Surgical treatment of cataract associated with lens subluxation of different origins
DOI: 10.32364/2311-7729-2025-25-2-2
E.A. Ivachyov1,2, S.A. Kochergin3, O.T. Ivachyova4, E. Khmedi5, Kh. Ben Hadzh Yunes5
1Penza State University, Penza, Russian Federation
2Clinical Hospital "RZD-Meditsina" of the city of Penza, Penza, Russian Federation
3Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
4IRIS Ophthalmological Center LLC, Penza, Russian Federation
5I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Aim: to investigate clinical outcomes of intraocular lens suturing to the iris in patients with baseline ligamentous instability.
Materials and Methods: 84 patients with complicated cataract and ligamentous instability were enrolled. Lens subluxation was associated with glaucoma (n=52, group 1), a history of ocular trauma (n=25, group 2), and Marfan syndrome (n=7, group 3). The best corrected visual acuity (BCVA) was 0.22±0.09, 0.19±0.09, and 0.53±0.1, respectively. Pronounced ligamentous lenticular instability complicates phacoemulsification due to increased probability of intraoperative lens luxation into the vitreal cavity. Also, intraocular lens fixation without capsular support in the posterior chamber is accompanied by a risk of lens displacement. Considering these complicating factors, the authors have proposed a method of cataract extraction and IOL stitching to the iris. Surgical technique: a 2.2 mm tunnel is formed in the paralimbal region of the cornea at the 9 o'clock position, and paracenteses (1.0 mm) are provided at the 2, 3, 5, 8 and 11 o'clock positions. Next, a 5 mm circular capsulorhexis is performed, and 4 iris retractors are hooked to its edge. Thus, the lens-iris diaphragm is secured. Phacofragmentation and aspiration of the lenticular nucleus and cortex are performed. Then, 2 iris retractors are removed from the 5 and 11 o'clock positions. The intraocular lens is implanted in the posterior chamber on the anterior leaflet of the capsular bag; the haptic elements are placed behind the iris at the meridian of 5 and 11 o'clock positions. Stretched between the iris retractors at the 2 and 8 o'clock positions, the capsular bag acts as a diaphragm separating the vitreal cavity from the posterior chamber. Along with this, the structure temporarily secures the lens in the posterior chamber without instrumental support. Further, each haptic element is sutured to the iris with 10/0 interrupted suture. After that, the iris retractors are removed, and the capsular bag is removed from under the optical part of the lens through the tunnel with tweezers. Finally, all paracenteses and the tunnel are hydrated.
Results: ultrasound biomicroscopy revealed lens tilt (13.5%, 8% and 14.3% in Groups 1, 2 and 3, respectively) in 2 years after surgical treatment of cataract associated with ligamentous instability. The BCVA values were 0.52±0.06, 0.68±0.05, and 0.87±0.1, respectively.
Conclusion: the proposed original technique of the intraocular lens suturing to the iris provides to create a diaphragm from the capsular bag using iris retractors. In turn, this results in temporary fixation of the lens and its centration during suturing, as well as reduces a risk of vitreous body prolapse. The technique allows to use intraocular lenses with different shapes of haptic elements. Moreover, it reduces a risk of postoperative decentration of the intraocular lens and vitreous herniation in the pupil lumen.
Keywords: cataract, phacoemulsification, intraocular lens, lens suturing, lens subluxation.
For citation: Ivachyov E.A., Kochergin S.A., Ivachyova O.T., Khmedi E., Ben Hadzh Yunes Kh. Surgical treatment of cataract associated with lens subluxation of different origins. Russian Journal of Clinical Ophthalmology. 2025;25(2):87–93 (in Russ.). DOI: 10.32364/2311-7729-2025-25-2-2
ABOUT THE AUTHORS:
Evgenii A. Ivachyov — C. Sc. (Med.), Assistant Professor of the Department of Maxillofacial Surgery with the Ophthalmology and Otorhinolaryngology Course, Penza State University; 40, Krasnaya str., Penza, 440026, Russian Federation; Head of the Ophthalmological Department, Clinical Hospital "RZD-Meditsina" of the city of Penza; 118, Uritsky str., Penza, 440600, Russian Federation; ORCID iD 0000-0001-5662-4195
Sergey A. Kochergin — Dr. Sc. (Med.), Professor of the Department of Ophthalmology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000‑0002‑8913‑822X
Olga T. Ivachyova — Ophthalmologist, IRIS Ophthalmological Center LLC; 4, Bekeshskaya st., Penza, 440018, Russian Federation; ORCID iD 0000-0001-9180-1273
Emin Khmedi — Postgraduate Student, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0009-0003-9164-2825
Khamza B.H. Yunes — Postgraduate Student, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0009-0006-3212-5846
Contact information: Evgenii A. Ivachyov, e-mail: eivachov1@yandex.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 01.04.2025.
