Capsule expander (CE) and modified-capsule expander (M-CE).

<p>(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.</p

Capsule stabilization device usage.

<p>Capsule stabilization device usage.</p

The shifted distance of the lens in all cases (N = 402).

<p>The mean shifted distance was 0.18 ± 0.13 mm.</p

Objective classification of zonular weakness based on lens movement at the start of capsulorhexis

<div><p>Purpose</p><p>To quantify zonular weakness based on lens movement at the start of continuous curvilinear capsulorhexis (CCC) and establish a classification system for it.</p><p>Setting</p><p>Kozawa Eye Hospital and Diabetes Center, Mito, Japan.</p><p>Design</p><p>Retrospective interventional case series.</p><p>Methods</p><p>We examined 402 consecutive eyes of 316 patients who underwent CCC, phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. The movement of the lens capsule was measured using images from video recordings of the CCC procedure. Zonular weakness was classified based on the shifted distance: Grade I, less than 0.20 mm; Grade II, 0.20–0.39 mm; and Grade III, greater than 0.40 mm. For each of these grades, we examined the use of the capsule stabilization device during PEA, the surgical procedure for lens removal, and IOL fixation.</p><p>Results</p><p>We classified 276 eyes (68.6%) as Grade I, 102 eyes (25.4%) as Grade II, and 24 eyes (6.0%) as Grade III. As the grade increased, the use of the capsule stabilization device in PEA and scleral suture fixation of IOL increased.</p><p>Conclusions</p><p>Zonular weakness was quantified by measuring the movement of the lens capsule. An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery.</p></div

Surgical procedure for intraocular lens (IOL) fixation.

<p>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.</p

Classification of zonular weakness.

<p>Classification of zonular weakness.</p

Measurement of the shifted distance of the lens in a patient with cataract.

<p>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).</p

The presence of anterior striae according to zonular weakness grade.

<p>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)</p