case report / Aplicação de anel expansor de pupila pequena em formato de anel aberto para cirurgia de catarata em coloboma de íris: relato de caso

ABSTRACT In this report, we describe a new pupil expander device that was used to obtain adequate pupil dilation and centering in a patient with an iris coloboma. Specifically, we describe the case of a patient with an iris coloboma; a Malyugin ring was inserted to facilitate dilation during phacoemulsifi­cation surgery. One of the scrolls did not engage which resulted in an uneven distribution of forces and an eccentric pupil. A Canabrava Ring was then implanted that promoted effective pupillary dilation and remained stable and effective throughout the surgical procedure.

RESUMO Neste relato, descrevemos um novo dispositivo expansor pupilar que foi usado obter adequada dilatação e centralização da pupila em um paciente com coloboma de íris. Especificamente, descrevemos um caso de cirurgia de facoemulsificação em um paciente com coloboma de íris associado à pupila pequena e que, previamente, tentou-se sem sucesso o uso do expansor Malyugin Ring, que provocou uma dilatação pupilar descentrada. Entretanto, com o uso do expansor de íris Canabrava Ring, a pupila permaneceu dilatada e centrada durante toda a cirurgia, permitindo a realização de um procedimento seguro.

The Canabrava Ring, an open ring-shaped pupil expander for cataract surgery associated with iris colobomata: a case report.

In this report, we describe a new pupil expander device that was used to obtain adequate pupil dilation and centering in a patient with an iris coloboma. Specifically, we describe the case of a patient with an iris coloboma; a Malyugin ring was inserted to facilitate dilation during phacoemulsifi-cation surgery. One of the scrolls did not engage which resulted in an uneven distribution of forces and an eccentric pupil. A Canabrava Ring was then implanted that promoted effective pupillary dilation and remained stable and effective throughout the surgical procedure.

Novel double-flanged technique for managing Marfan syndrome and microspherophakia.

A new technique for fixating the capsular bag in patients with ectopia lentis is presented. In this technique, the capsulorhexis is performed using a femtosecond laser, followed by the insertion of a standard capsular tension ring to redistribute capsular forces. The nucleus is hydroprolapsed into the anterior chamber and nuclear disassembly is performed above the iris plane to reduce zonular stress. Finally, a 5-0 polypropylene monofilament is used to fixate a capsular tension segment and subluxated capsular bag. This novel double-flanged method, achieved with cautery, does not require direct suturing of the monofilament on the sclera. This article describes the use of this new technique in 3 eyes, 2 in patients with Marfan syndrome and 1 in a patient with microspherophakia.

Four-Flanged Intrascleral Intraocular Lens Fixation Technique: No Flaps, No Knots, No Glue.

PURPOSE: To develop a novel, sutureless, single-piece, nonfoldable intraocular lens (IOL) intrascleral fixation technique based on the existing Malbran IOL scleral fixation and Yamane double-needle techniques. METHODS: The novel method uses a 5.0 polypropylene suture and a bipolar cautery to create 2 flanges in the eyelets of the IOL and 2 flanges outside to insert inside the scleral tunnel and thus fixate the IOL. RESULTS: This technique had been applied in 4 patients with aphakia after phacoemulsification complications. The mean preoperative and postoperative corrected distance visual acuities were 0.45 ± 0.17 and 0.67 ± 0.27 (Snellen decimal units), respectively. CONCLUSIONS: The 4-flanged technique improves and simplifies the existing single-piece, nonfoldable IOL intrascleral fixation techniques.

Efficacy of the Canabrava Ring (pupil expansion device) in cataract surgery for eyes with small pupils: the first 30 cases.

PURPOSE: To evaluate the outcomes of the first 30 cataract surgeries performed with a new disposable, injector-free, small-pupil expansion device. METHODS: This consecutive case series included 30 eyes from 29 patients who underwent cataract surgery using a new disposable small-pupil expansion device called the Canabrava Ring (AJL Ophthalmic S.A, Spain). It is the first iris expansion ring produced with indents that do not align with each other in the superior and inferior regions, resulting in a small vertical length (0.4 mm) that minimizes the risk of endothelial contact. All eyes had poorly dilated pupils of less than 5 mm preoperatively. Fifteen eyes had significant infective or traumatic pathologies preoperatively. Vertical and horizontal pupil diameters were evaluated preoperatively, intraoperatively, and 1 month postoperatively. RESULTS: The mean patient age was 64 ± 11.8 (standard deviation) years. The Canabrava Ring remained engaged throughout all surgeries, except one. All pupils were intraoperatively expanded to a diameter of 6.3 mm. Although preexisting pathology on the innervation of the pupils, the mean pupil diameter returns to a close preoperative size after 1 month surgery. The mean pupil diameters postoperatively and preoperatively were 4.41 and 3.77 mm, respectively (p<0.05). Postoperative complications occurred in eight eyes (one toxoplasmosis reactivation, one retinal detachment, one posterior capsule rupture, one posterior capsule opacification, and four posterior synechiae). These complications occurred in eyes with preexisting traumatic or infective pathologies or synechiae. CONCLUSION: The Canabrava Ring is effective for expanding and maintaining expansion of small pupils in cataract surgery. The increase in postoperative pupil diameter is clinically diminutive and can most likely be attributed to preexisting pathologies affecting pupil innervation. Further large-scale studies are required to support the present findings.

