Long-Term Postoperative Outcomes Following Cionni Ring and In-the-Bag Intraocular Lens Implantation in Eyes With Subluxated Lenses

• Published in: American journal of ophthalmology 2024-12, Vol.268, p.136-142
• Main Authors: Sandhu, Rasikpriya, Shankar, Vijayvarschini, Vasavada, Vaishali, Vasavada, Shail, Vasavada, Abhay R., Vasavada, Viraj A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Lens Capsule, Crystalline - surgery; Lens Implantation, Intraocular; Lens Subluxation - physiopathology; Lens Subluxation - surgery; Lenses, Intraocular; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Prostheses and Implants; Retrospective Studies; Suture Techniques; Treatment Outcome; Visual Acuity - physiology; Young Adult
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.07.006

•This study reports on the longest reported follow-up (mean 9.9 years) of Cionni modified capsule tension ring using 9-0 polypropylene suture to fixate the bag in subluxated lenses.•Seventeen percent of the eyes had decentration of the intraocular lens (IOL)-capsular bag complex at a mean follow-up of 9 years.•Both adult and pediatric eyes showed decentration of the IOL.•Posterior capsule opacification was the commonest postoperative complication, occurring in 41% of the eyes.•Seventy-four percent of the eyes had a corrected distance visual acuity of at least 0.3 logMAR.•Preserving the capsular bag maintains the natural compartmentalization of the eye and allows placement of the IOL in its most physiological location. Evaluate long-term outcomes following Cionni modified capsule tension ring (MCTR) and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. Retrospective case series. Forty-one eyes of 31 patients from Raghudeep Eye Hospital, India, with subluxated lenses who had completed a minimum of 5 years’ postoperative follow-up were included. Lens extraction, capsular bag fixation with MCTR using 9-0 polypropylene suture, and in-the-bag IOL implantation were performed in all eyes. Corrected distance visual acuity (CDVA), IOL centration, posterior capsule opacification, glaucoma, and retinal complications were documented at final follow-up. The mean age of the cohort was 20.48 ± 16.46 (SD) years. Twenty-four eyes (58%) were below 15 years of age at the time of surgery. Marfan syndrome accounted for 37% cases. Mean follow-up was 9.89 ± 3.81 (SD) years. Thirty-two eyes (74%) had a CDVA of ≥0.3 logMAR at final follow-up. IOL decentration was noted in 7 eyes (17%), requiring a secondary surgery. The mean duration from primary surgery to resurgery was 8.79 years. Seventeen eyes (41%) required a laser capsulotomy, 88% of which were pediatric eyes. Retinal detachment occurred in 4 eyes (10%), 3 of which had Marfan syndrome. Capsular bag fixation with an MCTR using 9-0 polypropylene and in-the-bag IOL implantation had good long-term visual outcomes with an acceptable rate of serious postoperative complications in eyes with subluxated lenses. This approach allows preservation of the natural compartments of the eye and placement of an IOL in its most physiological position. However, considering a 17% rate of IOL decentration requiring surgical intervention, long-term stability with nonbiodegradable suture materials such as polytetrafluoroethylene a