Revised 24.04.2025.
Accepted 30.04.2025.
2. Оразбеков Л.Н., Шабанова А.А. Транссклеральная фиксация интраокулярной линзы в лечении сублюксации хрусталика у детей. Вестник офтальмологии. 2024;140(3):27–33. DOI: 10.17116/oftalma202414003127Orazbekov L.N., Shabanova A.A. Transscleral fixation of intraocular lens in the treatment of lens subluxation in children. Russian Annals of Ophthalmology. 2024;140(3):27–33 (in Russ.). DOI: 10.17116/oftalma202414003127
3. Паштаев Н.П., Куликов И.В. Хирургия катаракты с подвывихом хрусталика. Практическая медицина. 2017;9(2):155–157.Pashtaev N.P., Kulikov I.V. Subluxated cataract surgery. Practical medicine. 2017;9(2):155–157 (in Russ.).
4. Першин К.Б., Пашинова Н.Ф., Черкашина А.В., Цыганков А.Ю. Оценка способов фиксации интраокулярных линз при ленсэктомии у детей с синдромом Марфана. Российская педиатрическая офтальмология. 2017;12(1):11–16. DOI: 10.18821/1993-1859-2017-12-1-11-16Pershin K.B., Pashinova N.F., Cherkashina A.V., Tsygankov A.Yu. The evaluation of the types of fixation of intraocular lenses during lensectomy in the children presenting with Marfan's Syndrome. Russian Pediatric Ophthalmology. 2017;12(1):11–16 (in Russ.). DOI: 10.18821/1993-1859-2017-12-1-11-16
5. Jacqueline N., Behshad S., Farid M. Review of surgical techniques for posterior chamber intraocular lens fixation in the absence of capsular lens support. US Ophthalmic Review. 2015;8(2):86–91. DOI: 10.17925/USOR.2015.08.02.86
6. Иванов Д.И., Никитин В.Н. Транссклеральная фиксация дислоцированного комплекса «ИОЛ — капсульный мешок» при контракционном капсулярном синдроме. Офтальмология. 2022;19(1):77–82. DOI: 10.18008/1816-5095-2022-1-77-82Ivanov D.I., Nikitin V.N. Transscleral fixation of the dislocated IOL-capsular bag complex in contraction capsular syndrome. Ophthalmology in Russia. 2022;19(1):77–82 (in Russ.). DOI: 10.18008/1816-5095-2022-1-77-82
7. Xiao Ma, Zhaohui Li. Capsular tension ring implantation after lens extraction for management of subluxated cataracts. Int J Clin Exp Pathol. 2014;7(7):3733–3738. PMID: 25120749
8. Малюгин Б.Э., Пантелеев Е.Н., Хапаева Л.Л., Савенков С.Г. Результаты смешанной цилиокапсулярной фиксации трехчастной ИОЛ при факоэмульсификации у пациентов с несостоятельностью связочного аппарата хрусталика. Офтальмохирургия. 2023;1:6–17. DOI: 10.25276/0235-4160-2023-1-6-17Malyugin B.E., Panteleev E.N., Khapaeva L.L., Savenkov S.G. Mixed ciliary-capsular fixation of a three-piece IOL during phacoemulsification in patients with the lenticular ligamentous-capsular system's failure. Fyodorov Journal of Ophthalmic Surgery. 2023;1:6–17 (in Russ.). DOI: 10.25276/0235-4160-2023-1-6-17
9. Пирогова Е.С., Фабрикантов О.Л., Николашин С.И. Оптимизация технологии факоэмульсификации при осложненной катаракте с подвывихом хрусталика. Вестник офтальмологии. 2021;137(5):78–85. DOI: 10.17116/oftalma202113705178Pirogova E.S., Fabrikantov O.L., Nikolashin S.I. Optimization of phacoemulsification in complicated cataract with lens subluxation. Russian Annals of Ophthalmology. 2021;137(5):78–85 (in Russ.). DOI: 10.17116/oftalma202113705178
