Psödoeksfoliasyonlu katarakt hastalarında kapsül germe halkası uygulanması

Amaç: Psödoeksfolyasyonlu katarakt olgularında, fakoemülsifkasyon sırasında kapsül germe halkası (KGH) implantasyonunun, zonül zayıfığı ve artmış kapsül frajilitesine bağlı gelişebilecek komplikasyonları önlemedeki başarısını değerlendirmek. Gereç ve Yöntem: Fakoemülsifkasyon cerrahisi yapılan psödoeksfolyasyonlu 148 hastanın 148 gözü çalışmaya alındı. Grup 1’deki (çalışma grubu) 74 göze hidrodisseksiyonu takiben KGH uygulandı, kontrol grubundaki (Grup 2) 74 göze ise KGH uygulanmadı. Tüm olgularda ameliyat sırasında gelişen zonül diyalizi, arka kapsül rüptürü, ekstrakapsüler katarakt ekstraksiyonu (EKKE) ya da intrakapsüler katarakt ekstraksiyonu (İKKE)’ye dönme, vitreus kaybı gibi intraoperatif komplikasyonlarla, erken postoperatif komplikasyonlar kaydedilerek, sonuçların gruplar arası karşılaştırılması yapıldı. Bulgular: Grup 1’de 74 gözün 64’ünde (%86.5) komplikasyon gelişmedi ve kapsül içi göz içi lens (GİL) kondu, 10 gözde (%13.5) arka kapsül perfore oldu, bunların 4’ünde EKKE’ye geçilerek 2’sine sulkus lensi, 2’sine ön kamara lensi kondu. Diğer 6 gözde (%8.1) ise; fakoemülsifkasyon tamamlanarak 4 GİL sulkusa, 2 GİL ön kameraya kondu. Grup 2’de ise 74 gözün 42’sinde (%56.8) komplikasyon gelişmedi ve hepsine kapsül içi GİL kondu, 10 hastada (%13.5) zonül diyalizi oldu, bunların 4’ünde haff diyaliz vardı ve fakoemülsifkasyon tamamlanarak kapsül içi GİL kondu, 6 gözde ileri derecede zonül diyalizi görüldü ve hepsinde İKKE’ye geçilerek, ön kamara GİL kondu. Yirmi gözde (%27) arka kapsül perforasyonu gelişti, hepsinde EKKE’ye geçildi, EKKE’ye geçilen 14 gözde (%18.9) sulkusa, 6 gözde ön kameraya GİL implantasyonu yapıldı, 2 gözde kapsüloreksis perifere kaçtığı için EKKE’ye geçildi ve GİL kondu. Sonuç: Psödoeksfolyasyonlu hastalarda katarakt cerrahisinde KGH kullanımının; zonül hasarını engelleyip fako- emülsifkasyonu kolaylaştırdığı, kapsül içi GİL implantasyonu oranını arttırdığı, cerrahi sonrası GİL desantralizasyonu oluşumunu önemli ölçüde engellediği görüldü.

Capsular tension ring implantation in cataract patients with pseudoexfoliation

Purpose: To investigate the infuence of capsular tension ring (CTR) on prevention of intraoperative complications due to zonular weakness and increased capsular fragility during phacoemulsifcation of cataracts with pseudoexfoliation. Materials and methods: 148 eyes of 148 patients who had cataract with pseudoexfoliation underwent phacoemulsifcation surgery included. 74 eyes of the frst group (study group) were implanted with CTR after hydrodissection, while CTR was not performed in 74 eyes of control group (Group 2). In both groups, intraoperative complications such as zonular dialysis, conversion to extracapsular cataract extraction (ECCE) or intracapsular cataract extraction (ICCE), posterior capsular rupture, vitreus loss, and early postoperative complications were recorded and compared between two groups. Results: In group 1, no complication occurred in 64 eyes (86.5%) and intraocular lens (IOL) implanted in the bag. In 10 eyes (13.5%) posterior capsule rupture occurred, in 4 of them converted to ECCE, IOL implanted in four eyes. In other 6 eyes, phacoemulsifcation completed underlay viscoelastic. In group 2, no complication occured in 42 eyes and IOL implanted in the bag. In 10 patients (13.5%) zonular dialysis occurred, in 4 of them IOL implanted in the bag and in 6 of them converted to ICCE and IOL implanted in anterior chamber. Posterior capsule rupture occurred in 20 eyes (27.0%), all of them converted to ECCE and IOL was implanted. In 2 eyes capsullorrhexis occurred and converted to ECCE, IOL was implanted in sulcus. Conclusion: In patients with pseudoexfoliation, CTR implantation in phacoemulsifcation simplifed the surgery, increased the rate of IOL implanted in the bag and prevented complications like IOL desantralization after surgery.