Efficacy of the Canabrava Ring (pupil expansion device) in cataract surgery for eyes with small pupils: the first 30 cases / Eficácia do dispositivo de expansão pupilar Anel de Canabrava em cirurgia de catarata com pupilas pequenas: 30 primeiros casos

ABSTRACT Purpose: To evaluate the outcomes of the first 30 cataract surgeries performed with a new disposable, injector-free, small-pupil expansion device. Methods: This consecutive case series included 30 eyes from 29 patients who underwent cataract surgery using a new disposable small-pupil expansion device called the Canabrava Ring (AJL Ophthalmic S.A, Spain). It is the first iris expansion ring produced with indents that do not align with each other in the superior and inferior regions, resulting in a small vertical length (0.4 mm) that minimizes the risk of endothelial contact. All eyes had poorly dilated pupils of less than 5 mm preoperatively. Fifteen eyes had significant infective or traumatic pathologies preoperatively. Vertical and horizontal pupil diameters were evaluated preoperatively, intraoperatively, and 1 month postoperatively. Results: The mean patient age was 64 ± 11.8 (standard deviation) years. The Canabrava Ring remained engaged throughout all surgeries, except one. All pupils were intraoperatively expanded to a diameter of 6.3 mm. Although preexisting pathology on the innervation of the pupils, the mean pupil diameter returns to a close preoperative size after 1 month surgery. The mean pupil diameters postoperatively and preoperatively were 4.41 and 3.77 mm, respectively (p<0.05). Postoperative complications occurred in eight eyes (one toxoplasmosis reactivation, one retinal detachment, one posterior capsule rupture, one posterior capsule opacification, and four posterior synechiae). These complications occurred in eyes with preexisting traumatic or infective pathologies or synechiae. Conclusion: The Canabrava Ring is effective for expanding and maintaining expansion of small pupils in cataract surgery. The increase in postoperative pupil diameter is clinically diminutive and can most likely be attributed to preexisting pathologies affecting pupil innervation. Further large-scale studies are required to support the present findings.

RESUMO Objetivo: Avaliar a estabilidade intraoperatória, segurança e eficácia dos 30 primeiros casos operados com um novo anel expansor de pupilas. Métodos: Série de casos de 30 olhos de 29 pacientes submetidos a cirurgia de catarata com Anel de Canabrava (AJL Oftalmic, SPAIN). Trata-se do primeiro anel expansor de íris produzido com indentações não alinhadas entre as regiões superiores e inferiores. Devido a isso, apresenta altura vertical de 0,4 mm, diminuindo os riscos de toque endotelial. O diâmetro pupilar dos pacientes era menor que 5 mm. Os diâmetros verticais e horizontais foram avaliados antes, durante e um mês após a cirurgia. Resultados: A idade média dos pacientes foi de 64 ± 11,8 (desvio padrão) anos. O anel permaneceu estável em todas as cirurgias, exceto uma. Todas as pupilas foram expandidas no intraoperatório para um diâmetro de 6,3 mm. Apesar de patologias pupilares pré-existentes, o diâmetro médio da pupila retornou a um tamanho próximo após 1 mês de cirurgia. Os tamanhos médios da pupila no pós-operatório e pré-operatório foram medidos em 4,41 e 3,77 mm, respectivamente (p<0,05). As complicações pós-operatórias ocorreram em 8 olhos: 1 reativação de toxoplasmose, 1 descolamento de retina, 1 ruptura de cápsula posterior, 1 opacificação da cápsula posterior, 4 sinéquias posteriores. Essas complicações ocorreram nos olhos com patologias traumáticas, infecciosas ou sinéquias pré-existentes. Conclusão: O Anel de Canabrava parece efetivo na expansão e manutenção de pupilas pequenas submetidas à cirurgia de catarata. O aumento do diâmetro da pupila pós-operatória é clinicamente pouco relevante e provavelmente pode ser atribuído à patologias pré-existentes que afetam as inervações pupilares. Outros estudos em larga escala são necessários para suportar os achados do estudo.

Double-flanged-haptic and capsular tension ring or segment for sutureless fixation in zonular instability.

PURPOSE: This paper introduces a surgical technique for the sutureless management of zonular dialysis greater than 120° using a capsular tension segment (CTS) or a modified capsular tension ring (m-CTR; CTR with suturing eyelets) and a haptic removed from a 3-piece polypropylene IOL. METHODS: A CTR is used as normal. Cataract removal is followed by connection of the CTS or m-CTR to the single haptic and created using heat to make a flange in one haptic's extremity. The other extremity is placed in the CTS or m-CTR's central hole. The CTS or m-CTR/flanged-haptic complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 30-gauge needle guides the externalization of the free haptic extremity through the adjacent pars plana and creates a flange on the second haptic tip permitting intrascleral fixation of the CTS or m-CTR. RESULTS: The result is a successful IOL implantation with a sutureless technique. CONCLUSIONS: This double-flanged m-CTR/CTS technique allows suture-free option for managing zonular weakness or dialysis while performing cataract surgery.