Tansu GÖNEN, Ekrem ÇELİK, Büşra ENGİN POTOĞLU, Lütfiye Ebru BABADAĞ

Fakoemülsifikasyon Cerrahisinde İmplantasyon Sırasında Gelişen Göz İçi Lens Hasarına Neden Olan Faktörler

Amaç: Fakoemülsifikasyon cerrahisinde implantasyon sırasında göz içi lens (GİL) bütünlüğünü etkileyen faktörleri değerlendirmek. Gereç ve Yöntem: Bu çalışmada, Ağustos 2010-Temmuz 2019 tarihleri arasında fakoemülsifikasyon ve kartuş yardımlı katlanabilir GİL implantasyonu yapılmış 3.856 hastanın (4.778 göz) tıbbi kayıtları geriye dönük olarak incelendi. İmplantasyon sırasında GİL bütünlüğü bozulan 11 hastanın 11 gözü çalışmaya dahil edildi. Diğer gözlerin GİL ve implantasyon sistemi verileri kaydedildi. Bulgular: İncelenen 4.778 GİL’nin 4.195’i hidrofobik akrilik (835’i SA60AT, 2.438’i AAB00 ve 922’si ZCB00) ve 583’ü hidrofobik yüzeyli yüksek su içerikli akrilik (UD 613) idi. Hidrofobik yüksek su içerikli akrilik GİL’ler tek kullanımlık plastik enjektör ve katlanan kartuş, hidrofobik akrilik GİL’ler yeniden kullanılabilir metal enjektör ve tek kullanımlık katlanmayan kartuş ile göz içine yerleştirilmişti. Bütünlüğü bozulmuş 11 GİL’in 8’i hidrofobik yüzeyli yüksek su içerikli akrilik iken 3’ü hidrofobik akrilikti (p

Factors Causing Intraocular Lens Damage During Implantation in Phacoemulsification Surgery

Aim: To evaluate the factors affecting intraocular lens (IOL) integrity during implantation in phacoemulsification surgery.Materials and Methods: In this study, medical records of 3,856 patients (4,778 eyes) who underwent phacoemulsification and foldable IOLimplantation by cartridge between August 2010 and July 2019 were retrospectively reviewed. The 11 eyes of 11 patients who had undergone IOLremoval and reimplantation were noted for IOL damage during implantation. In other eyes, implanted IOL material, injector and cartridge typeinformation were recorded.Results: The properties of implanted 4,195 IOLs of 4,778 were hydrophobic acrylic (835 SA60AT, 2,438 AAB00, 922 ZCB00). The remaining 583 IOLswere hydrophobic surfaced high water content acrylic (UD 613). Hydrophobic acrylic IOLs with high water content were inserted with a disposableplastic syringe and foldable cartridge, and hydrophobic acrylic IOLs were inserted with a reusable metal syringe and disposable non-foldablecartridge. Of the 11 IOLs whose integrity was impaired during implantation, 8 were hydrophobic surfaced high water content acrylic and 3 werehydrophobic acrylic (p

PDF

___

1. Lee GA, Dal Pra ML. Cracked acrylic intraocular lens requiring explantation. Aust N Z J Ophthalmol. 1997;25:71-3.
2. Singh SK, Winter I. Explantation of damaged foldable acrylic lens with implantation of foldable intraocular lens without enlarging incision. Kathmandu Univ Med J (KUMJ). 2008;6:239-41.
3. Olson R, Cameron R, Hovis T, Hunkeler J, Lindstrom R, Steinert R. Clinical evaluation of the Unfolder. J Cataract Refract Surg. 1997;23:1384-9.
4. Harsum S, Mann S, Clatworthy I, Lewin J, Little B. An investigation of intraocular lens damage and foreign bodies using an injectable hydrophilic acrylic lens implant. Eye (Lond). 2010;24:152-7.
5. Bellucci R. An introduction to intraocular lenses: material, optics, haptics, design and aberration. Cataract. ESASO Course Series. Basel, Karger 2013;3:38-55.
6. Singh AD, Fang T, Rath R. Cartridge cracks during foldable intraocular lens insertion. J Cataract Refract Surg. 1998;24:1220-2.
7. Tognetto D, Toto L, Sanguinetti G, Cecchini P, Vattovani O, Filacorda S, et al. Lens epithelial cell reaction after implantation of different intraocular lens materials: two-year results of a randomized prospective trial. Ophthalmology. 2003;110:1935-41.
8. Huang Q, Cheng GP, Chiu K, Wang GQ. Surface Modification of Intraocular Lenses. Chin Med J (Engl). 2016;129:206-14.
9. Özyol P, Özyol E, Karel F. Biocompatibility of Intraocular Lenses. Turk J Ophthalmol. 2017;47:221-5.
10. Davison JA. Clinical performance of Alcon SA30AL and SA60AT single-piece acrylic intraocular lenses. J Cataract Refract Surg. 2002;28:1112-23.
11. Wahba SS, Riad RF, Morkos FF, Hassouna AK, Roshdy MM. Visual performance of the Tecnis one-piece lens ZCB00. Clin Ophthalmol. 2011;5:1803-8.
12. Remón L, Siedlecki D, Cabeza-Gil I, Calvo B. Influence of material and haptic design on the mechanical stability of intraocular lenses by means of finiteelement modeling. J Biomed Opt. 2018;23:1-10.
13. Akkuş ÖG, Petriçli IS. Comparison of visual outcomes and reading performance after bilateral implantation of multifocal intraocular lenses with bilateral monofocal intraocular lenses. Int Ophthalmol. 2018;38:1011-9.
14. Mamalis N, Brubaker J, Davis D, Espandar L, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention--2007 survey update. J Cataract Refract Surg. 2008;34:1584-91.
15. Grabow HB. Indications and techniques of intraocular lens removal. 2005;2-9.
16. Olson RJ. Cartridge cracks with different viscoelastic agents. J Cataract Refract Surg. 1999;25:465-6.
17. Saxena R, Sinha A, Khokhar S, Dhawan M, Turuka K. Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder silver series system using hydroxypropylmethylcellulose. Indian J Ophthalmol. 2007;55:396-7.
18. Pfister DR. Stress fractures after folding an acrylic intraocular lens. Am J Ophthalmol. 1996;121:572-4.
19. Lee MH, Webster DL. Intraocular lens exchange-removing the optic intact. Int J Ophthalmol. 2016;9:925-8.
20. Osher RH. Crisscross lensotomy: New explantation technique. J Cataract Refract Surg. 2006;32:386-8.
21. Batlan SJ, Dodick JM. Explantation of a foldable silicone intraocular lens. Am J Ophthalmol. 1996;122:270-2.
22. Por YM, Chee SP. Trisection technique: a 2-snip approach to intraocular lens explantation. J Cataract Refract Surg. 2007;33:1151-4.
23. Zheng D, Zhang Z, Yang W, Chen W. Foldable lens explantation and exchange: the reason and solution. Yan Ke Xue Bao. 2001;17:54-6.
24. Marques FF, Marques DM, Smith CM, Osher RH. Intraocular lens exchange assisted by preoperative neodymium:YAG laser haptic fracture. J Cataract Refract Surg. 2004;30:247-9.
25. Mehta JS, Wilkins MR, Gartry DS. Explantation of an acrylic Acrysof intraocular lens without wound enlargement. Acta Ophthalmol Scand. 2005;83:262-3.