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Capsular anchor enables stable fixation of subluxated IOL
A central rod and two prongs sutured to the sclera provide accurate centration of the IOL and capsular bag complex.
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A novel capsular anchor showed promising results in managing subluxated IOLs in the capsular bag, according to a published report.
The AssiAnchor (Hanita Lenses) enables preservation of the lens capsule and IOL implantation in the capsular bag with scleral suturing.
“In comparison to other techniques, the device extends to the capsule periphery and does not puncture the capsule. The insertion of the anchor is conducted at the optic edge area, typically centered in subluxation cases; thus, visualization is made easy,” corresponding author Yokrat Ton, MD, told Ocular Surgery News.
The device was originally designed for subluxated crystalline lenses in which implantation of the anchor early in the lens removal procedure is an advantage, she said.
The report was published in the Journal of Cataract and Refractive Surgery.
Placement and suturing
The anchor is made of PMMA and comprises a central rod placed in front of the anterior capsule and two lateral prongs placed under the anterior capsulorrhexis edge. The tips of the prongs extend to the capsule equator and provide localized support.
A small pocket is created under the capsule to enable insertion of the prongs. A fixation suture encircling the central rod or threaded through a hole at the base of the rod is affixed to the scleral wall.
Implantation requires a 2.5-mm incision followed by gentle separation of the capsule adhesions to the IOL optic to insert the prongs under the rim of the anterior capsule. A spatula or microvitreoretinal knife is used to separate synechiae between the fibrotic capsule and IOL.
An ab interno or ab externo approach is used to make two passages of a scleral-fixating 9-0 or 10-0 polypropylene or polytetrafluoroethylene suture. The central rod and base are pulled peripherally to center the IOL-capsular bag complex.
Image: Ton Y
In some cases, a temporary safety suture is passed through a positioning hole between the prongs to prevent posterior dislocation of the IOL during surgery through the large zonular defect.
The fixating suture is buried under the conjunctiva or a scleral flap. Ton noted that adjusting suture tension is critical to centering the implant.
“A clear advantage of scleral suturing is that it is performed within a relatively closed chamber through incisions no larger than 1 mm,” Ton said. “Its downside is that a single pass via the capsule punctures the capsular bag, sometimes through a Soemmering ring, and provides a one-point fixation. Thus, the lens is prone to significant phacodonesis and tilt. This is especially relevant for multifocal lenses.”
Preliminary results
The capsular anchor was implanted in six pseudophakic patients. Underlying causes of IOL subluxation included pseudoexfoliation syndrome, surgical trauma to the zonular fibers during primary cataract surgery and postoperative trauma.
Only one lateral prong was successfully placed under the capsule rim in two cases with IOL-bag instability and firm fibrotic tissue adherent to the optic.
“Nevertheless, in both cases the IOL was well secured to the sclera,” Ton said. “As in any case of scleral fixation, puncture of the scleral wall and uveal tissue may be associated with complications such as intraocular hemorrhage, inflammation or infection.”
Two anchors were used 1 month apart after repeated traumatic zonular injury in one eye. The capsular bag holding the IOL remained centered and stable throughout the follow-up period.
“In our study we found the same anchor to be helpful in fixation of the IOL-capsule complex in six subluxated IOLs located in the capsular bag,” Ton said. “In cases of subluxated IOL due to various etiologies, such as trauma or pseudoexfoliation syndrome, the original IOL can be preserved and secured to the sclera using the strong fibrotic capsulorrhexis edge. The wide support of the anchor over the capsule resulted in a firm planar fixation of the capsule. In most cases an additional fixation point was not necessary to achieve a central and stable IOL.” – by Matt Hasson
- Reference:
- Ton Y, et al. J Cataract Refract Surg. 2016;doi:10.1016/j.jcrs.2016.04.002.
- For more information:
- Yokrat Ton, MD, can be reached at Ophthalmology Department, Meir Medical Center, 59 Tchernichovsky St., Kfar-Saba, 4435757, Israel; email: yokrat.ton@gmail.com.
Disclosure: Ton reports no relevant financial disclosures.
Perspective
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John A. Hovanesian, MD FACS
Securing the subluxated lens-bag complex has become an essential skill for every anterior segment surgeon, given that as many as 3% to 4% of pseudoexfoliation patients with uneventful cataract surgery will one day have a dislocation. This article describes a proprietary device, invented by one of the authors, that holds the capsule edge and allows scleral suturing. Similar to a capsular tension segment, it can be left in the eye following implantation. It is a welcome addition to our current technology.
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