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Yusef YN, Yusef SN, Ivanov MN, Fokina ND, Alkharki L, Ryzhkova EG, Shkolyarenko NY. [Morphofunctional changes and complications after out-of-the-bag intraocular lens implantation]. Vestn Oftalmol 2019; 135:235-240. [PMID: 31691666 DOI: 10.17116/oftalma2019135052235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article reviews morphofunctional changes and complications after using modern methods of out-of-the-bag implantation of the intraocular lens (IOL). Literature data shows that the smallest morphofunctional changes in intraocular structures and the best results are obtained after retropupillary implantation of an iris-claw lens and transscleral fixation of posterior chamber IOL.
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Affiliation(s)
- Yu N Yusef
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - S N Yusef
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - M N Ivanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N D Fokina
- I.M. Sechenov First Moscow State Medical University, Department of Ophthalmology, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - L Alkharki
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E G Ryzhkova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N Yu Shkolyarenko
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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de Rojas MV, Viña S, Gestoso A, Simón P, Álvarez M. Intraocular lens explantation in Spain: indications and outcomes at a tertiary referral center from 2010 to 2018. Int Ophthalmol 2019; 40:313-323. [PMID: 31565759 DOI: 10.1007/s10792-019-01181-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/22/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the causes of IOL explantation, techniques for secondary IOL implantation, visual outcomes and complications. METHODS Setting: Department of Ophthalmology Complexo Hospitalario Universitario A Coruña, Spain. DESIGN Retrospective study. All explanted IOLs from January 2010 to June 2018 were included. Medical records were reviewed to determine the surgical indication for IOL explantation, type of IOL implanted, time between surgeries, visual outcomes and surgical complications. RESULTS One hundred forty-one IOLs were explanted (134 patients). Mean time from original surgery to IOL explantation was 7.89 ± 5.81 years. Causes of IOL explantation were IOL dislocation (81.56%)-in-the-bag IOL dislocation (71.63%), out-of-the-bag IOL dislocation (9.9%)-corneal decompensation (12.05%), refractive surprise (3.5%), uveitis-glaucoma-hyphema syndrome (1.4%), IOL opacification (1.4%). Procedures for secondary IOL implantation were retropupillar iris-claw IOL (63.8%), flanged scleral fixated IOL (9.2%), three-piece IOL in ciliary sulcus (8.5%), angle-supported anterior chamber IOL (7.1%), in-the-bag IOL (3.5%), scleral fixated IOL with sutures (0.7%). Ten cases (7.1%) were left aphakic. Mean preoperative and postoperative logMAR CDVA were 1.34 ± 0.87 and 0.63 ± 0.69, respectively (p = 0.000). Mean preoperative IOP and postoperative IOP were 16.78 ± 4.49 and 15.53 ± 3.476 mmHg, respectively (p = 0.005). Complications include cystoid macular edema (7.8%), glaucoma (7.1%), IOL luxation (2.1%), retinal detachment (1.4%), trophic ulcer and leucoma (1.4%), corneal decompensation (1.4%). CONCLUSIONS In-the-bag IOL dislocation was the most frequent indication for IOL explantation, followed by pseudophakic bullous keratopathy. Simultaneous IOL exchange for a retropupillar iris-claw IOL was the most frequent procedure for secondary IOL implantation. Mean CDVA improved significantly and IOP decreased significantly after IOL explantation. The most frequent postoperative complication was cystoid macular edema.
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Affiliation(s)
- Mª Victoria de Rojas
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain.
| | - Sara Viña
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
| | - Antía Gestoso
- Department of Ophthalmology, Hospital Povisa, Vigo, Spain
| | - Patricia Simón
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
| | - Marcelino Álvarez
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
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Shuaib AM, El Sayed Y, Kamal A, El Sanabary Z, Elhilali H. Transscleral sutureless intraocular lens versus retropupillary iris-claw lens fixation for paediatric aphakia without capsular support: a randomized study. Acta Ophthalmol 2019; 97:e850-e859. [PMID: 30884195 DOI: 10.1111/aos.14090] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare results of sutureless transscleral intraocular lens (IOL) fixation to retropupillary iris-claw lens implantation in cases of paediatric aphakia without capsular support. METHODS Thirty eyes of children with insufficient capsular support for IOL implantation were randomized to undergo sutureless transscleral IOL fixation or iris-claw lens fixation. The primary outcome was best-corrected visual acuity (BCVA). Secondary outcomes included operative time, astigmatism, central corneal thickness, endothelial cell count (ECC), IOL decentration and tilt, central foveal thickness and complications. RESULTS There was a significant improvement in BCVA at all follow-up visits, with no significant difference between both groups. 53.3% in the transscleral-fixated IOL group and 80% in the iris-claw IOL group had a final BCVA ≥0.3. The operative time was significantly shorter in the iris-claw IOL group (p = 0.001). IOL decentration and tilt were higher in the transscleral-fixated IOL group, but the difference was not significant. The ECC was reduced by 14.6% in the transscleral-fixated IOL group and 11% in the iris-claw group at 6 months, with no significant difference between both groups (p = 0.5). In the transscleral-fixated IOL group, two eyes developed ocular hypertension and two eyes had IOL decentration, while in the iris-claw IOL group, 1 eye developed glaucoma, three eyes had haptic disenclavation, and one eye had retinal detachment. CONCLUSION Both techniques yielded a comparable visual outcome. Retropupillary iris-claw lens fixation is a shorter procedure and technically easier than sutureless transscleral fixation, but the risk of disenclavation should be considered especially in younger age groups. Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss.
