18 Jacob Paper Clip Capsule Stabilizer
Summary
Subluxated cataracts are managed depending on the degree of zonular dialysis. For a subluxation of up to one quadrant, a capsular tension ring may be used. However, for larger subluxations, scleral fixation with sutures is necessary to avoid a decentered or subluxated bag in the postoperative period. To avoid suture related difficulties and complications, Dr. Jacob has designed a new device called the “paper clip capsule stabiliser” that is aimed at fixating the capsular bag in a sutureless manner to the scleral wall. It is made of blue polymethyl methacrylate and is a single-piece device, which has a fixation element and a haptic. The fixation element fixes onto the rhexis rim and thus engages the rhexis. The haptic is 13-mm long with indentations and it passes trans-sclerally through a sclerotomy made under a scleral flap and is then tucked into an intrascleral Scharioth tunnel. The fixation element is 2.5-mm wide and can be easily passed into the anterior chamber (AC) through the phaco incision. This device has its own advantages that it allows easier, faster, and safer surgery. The surgery requires less manoeuvring than sutured segments to be able to anchor the capsular bag to the scleral wall. The lack of sutures also removes all postoperative suture-related complications. Intraoperative centration of the intraocular lens (IOL) may be done easily by adjusting the degree of tuck of the haptic. For larger degrees of subluxation, two capsule stabilizers may be used. Subluxated in-the-bag IOLs may also be refixated easily using the Jacob capsule stabilizer.
18.1 Introduction
Subluxated cataracts 1 , 2 are managed depending on the degree of zonular dialysis. For a subluxation of up to one quadrant, a capsular tension ring may be used. 3 , 4 , 5 However, for larger subluxations, some form of scleral fixation is necessary to avoid a decentered or subluxated bag in the postoperative period. The currently available devices for scleral fixation are all sutured and include the Ahmed segment, 6 the Cionni single- and double-hook rings, 5 the Assia segment, 7 and so forth. All these devices, once implanted, are sutured onto the sclera wall using either 9–0 Prolene suture or Gore-Tex suture. The disadvantages of having to suture these devices to the scleral wall are many. It involves the manipulations required to pass long and thin needles across the AC, which can involve complicated maneuvering. This makes surgery more difficult and also takes a longer time. In addition, the tension with which the suture knot is tied down determines the degree of centration of the IOL. If the knot happens to be tied either too loose or too tight, the IOL remains decentered. This situation would necessitate cutting the suture and performing the entire complicated maneuvering of sutured scleral fixation again. One of the authors (Jacob) had described the glued endocapsular ring 8 , 9 and the glued capsular hook 10 technique for sutureless capsular bag stabilization. In addition, Jacob also designed the Jacob capsule stabilizer (Morcher GmbH, Germany), which makes this a simple procedure to perform. It is a new device that is aimed at fixating the capsular bag in a sutureless manner to the scleral wall. 11 , 12 , 13 , 14
18.2 Design of the Device
The paper clip capsule stabilizer is made of blue polymethyl methacrylate and is a single-piece device, which has a fixation element and a haptic. The fixation element has two flanges on either side and a central extension that together forms a paper clip component (▶Video 18.1). This paper clip component fixes onto the rhexis rim and thus engages the rhexis. The haptic passes trans-sclerally through a sclerotomy that has been made under a scleral flap and is then tucked into an intrascleral Scharioth tunnel. The haptic is 13-mm long and has indentations, which help to obtain a firm grip within the Scharioth tunnel. The fixation element is 2.5-mm wide and can be easily passed into the AC through the phaco incision (▶Fig. 18.1).
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