J Korean Ophthalmol Soc.  2015 Apr;56(4):614-619. 10.3341/jkos.2015.56.4.614.

Modified Capsular Tension Ring Scleral Fixation and Toric Intraocular Lens Implantation in a Patient with Homocystinuria

Affiliations
  • 1Department of Ophthalmology, Soonchunhyang University College of Medicine, Cheonan, Korea. schcornea@schmc.ac.kr

Abstract

PURPOSE
Purpose: To report a case of modified capsular tension ring scleral fixation and in-the-bag toric intraocular lens (IOL) implantation in a pediatric patient with severe crystalline lens subluxation due to homocystinuria.
CASE SUMMARY
A 9-year-old male diagnosed with homocystinuria and crystalline lens subluxation presented with progressive decrease of visual acuity. Uncorrected distant visual acuity (UDVA) and corrected distant visual acuity were 0.03 and 0.6 in the right eye and 0.01 and 0.5 in the left eye, respectively. Slit-lamp examination showed severe crystalline lens subluxation toward the inferiomedial side in both eyes. Corneal astigmatism in the right eye and left eye was 2.75 diopters (D) and 3.00 D, respectively based on keratometry. A combination of subluxated crystalline lens aspiration, scleral-fixated modified capsular tension ring insertion and in-the-bag toric IOL implantation were performed in both eyes. After continuous curvilinear capsulorhexis, nucleus and cortex of the crystalline lens were removed by irrigation and aspiration. A modified capsular tension ring with 2 fixation hooks (Model 2-L) was inserted into the capsular bag and fixed at the scleral wall. Next, toric IOL was inserted into the capsular bag. UDVA was 0.8 in the right eye and 0.9 in the left eye and 3 months postoperatively, the IOL rotation was less than 3 degrees from intended axis in both eyes.
CONCLUSIONS
In a patient with severe congenital crystalline lens subluxation and moderate to severe corneal astigmatism, scleral fixation of modified capsular tension ring and in-the-bag toric IOL implantation is a possible surgical option.

Keyword

Crystalline lens subluxation; Homocystinuria; Modified capsular tension ring; Toric intraocular lens

MeSH Terms

Astigmatism
Axis, Cervical Vertebra
Capsulorhexis
Child
Homocystinuria*
Humans
Lens Implantation, Intraocular*
Lens, Crystalline
Lenses, Intraocular
Male
Visual Acuity

Figure

  • Figure 1. Slit-lamp photographs showing bilateral inferomedial crystalline lens subluxation through the dilated pupil. (A) Inferomedial crystalline lens subluxation in the right eye. (B) Inferomedial crystalline lens subluxation in the left eye. OD = oculus dexter; OS = oculus sinister.

  • Figure 2. Intraoperative photographs. (A) Making anterior capsule tear using two 26-gauge needles. (B) Supporting anterior capsule using 3 microhook iris retractors. (C) Fixation of modified capsular tension ring (MCTR) to the sclera. Note that two hooks are not perpendicular. The meridian of second hook is determined by the diameters of MCTR and sulcus, individually. (D) A complex of toric intraocular lens and scleral fixated MCTR is well centered along the intended axis.

  • Figure 3. Postoperative photohgraphs. (A, B) External photographs shows clear cornea, conjunctiva and round pupil 3 months after operation. (C) Three degrees counterclockwise axis rotation is found in a postoperative 3 months slit-lamp photograph in the right eye. (D) Two degrees clockwise axis rotation is found in a postoperative 3 months slit-lamp photograph in the left eye. OD = oculus dexter; OS = oculus sinister.


Reference

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