PDF

___

1. Linebarger EJ, Hardten DR, Shah GK, Lindstrom LR. Phacoemulsifcation and modern cataract surgery. Surv Ophthalmol 1999;44:123-147.
2. Kelman CD. The history and development of phacoemulsifcation. Int Ophthalmol Clin 1994;34:1-12.
3. Fine IH, Hoffman RS: Phacoemulsifcation in the presence of pseudoexfoliation: challenges and options. J Cataract Refract Surgery 1997;23:160-165.
4. Skuta LG, Parrish KR. Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome. Arch Ophthalmol 1987;105:1318-1319.
5. Hara T, Hara T, Yamada Y: ”Equator ring” for maintenance of the completely circular contour of the capsular bag equator after cataract removal. Ophthalmic Surg 1991;22:358-359.
6. Hara T, Hara T, Sakanishi K, Yamada Y: Effcacy of equator rings in an experimental rabbit study. Arch Ophthalmol 1995;113:1060-1065.
7. Cionni RJ, Osher RH: Management of profound zonular dialysis or weakness with a new endocapsular ring designed for scleral fxation. J Cataract Refract Surg 1998;24:1299-1306.
8. Legler UFC, Witschel BM: The capsular ring: a new device for complicated cataract surgery. German J ophthalmol 1994;20:417-420.
9. Menapace R, Findl O, Georgopoulos M, Rainer G, Vass C; Schmettere K. The capsular ring: Designs; applications and techniques. J Cataract Surg 2000;26:898-912 .
10. Cionni RJ, Osher RH, Marques DM, Marques FF, Synder ME, Shapiro S. Modifed capsular tension ring for patients with congenital loss of zonular support. J Cataract Surg 2003;29:1668-1673.
11. Gimbel HV, Sun R, Heston JP; Management of zonular dialysis in phacoemulsifcation and IOL implantation using the capsular tension ring. Ophthalmic Surg Lasers 1997;28:273-281.
12. Freyler H, Radax U. pseudoexfoliation syndrome –a risk factor in modern cataract surgery? Klin Monatsbl Augenheilkd 1994;205:275-279.
13. Schlötzer SU, Naumann OG. A histopatholologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol 1994;118:730-733.
14. Wirbelauer C, Anders N, Pham DT, Wollensek J, Corneal endothelial cell changes in pseudoexfoliation syndrome after cataract surgery. Arch Ophthalmol 1998;116:145-149.
15. Bayraktar S, Atlan T, Küçüksümer Y, Yılmaz ÖF. Capsular tension ring implantation after capsulorhexis in phacoemülsifcation of cataracts associated with pseudoexfoliation syndrome: intraoperative complications and early postoperative fndings. J Cataract Refract Surg 2001;27:1620-1628.
16. Fine IH. Cortical cleaving hydrodissection. J Cataract Refract Surg 1992;18:508-512.
17. Yüksel N, Karabaş VL, Arslan A, Demirci A, ÇağlarY. Ocular hemodynamics in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Ophthalmology 2001;108:1043-1049.
18. Puska P, Tarkanken A. Exfoliation Syndrome as a risk factor for cataract development: fve-year follow-up of lens opacities in exfoliation syndrome. J Cataract Refract Surg 2001;27:1992-1998.
19. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001;45:265-315.
20. Lumme P, Laatikainen L. Exfoliation syndrome and cataract extraction. Am J Ophthalmol 1993;116:51-55.
21. Scorolli L, Campo EC, Bassien L, Meduri RA. Pseudoexfoliation syndrome: a cohort study on intraoperative complications in cataract surgery. Ophthalmologica 1998; 212:278-280.
22. Guzek JP, Holm M, Cotter JB, et al. Risk factors for intraoperative complications: 1000 extracapsular cases. Ophthalmology 1987;94:461-466.
23. Ermiş SS, İnan ÜÜ, Öztürk F: The Effect of Pseudoexfoliation syndrome in phacoemulsifcation cataract surgery and small anterior chamber depth as a risk factor. MN Oftalmoloji Dergisi 2002;4:319-323.
24. Aslan BS, Altıparmak UE, Duman S. Psödoeksfolyatif sendromlu gözlerde fakoemülsifkasyon sırasında kapsül germe halkası uygulanımının cerrahi komplikasyonlara etkisi. Türk Oftalmoloji Gazetesi 2003;33:596-599.
25. Köz ÖG, Yarangümeli A, Akyol S, Kural G. Kapsül germe halkası ile fakoemülsifkasyon cerrahisi uygulanan psödoeksfolyasyonlu olgularda glokom ve postoperatif sonuçların ilişkisi. MN Oftalmoloji Dergisi 2004;11:114-117.
26. Fries UK, Ohrloff. C. Ultrasound biomicroscopy image of the capsula supporting ring in pseudophakia. Klin Monatsbl Augenheilkd 1996;209:211-214.
27. Drolsum L, Haaskjold E, Sandvig K. Phacoemulsifcation in eyes with pseudoexfoliation J Cataract Refract Surg 1998;24:787-792.