10. Шиловских А.О., Пономарев В.О., Малюгин Б.Э. Эволюция интраокулярных линз и методов их фиксации. Исторические и современные аспекты. Офтальмохирургия. 2025;1(143):115–128. DOI: 10.25276/0235-4160-2025-1-115-128Shilovskikh A.O., Ponomarev V.O., Malyugin B.E. The evolution of intraocular lenses and their methods of fixation: A historical and modern perspective. Fyodorov Journal of Ophthalmic Surgery. 2025;1(143):115–128 (in Russ.). DOI: 10.25276/0235-4160-2025-1-115-128
11. Thapa B.B., Agarwal A., Rum J., Singh R. Phacoaspiration with a Cionni ring versus pars plana lensectomy, vitrectomy and sutureless transscleral IOL fixation. Graefes Arch Clin Exp Ophthalmol. 2016;254(5):901–909. DOI: 10.1007/s00417-016-3297-y
12. Das P., Nicholson M., Deshpande K. et al. Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children. Indian J Ophthalmol. 2009;57(6):431–436. DOI: 10.4103/0301-4738.57149
13. Wilson M.E. Pediatric cataract surgery. Technique, complication and menegement. Philadelphia: Wolter Kluwer health; 2014.
14. Zhang Y., He F., Jiang J. et al. Modified technique for intrascleral fixation of posterior chamber intraocular lens without scleral flaps. J Cataract Refract Surg. 2017;43(2):162–166. DOI: 10.1016/j.jcrs.2016.10.029
15. Narang P., Agarwal A. Glued intrascleral haptic fixation of an intraocular lens. Indian J Ophthalmol. 2017;65(12):1370–1380. DOI: 10.4103/ijo.IJO_643_17
16. Никитин В.Н., Иванов Д.И. Определение положения интраокулярной линзы после шовной фиксации к радужной оболочке в отсроченном послеоперационном периоде при помощи оптической когерентной томографии. Офтальмология. 2022;19(3):500–505. DOI: 10.18008/1816-5095-2022-3-500-505Nikitin V.N., Ivanov D.I. Definition of intraocular lens position after suture fixation to the iris in remote post-op period with optical coherence tomography. Ophthalmology in Russia. 2022;19(3):500–505 (in Russ.). DOI: 10.18008/1816-5095-2022-3-500-505
17. Сажин Т.Г., Соколова М.О. Склерокорнеальная фиксация заднекамерных интраокулярных линз в осложненных случаях хирургии катаракты с использованием политетрафторэтиленовых нитей. Офтальмохирургия. 2024;142(1):13–20. DOI: 10.25276/0235-4160-2024-1-13-20Sazhin T.G., Sokolova M.O. Sclerocorneal fixation of posterior chamber intraocular lenses in complicated cases of cataract surgery using polytetrafluoroethylene suture. Fyodorov Journal of Ophthalmic Surgery. 2024;142(1):13–20 (in Russ.). DOI: 10.25276/0235-4160-2024-1-13-20
18. Кожухов А.А., Капранов Д.О., Овечкин И.Г., Овечкин Н.И. Разработка и оценка клинической эффективности методики фиксации интраокулярной линзы после факоэмульсификации катаракты, осложненной нарушением капсульной поддержки хрусталика. Офтальмология. 2018;15(2):124–131. DOI: 10.18008/1816-5095-2018-2-124-131Kozhukhov A.A., Kapranov D.O., Ovechkin I.G., Ovechkin N.I. Development and evaluation of clinical efficacy of intraocular lens fixation after cataract phacoemulsification, complicated by capsular lenticular disruption. Ophthalmology in Russia. 2018;15(2):124–131 (in Russ.). DOI: 10.18008/1816-5095-2018-2-124-131
This work is licensed under a Creative Commons «Attribution» 4.0 License.
