Abstract:AIM: To observe the clinical efficacy of two different surgical methods in treating lens subluxation of varying degrees with cataracts.
METHODS: Prospective observational study. Patients with lens subluxation and cataracts who were treated in Yulin Hospital of Traditional Chinese Medicine from May 1, 2021 to April 30, 2024 were included. The surgical method was determined according to the range of zonular abnormalities or injuries. If the zonular abnormality or injury range was ≤6 clock hours and the capsular bag was intact and stable with no aggravation of the zonular injury after completion of phacoemulsification, the triple procedure of phacoemulsification combined with capsular tension ring(CTR)implantation plus intraocular lens(IOL)implantation was adopted(CTR group); if the zonular abnormality or injury range is >6-9 clock hours, or if the stability of the lens capsular bag was poor and the zonular injury range was aggravated intraoperatively, phacoemulsification combined with scleral-sutured intracapsular IOL fixation was performed(Suture group). Visual acuity(LogMAR), spherical equivalent, intraocular pressure, corneal endothelial cell count, anterior chamber depth and complications of all patients were recorded at different time points after surgery, respectively.
RESULTS: A total of 40 cases(40 eyes)were included in study, including 21 cases(21 eyes)in CTR group(age 60.62±1.65 y, 15 males and 6 females)and 19 cases(19 eyes)in Suture group(age 64.26±1.69 y, 15 males and 4 females).The median range of zonular injury in the CTR group was 4.0(2.75, 5.25)clock hours, while that in the Suture group was 7.0(6.5, 8.0)clock hours(P<0.001), and there were no significant differences in other basic data between the two groups. The visual acuity of patients in both groups significantly improved one month after surgery. The CTR group showed an improvement of 0.72±0.45 logMAR compared with preoperative values(t=5.44, P<0.001), and the Suture group showed an improvement of 1.11±1.01 LogMAR compared with preoperative values(t=4.09, P=0.001). There was no significant difference in visual acuity between the two groups 12 mo after surgery(t=0.24, P=0.81). There was no significant difference in the spherical equivalent between the two groups at 1, 12 mo after surgery(both P>0.05). The corneal endothelial cell count in the Suture group was significantly lower than that in CTR group after surgery(t=3.75, P=0.001). In the CTR group, at postoperative 6 mo, IOL horizontal tilt was 3.06°±1.47°, and the IOL horizontal decentration was 0.25±0.10 mm, both of which were significantly lower than those in the Suture group(both P<0.001). There was no significant difference in the total incidence of complications between the two groups(23.8% vs 36.8%, χ2=0.807, P=0.369).
CONCLUSION:For cases with zonular abnormalities or injury involving ≤6 clock hours, where the capsular bag remains intact and stable after phacoemulsification, the triple procedure of phacoemulsification combined with CTR implantation and IOL implantation is adopted. In cases with zonular abnormalities or injury involving >6-9 clock hours, or when intraoperative capsular bag stability is poor and zonular injury worsens, phacoemulsification combined with scleral-sutured intracapusular IOL fixation is performed. Both approaches can achieve favorable postoperative outcomes. Comprehensive preoperative and intraoperative evaluations help determine the appropriate surgical method.
