Late dislocation of the capsular bag-intraocular lens-modified capsular tension ring complex after knotless transscleral suturing using 9-0 polypropylene - PubMed (original) (raw)

Case Reports

Late dislocation of the capsular bag-intraocular lens-modified capsular tension ring complex after knotless transscleral suturing using 9-0 polypropylene

Natalia S Anisimova et al. Digit J Ophthalmol. 2020.

Abstract

We report a case of late breakage of a 9-0 polypropylene transscleral suture used for fixation of a dislocated capsular bag-intraocular lens-modified capsular tension ring complex in a 52-year-old woman with Marfan syndrome. Breakage occurred despite use of a cow-hitch technique for external and internal fixation. We believe breakage was caused by the suture chafing on the sharp edges of the modified capsular tension ring eyelet. Cross-sectional analysis of Malyugin-modified capsular tension rings from two different manufacturers revealed a difference with respect to radius of curvature. Suturing intraocular implants with relatively sharp edges may cause suture breakage; further studies are needed to identify the critical parameters for the surface quality of sutured intraocular implants.

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Figures

Figure 1

Slit-lamp photographs of subluxated transscleral sutured capsular bag–intraocular lens (IOL)–Malyugin-modified capsular tension ring (MCTR) complex in the inferior temporal direction 5 years after implantation. A, Direct gaze, showing the edge of the IOL optic bisecting the pupil. B, View of the 9-0 polypropylene Z-suture in the inferior temporal quadrant. C, View of the 9-0 polypropylene Z-suture in the upper nasal quadrant.

Figure 2

Scanning electron microscopy (original magnification ×1500) and EDX-spectroscopy of the new (A,C) and the explanted (B,D) polypropylene 9-0 suture material. A, The suture structure is symmetrical with smooth surface and no features of biodegradation. B, Circumferential wrinkling of the suture is observed, but the wrinkles pass around the suture at right angles to its axis; the fracture is slightly oblique. C, The elemental profile of the new control suture included artifactual spikes caused by the microscope chamber and silicon substrate (silicon, copper, zinc, nickel). D, The elemental profile of the control suture included sodium, sulfur, phosphorus, potassium, and calcium.

Figure 3

Scanning electron microscopy (original magnification ×500) and EDX-spectroscopy of the distal parts of the explanted 9-0 polypropylene suture material. A, The suture structure is asymmetric, with gradual narrowing toward the apex; the surface is smooth, without features of biodegradation. B, Concave flattening is observed in proximity to the apex with in situ laceration at the very end of the suture breakage. C, The elemental profiles of the suture ends are similar, except for the absence of natrium at one end of the suture. D, The expected natrium could be hidden by the peak of zinc.

Figure 4

Scanning electron microscopy of various MCTRs manufacturers (Reper-NN, Russia; Morcher GmbH, Germany) at ×180 and ×110 magnification from various observation points. A, The relatively sharp edge of the inner side of the Reper-NN MCTR eyelet (red arrow). B, The relatively sharp edge of the inner side of the Morcher MCTR eyelet (red arrow). C, The overall view of the MCTR (Reper-NN, Russia) fixation eyelet constituting the presence of the relatively sharp edge of the outer side (green arrow). D, The overall view of the MCTR (Morcher GmBH, Germany) fixation eyelet showing the presence of a relatively sharp edge at its inner side (green arrow).

Figure 5

The AutoCAD report of the SEM photographs (original magnification ×300). The radius of curvature of the cross-section Morcher and Reper MCTRs profiles are shown in micrometers (converted according to the present scale bar of 10 µm). The internal and external parts are highlighted in red and green, respectively. A–B, The fragment of the eyelet Morcher MCTR and Reper MCTR, respectively. C–D, The fragment of the haptic Morcher MCTR and Reper MCTR, respectively.

Video 1.

Primary surgery. Cataract surgery was performed with consequent implantation of the MCTR (Reper-NN, Nyzhny Novgorod, Russia) transsclerally sutured with 9-0 polypropylene using a cow-hitch and Z-suture technique.

Video 2.

Repeat surgery. Refixation surgery was performed by transsclerally suturing MCTR haptic with the cow-hitch technique using the 9-0 polypropelene in the two opposite directions.

References

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Late dislocation of the capsular bag-intraocular lens-modified capsular tension ring complex after knotless transscleral suturing using 9-0 polypropylene - PubMed (original) (raw)