Study on Preoperative Observation of Cataract Patients' Zonules by Ultrasound Biomicroscopy_West China Medical Journal

Authors：

 MiaoNa , TangXuelin , HuangYongzhi , LiRuili ,  FanWei

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FanWei, Email: fanwei55@yahoo.com

Keywords：

Cataract; Intraocular lens; High myopia; Zonules; Ultrasound biomicroscopy

DOI：

10.7507/1002-0179.201600547

Video：

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Objective To use ultrasound biomicroscope (UBM) to observe the zonules in patients before cataract surgery and study the relation between the length of zonules and axial length (AL), so as to understand the underlying anatomical and pathological basis of factors influencing the stability of lens capsule in high axial myopic patients and provide objective theoretical references for surgical risk reduction and postoperative follow-up guidance. Methods Fifty-five patients (55 eyes) proposed to receive phacoemulsification between October 2014 and October 2015 were divided into group A (AL < 26 mm, n=21), group B (26 mm≤AL < 29 mm, n=14), and group C (AL≥29 mm, n=20) according to their AL.UBM examination was conducted preoperatively.Through measuring the length of zonules in supine position at 12, 3, 6, and 9 o'clock respectively, we compared the difference of the length of zonules among those three groups, and explored the correlation between the length of zonules and axial length. Results The average length of zonules in group A was (0.67±0.13) mm, while that in group B and group C was (0.93±0.29) and (0.98±0.19) mm, respectively.The length of zonules in group A was shorter than that in group B and Group C, and the differences were statistically significant (P < 0.001);and that in group B was shorter than that in group C, but the difference was of no statistical significance (P=0.331).In the correlation analysis between axial length and the average length of zonules, the length of zonules was positively correlated with the axial length (r=0.502). Conclusions UBM provides a quantitative method for observing zonules.In the assessment before cataract surgery, it is a more accurate method for evaluation of zonules, and probably has a certain value in pre-assessment of intra ocular lens dislocation after cataract surgery.

Citation： MiaoNa, TangXuelin, HuangYongzhi, LiRuili, FanWei. Study on Preoperative Observation of Cataract Patients' Zonules by Ultrasound Biomicroscopy. West China Medical Journal, 2016, 31(12): 1995-1999. doi: 10.7507/1002-0179.201600547 Copy

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3.	戚沆, 陈长征, 翁铭, 等.成年高度近视患者脉络膜厚度及其相关影响因素分析[J].中华实验眼科杂志, 2014, 32(5):439-442.
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6.	Davis D, Brubaker J, Espandar L, et al. Late in-the-bag spontaneous intraocular lens dislocation:evaluation of 86 consecutive cases[J]. Ophthalmology, 2009, 116(4):664-670.
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11.	Su W, Chang H. Spontaneous, late, in-the-bag intraocular lens subluxation in a patient with a previous acute angle-closure glaucoma attack[J]. J Cataract Refract Surg, 2004, 30(8):1805-1807.
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13.	Hayashi K, Hayashi H, Matsuo K, et al. Anterior capsule contraction and intraocular lens dislocation after implant surgery in eyes with retinitis pigmentosa[J]. Ophthalmology, 1998, 105(7):1239-1243.
14.	Rao K, Parikh S, Padhmanabhan P. Isolated posterior capsule rupture in blunt trauma:pathogenesis and management[J]. Ophthalmic Surg Lasers, 1998, 29(4):338-342.
15.	Auffarth GU, Tsao K, Wesendahl TA, et al. Centration and fixation of posterior chamber intraocular lenses in eyes with pseudoexfoliation syndrome[J]. Acta Ophthalmol Scand, 1996, 74(5):463-467.
16.	Cionni RJ. Surgical management of the congenitally subluxated crystalline lens using the modified capsular tension ring[M]. Cataract Surgery:Technique, 2004:305-313.
17.	刘家琦, 李凤鸣.实用眼科学[M]. 3版.北京:人民卫生出版社, 2010:26.
18.	Mcwhae A, Crichton C, Rinke M. Ultrasound biomicroscopy for the assessment of zonules after ocular trauma[J]. Ophthalmology, 2003, 110(7):1340-1343.
19.	Sbeity Z, Dorairaj K, Reddy S, et al. Ultrasound biomicroscopy of zonular anatomy in clinically unilateral exfoliation syndrome[J]. Acta Ophthalmol (Copenh), 2008, 86(5):565-568.
20.	Jin J, Crandall S, Jones J. Changing indications for and improving outcomes of intraocular lens exchange[J]. Am J Ophthalmol, 2005, 140(4):688-694.
21.	Pueringer L, Hodge O, Erie C. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009:a population-based study[J]. Am J Ophthalmol, 2011, 152(4):618-623.
22.	Fernández-Buenaga R, Alio L, Pérez-Ardoy L, et al. Late in-the-bag intraocular lens dislocation requiring explantation:risk factors and outcomes[J]. Eye (Lond), 2013, 27(7):795-801.
23.	Cochener B, Jacq L, Colin J. Capsule contraction after continuous curvilinear capsulorhexis:poly (methyl methacrylate) versus silicone intraocular lenses[J]. J Cataract Refract Surg, 1999, 25(10):1362-1369.
24.	Jehan S, Mamalis N, Crandall S. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients[J]. Ophthalmology, 2001, 108(10):1727-1731.
25.	Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery[J]. Ophthalmology, 2007, 114(5):969-975.

