In cataract surgery, in a patient with poor zonules of Zinn, suspensory ligament of lens and disloca

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Intr duction
In cataract surgery, in a patient with poor
zonules of Zinn, suspensory ligament of lens and
dislocation of lens fragments into the vitreous
cavity could easily occur. This potential
problem makes the selection of surgical technique
difficult. As a countermeasure against poor
support of zonules of Zinn (or effective
phacoemulsification in such cases), we have
developed a completely new capsule expander.
Capsule Expander
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Purpose
Ordinarily, cases with significantly poor zonules
of Zinn are not good candidates for
phacoemulsification. Intracapsular cataract
extraction (ICCE) is the choice.In cases where
insufficient support of the zonules is relatively
minor, phacoemulsification may be performed. For
such patients, an iris retractor, a capsular
tension ring (CTR) and other supportive devices
are concurrently used.While the iris retractor
gives support to the lens capsule by the hook
placed on the continuous circular capsulorhexis
(CCC), the retractor has no capability to expand
the equatorial region because the tip of the hook
does not reach the equator of the capsule. This
shortcoming makes phacoemulsification, especially
use of irrigation and aspiration tips (I/A) for
the lens cortex, quite impractical. The CTR
enlarges the lens capsule but lacks the means to
fix the capsule to the surrounding tissues.
Ordinarily, cases with significantly poor zonules
of Zinn are not good candidates for
phacoemulsification. Intracapsular cataract
extraction (ICCE) is the choice.In cases where
insufficient support of the zonules is relatively
minor, phacoemulsification may be performed. For
such patients, an iris retractor, a capsular
tension ring (CTR) and other supportive devices
are concurrently used.While the iris retractor
gives support to the lens capsule by the hook
placed on the continuous circular capsulorhexis
(CCC), the retractor has no capability to expand
the equatorial region because the tip of the hook
does not reach the equator of the capsule. This
shortcoming makes phacoemulsification, especially
use of irrigation and aspiration tips (I/A) for
the lens cortex, quite impractical. The CTR
enlarges the lens capsule but lacks the means to
fix the capsule to the surrounding tissues.
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Methods
The tip of the capsule expander is T-shaped and
expands the equatorial area as the CTR does. The
capsule expander is made of the same nylon
material as in No. 5-0 suture. The material is
soft and easily allows insertion from the limbus
stub incision and evulsion. Its total length is
12mm. The silicone stopper for fixation to the
sclera slides for to-and-flo adjustment.
We have therefore devised a completely new type
of capsule expander. This is a new auxiliary
device (to support the lens capsule) which
functions both as an iris retractor capable of
supporting the capsule and CTR capable of
expanding the capsule. (The use of this device
enables performance of phacoemulsification even
in cases of lens concussion or lens subluxation.)
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Methods 2
See additional video file.
In this case,we could take phacoemulsification
with four Capsule Expander.
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Results
In this case, the Capsule Expander is advanced to
the back of the anterior capsule and its tip is
inserted in the equator area of the lens capsule
to make the capsule stationary. Therefore a
normal operation can do operation very soon when
I use this new device 'Capsule Expander'
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Conclusion
Operability improved in the later operation
markedly by using this appliance adequately.We
were able to complete an operation by a near
method by a conventional cataract operation more
safely than the advice even if it was critical
disease example. Its extremely effective and a
great help!
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Acknowledgement
We do not have any financial or proprietary
interest in any of the instruments or materials
used in these surgeries.