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Affiliation(s)
| | - Yasmine El Sayed
- Department of Ophthalmology Cairo University Hospital Cairo Egypt
| | - Ahmed Kamal
- Department of Ophthalmology Cairo University Hospital Cairo Egypt
| | | | - Hala Elhilali
- Department of Ophthalmology Cairo University Hospital Cairo Egypt
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Bausili Portabella MM, Nadal J, Alvarez de Toledo J, Fideliz de la Paz M, Barraquer RI. Long-term outcome of scleral-sutured posterior chamber intraocular lens: a case series. Br J Ophthalmol 2019; 104:712-717. [PMID: 31434648 DOI: 10.1136/bjophthalmol-2019-314054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Purpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage. SETTING Barraquer Institute in Barcelona, Spain. DESIGN Retrospective study of consecutive cases. METHODS Study of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis. RESULTS 345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79. CONCLUSIONS Scleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.
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Affiliation(s)
- Maria Montserrat Bausili Portabella
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Cirurgia, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
- Centro de Oftalmología Barraquer, Barcelona, Spain
| | - Jeroni Nadal
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Oftalmología Barraquer, Barcelona, Spain
| | - Juan Alvarez de Toledo
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Oftalmología Barraquer, Barcelona, Spain
| | - María Fideliz de la Paz
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Oftalmología Barraquer, Barcelona, Spain
| | - Rafael Ignacio Barraquer
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
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Rezar-Dreindl S, Stifter E, Neumayer T, Papp A, Gschliesser A, Schmidt-Erfurth U. Visual outcome and surgical results in children with Marfan syndrome. Clin Exp Ophthalmol 2019; 47:1138-1145. [PMID: 31325202 PMCID: PMC6973035 DOI: 10.1111/ceo.13596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
IMPORTANCE To determine visual and surgical results in children with Marfan syndrome. BACKGROUND Marfan syndrome involves ocular complications which can lead to visual disturbance and amblyopia. Data about the visual and surgical results in children with Marfan syndrome is vital for the clinical management of these patients. DESIGN Retrospective data analysis. PARTICIPANTS Eighty-two eyes of 41 patients with a genetically proved diagnosis of Marfan syndrome. METHODS Medical records of patients with Marfan syndrome were reviewed between 2007 and 2017. Ocular complications, visual acuity (VA) of patients with/without lensectomy and surgical method were evaluated. MAIN OUTCOME MEASURES VA outcomes of patients with Marfan syndrome with/without surgical repair of ectopia lentis. RESULTS In 27 (66%) of the 41 patients a bilateral subluxation of the lens was visible and 14 (52%) patients received lensectomy. The mean age at initial presentation was 12.3 ± 9 years and mean follow-up was 3 years (range 1-7). VA varied from 1.2 to -0.1 logMAR at first examination. At initial presentation, mean VA was 0.1 ± 0.7 logMAR in patients with a normal lens status (n = 14) and 0.3 ± 0.5 logMAR in patients with subluxation of the lens (n = 27) (P < .01). VA improved from 0.2 ± 0.5 logMAR to 0.1 ± 0.5 logMAR (P = .06) in children with subluxation of the lens who did not need a lensectomy (n = 12) and from 0.5 ± 0.5 logMAR to 0.2 ± 0.5 logMAR (P = .02) in patients who were referred to lensectomy with/without secondary lens implantation. CONCLUSIONS AND RELEVANCE In Marfan syndrome subluxation of the lens was found in the majority of children. Improvement of VA resulted in children with subluxation of the lens and following lensectomy.
