Surgical treatment of cataract associated with lens subluxation of different origins

Aim: to investigate clinical outcomes of intraocular lens suturing to the iris in patients with baseline ligamentous instability. Materials and Methods: 84 patients with complicated cataract and ligamentous instability were enrolled. Lens subluxation was associated with glaucoma (n=52, group 1), a history of ocular trauma (n=25, group 2), and Marfan syndrome (n=7, group 3). The best corrected visual acuity (BCVA) was 0.22±0.09, 0.19±0.09, and 0.53±0.1, respectively. Pronounced ligamentous lenticular instability complicates phacoemulsification due to increased probability of intraoperative lens luxation into the vitreal cavity. Also, intraocular lens fixation without capsular support in the posterior chamber is accompanied by a risk of lens displacement. Considering these complicating factors, the authors have proposed a method of cataract extraction and IOL stitching to the iris. Surgical technique: a 2.2 mm tunnel is formed in the paralimbal region of the cornea at the 9 o'clock position, and paracenteses (1.0 mm) are provided at the 2, 3, 5, 8 and 11 o'clock positions. Next, a 5 mm circular capsulorhexis is performed, and 4 iris retractors are hooked to its edge. Thus, the lens-iris diaphragm is secured. Phacofragmentation and aspiration of the lenticular nucleus and cortex are performed. Then, 2 iris retractors are removed from the 5 and 11 o'clock positions. The intraocular lens is implanted in the posterior chamber on the anterior leaflet of the capsular bag; the haptic elements are placed behind the iris at the meridian of 5 and 11 o'clock positions. Stretched between the iris retractors at the 2 and 8 o'clock positions, the capsular bag acts as a diaphragm separating the vitreal cavity from the posterior chamber. Along with this, the structure temporarily secures the lens in the posterior chamber without instrumental support. Further, each haptic element is sutured to the iris with 10/0 interrupted suture. After that, the iris retractors are removed, and the capsular bag is removed from under the optical part of the lens through the tunnel with tweezers. Finally, all paracenteses and the tunnel are hydrated. Results: ultrasound biomicroscopy revealed lens tilt (13.5%, 8% and 14.3% in Groups 1, 2 and 3, respectively) in 2 years after surgical treatment of cataract associated with ligamentous instability. The BCVA values were 0.52±0.06, 0.68±0.05, and 0.87±0.1, respectively. Conclusion: the proposed original technique of the intraocular lens suturing to the iris provides to create a diaphragm from the capsular bag using iris retractors. In turn, this results in temporary fixation of the lens and its centration during suturing, as well as reduces a risk of vitreous body prolapse. The technique allows to use intraocular lenses with different shapes of haptic elements. Moreover, it reduces a risk of postoperative decentration of the intraocular lens and vitreous herniation in the pupil lumen. KEYWORDS: cataract, phacoemulsification, intraocular lens, lens suturing, lens subluxation. FOR CITATION: Ivachyov E.A., Kochergin S.A., Ivachyova O.T., Khmedi E., Ben Hadzh Yunes Kh. Surgical treatment of cataract associated with lens subluxation of different origins. Russian Journal of Clinical Ophthalmology. 2025;25(2):87–93 (in Russ.). DOI: 10.32364/2311- 7729-2025-25-2-2