Fig 1.
Capsule expander (CE) and modified-capsule expander (M-CE).
(A) The CE simultaneously expands the capsular equator and the edge of the continuous curvilinear capsulorhexis by a T-shaped footpad during phacoemulsification and aspiration performed in eyes with weak zonules. (B) The M-CE permanently fixates the lens capsule to the sclera with the intraocular lens inserted in the lens capsule in eyes with extensive or progressive zonular compromise.
Fig 2.
Measurement of the shifted distance of the lens in a patient with cataract.
Two images were captured, one showing when the needle tip caught the anterior capsule (A) and the other showing when the needle tip tore the capsule (B; the red line indicates the tear). The margins of the needle, pupil, and cortical opacity were traced, and the two images were overlaid such that the pupillary margins coincided (C). The distance moved by the cortical opacity (white line) was calculated based on the diameter of the cystotome (yellow line).
Fig 3.
The shifted distance of the lens in all cases (N = 402).
The mean shifted distance was 0.18 ± 0.13 mm.
Table 1.
Classification of zonular weakness.
Fig 4.
Surgical procedure for lens removal.
The use of a capsule stabilization device during phacoemulsification and aspiration increased as the zonular weakness grade (I–III) increased.
Table 2.
Capsule stabilization device usage.
Fig 5.
Surgical procedure for intraocular lens (IOL) fixation.
The rate of scleral suture fixation of the IOL and scleral suture fixation of the capsule using a modified-capsule expander increased as the zonular weakness grade (I–III) increased.
Fig 6.
The presence of anterior striae according to zonular weakness grade.
There was a statistically significant correlation between the shifted distance of the lens and the presence of anterior capsule striae. (Mann–Whitney U test, p < 0.001)