Intracapsular phacofragmentation as a method for rehabilitation of patients with extensive zonular defects

    Purpose. To introduce the technique and results of intracapsular phacofragmentation in eyes with rough zonular defects or an absence of the ciliary zonule system where phacoemulsification is impossible or has a high risk of intraoperative complications.
    Material and methods. The study included 50 patients (50 eyes) where the mechanical phacofragmentation was performed through the capsular bag. Trans-capsular mechanical phacofragmentation was performed without capsulorhexis through scleral tunnel incision using fragmentation forceps and cohesive viscoelastic. Operation was finished with IOL implantation and its suturing to the iris. There were in the study 32 males (64%) and 18 females (36%). Visual acuity before surgery ranged from light perception to 0.5 (mean 0.07±0.14), intraocular pressure - from 16 to 26 mmHg (mean 17.8±2.7 mmHg), preoperative corneal astigmatism was from 0 to 2.75D (mean 0.99±0.74D).
    Results. Postoperatively the following complications were observed: an inflammatory reaction in 2 cases (4%), folds of Descemet’s membrane in 3 (6%) cases, intraocular hypertension in 11 (22%) eyes. All the complications were treated conservatively within 3-5 days after surgery.
    On the second day the mean visual acuity was 0.37±0.21, 1 month later — 0.54±0.20, 6 months — 0.56±0.22, and 1 year — 0.57±0.19. Induced corneal astigmatism varied 1 year after surgery from 0.0 to 2.5D (mean 0.65±0.24D).
    Conclusion. The presented technology of intracapsular phacofragmentation is relatively safe, effective and provides a possibility to remove the lens through a small self-sealing incision, thus reducing the quantity of intra- and post-operative complications.
    Keywords: phacofragmentation, lens subluxation.