1. Saw SM, Katz J, Schein OD, et al. Epidemiology of myopia[J]. Epidemiol Rev, 1996, 18(2):175-187.
2. 董光静, 刘陇黔, 谭琦.不同年龄段青少年近视发展情况对比分析[J].华西医学, 2014, 29(7):1290-1292.
3. 戚沆, 陈长征, 翁铭, 等.成年高度近视患者脉络膜厚度及其相关影响因素分析[J].中华实验眼科杂志, 2014, 32(5):439-442.
4. 牟琳, 郝燕生.高度近视眼后发性白内障手术后囊切开方法研究[J].华西医学, 2010, 25(7):1282-1283.
5. Shigeeda T, Nagahara M, Kato S, et al. Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag[J]. J Cataract Refract Surg, 2002, 28(9):1689-1693.
6. Davis D, Brubaker J, Espandar L, et al. Late in-the-bag spontaneous intraocular lens dislocation:evaluation of 86 consecutive cases[J]. Ophthalmology, 2009, 116(4):664-670.
7. Gross G, Kokame T, Weinberg V, et al. In-the-bag intraocular lens dislocation[J]. Am J Ophthalmol, 2004, 137(4):630-635.
8. Jakobsson G, Zetterberg M, Lundström M, et al. Late dislocation of in-the-bag and out-of-the bag intraocular lenses:ocular and surgical characteristics and time to lens repositioning[J]. J Cataract Refract Surg, 2010, 36(10):1637-1644.
9. Clark A, Morlet N, Ng Q, et al. Whole population trends in complications of cataract surgery over 22 years in Western Australia[J]. Ophthalmology, 2011, 118(6):1055-1061.
10. Yasuda A, Ohkoshi K, Orihara Y, et al. Spontaneous luxation of encapsulated intraocular lens onto the retina after a triple procedure of vitrectomy, phacoemulsification, and intraocular lens implantation[J]. Am J Ophthalmol, 2000, 130(6):836-837.
11. Su W, Chang H. Spontaneous, late, in-the-bag intraocular lens subluxation in a patient with a previous acute angle-closure glaucoma attack[J]. J Cataract Refract Surg, 2004, 30(8):1805-1807.
12. Steeples R, Jones P. Late in-the-bag intraocular lens dislocation in patients with uveitis[J]. Br J Ophthalmol, 2015, 99(9):1206-1210.
13. Hayashi K, Hayashi H, Matsuo K, et al. Anterior capsule contraction and intraocular lens dislocation after implant surgery in eyes with retinitis pigmentosa[J]. Ophthalmology, 1998, 105(7):1239-1243.
14. Rao K, Parikh S, Padhmanabhan P. Isolated posterior capsule rupture in blunt trauma:pathogenesis and management[J]. Ophthalmic Surg Lasers, 1998, 29(4):338-342.
15. Auffarth GU, Tsao K, Wesendahl TA, et al. Centration and fixation of posterior chamber intraocular lenses in eyes with pseudoexfoliation syndrome[J]. Acta Ophthalmol Scand, 1996, 74(5):463-467.
16. Cionni RJ. Surgical management of the congenitally subluxated crystalline lens using the modified capsular tension ring[M]. Cataract Surgery:Technique, 2004:305-313.
17. 刘家琦, 李凤鸣.实用眼科学[M]. 3版.北京:人民卫生出版社, 2010:26.
18. Mcwhae A, Crichton C, Rinke M. Ultrasound biomicroscopy for the assessment of zonules after ocular trauma[J]. Ophthalmology, 2003, 110(7):1340-1343.
19. Sbeity Z, Dorairaj K, Reddy S, et al. Ultrasound biomicroscopy of zonular anatomy in clinically unilateral exfoliation syndrome[J]. Acta Ophthalmol (Copenh), 2008, 86(5):565-568.
20. Jin J, Crandall S, Jones J. Changing indications for and improving outcomes of intraocular lens exchange[J]. Am J Ophthalmol, 2005, 140(4):688-694.
21. Pueringer L, Hodge O, Erie C. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009:a population-based study[J]. Am J Ophthalmol, 2011, 152(4):618-623.
22. Fernández-Buenaga R, Alio L, Pérez-Ardoy L, et al. Late in-the-bag intraocular lens dislocation requiring explantation:risk factors and outcomes[J]. Eye (Lond), 2013, 27(7):795-801.
23. Cochener B, Jacq L, Colin J. Capsule contraction after continuous curvilinear capsulorhexis:poly (methyl methacrylate) versus silicone intraocular lenses[J]. J Cataract Refract Surg, 1999, 25(10):1362-1369.
24. Jehan S, Mamalis N, Crandall S. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients[J]. Ophthalmology, 2001, 108(10):1727-1731.
25. Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery[J]. Ophthalmology, 2007, 114(5):969-975.

West China Medical Journal

Study on Preoperative Observation of Cataract Patients' Zonules by Ultrasound Biomicroscopy

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