Method of intraocular lens fixation in patients with compensated glaucoma and cataract complicated by zonular weakness

BACKGROUND: The combination of cataract and glaucoma occurs in 14.6–76% of cases, and zonular weakness — in 34%. By suturing the lens in the posterior chamber, ophthalmic surgeons create a more physiological position for it. AIM: The aim of this study is to evaluate the clinical efficacy of intraocular lens fixation in patients with compensated glaucoma and cataract complicated by zonular weakness. MATERIALS AND METHODS: 49 patients with compensated glaucoma and cataract complicated by zonular weakness were operated. Uncorrected visual acuity — 0.19, best corrected visual acuity — 0.25, tonometric intraocular pressure — 18.9 mm Hg. Operation technique: a corneal tunnel is formed at 9 o’clock, 4 iris-retractors are inserted through paracenteses at 2, 5, 8, 11 hours and fixed at the edge of the capsulorhexis. After lens extraction, 2 iris-retractors (at 5, 11 hours) are removed . The lens is implanted into the anterior chamber. Haptic elements are tucked under the iris in the projection of 5 and 11 hours, the optical part is transferred to the posterior chamber. The support elements are sutured with interrupted sutures to the iris, then 2 iris-retractors are removed (at 2 and 8 hours), the capsular bag is removed using tweezers, and the paracenteses and the tunnel are hydrated. RESULTS: On the first day, the best corrected visual acuity was 0.34, by the 5th day, it increased to 0.49 ± 0.08, by the 14th day — 0.52. As the glaucoma process progressed during 2 years after surgery, best corrected visual acuity decreased to 0.47, intraocular pressure was 18.4 mm Hg. CONCLUSIONS: An original and easy to perform suture fixation of the lens to the iris is proposed, which allows to reduce the risk of lens decentration and tilt, as well as that of vitreous herniation.