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Affiliation(s)
- Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Thomas Neumayer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andrea Papp
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Gschliesser
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Madhivanan N, Sengupta S, Sindal M, Nivean PD, Kumar MA, Ariga M. Comparative analysis of retropupillary iris claw versus scleral-fixated intraocular lens in the management of post-cataract aphakia. Indian J Ophthalmol 2019; 67:59-63. [PMID: 30574894 PMCID: PMC6324140 DOI: 10.4103/ijo.ijo_326_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design.
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Affiliation(s)
| | - Sabyasachi Sengupta
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Manavi Sindal
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | | | | | - Murali Ariga
- Vitreoretina Services, MN Eye Hospitals, Chennai, Tamil Nadu, India
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Toro MD, Longo A, Avitabile T, Nowomiejska K, Gagliano C, Tripodi S, Choragiewicz T, Kaminska A, Figus M, Posarelli C, Forlini M, Jünemann AGM, Reibaldi M, Rejdak R. Five-year follow-up of secondary iris-claw intraocular lens implantation for the treatment of aphakia: Anterior chamber versus retropupillary implantation. PLoS One 2019; 14:e0214140. [PMID: 30970023 PMCID: PMC6457484 DOI: 10.1371/journal.pone.0214140] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of aphakia without sufficient capsule support. METHODS AND FINDINGS Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test). CONCLUSIONS Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of aphakia in eyes without capsule support.
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Affiliation(s)
- Mario Damiano Toro
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Katarzyna Nowomiejska
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- Institute for Ophthalmic Research, University Eye Hospital, Tuebingen, Germany
| | | | - Sarah Tripodi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Tomasz Choragiewicz
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kaminska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Matteo Forlini
- Institute of Ophthalmology, University of Parma, Parma, Italy
| | | | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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Frisina R, Pilotto E, Tozzi L, Parrozzani R, Midena E. A new technique of needle-guided retropupillary fixation of iris-claw intraocular lens. J Cataract Refract Surg 2019; 45:267-271. [PMID: 30733108 DOI: 10.1016/j.jcrs.2018.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/17/2018] [Accepted: 10/28/2018] [Indexed: 12/01/2022]
Abstract
The authors developed a new surgical technique of retropupillary implantation of an iris-claw intraocular lens (RP-ICIOL). RP-ICIOL is an alternative surgical option to the scleral-fixation technique for the treatment of aphakia without capsular support. Several studies have shown that RP-ICIOL is efficient and safe. However, although it is easier to perform than scleral fixation, it presents some critical issues related to the enclavation procedure. The success of the correct enclavation without excessive surgical manipulations, with subsequent pigment dispersion and without pupil distortion, is highly related to the surgical skills of the individual surgeon. The new technique proposed by the authors consists of using a guide needle to facilitate the enclavation, and to make this surgical procedure standard. The new technique was performed in 26 patients affected by aphakia without capsular support with encouraging functional and anatomical results.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, Italy.
| | | | - Luigi Tozzi
- Department of Ophthalmology, University of Padova, Italy
| | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Italy
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Secondary IOLs: ACIOL vs Iris Sutured vs Scleral Fixated vs Phakic IOL in Aphakic Settings. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lajoie J, Glimois V, Petit T, Amelie R, Varenne F, Fournie P, Pagot Mathis V, Malecaze F, Wargny M, Gallini A, Soler V. [Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]. J Fr Ophtalmol 2018; 41:696-707. [PMID: 30217610 DOI: 10.1016/j.jfo.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris. RESULTS We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P. CONCLUSION Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.
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Affiliation(s)
- J Lajoie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France.
| | - V Glimois
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - T Petit
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - R Amelie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - F Varenne
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - P Fournie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - V Pagot Mathis
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - F Malecaze
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - M Wargny
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - A Gallini
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - V Soler
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
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Comparison of the Techniques of Secondary Intraocular Lens Implantation after Penetrating Keratoplasty. J Ophthalmol 2018; 2018:3271017. [PMID: 30298105 PMCID: PMC6157166 DOI: 10.1155/2018/3271017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/05/2018] [Indexed: 11/29/2022] Open
Abstract
Aim To conduct a retrospective analysis of secondary IOL implantation in patients who underwent PK with no simultaneous IOL implantation. Materials and Methods The retrospective study of the secondary implantation of IOLs was conducted in 46 eyes that underwent a primary operation with PK and cataract/lens extraction with no IOL implantation due to capsule rupture or combining corneal or intraocular complications. The minimum period from PK was 12 months. All secondary IOL implantations were performed from January 2011 to August 2017. Aphakic postkeratoplasty patients were treated using one of the surgical techniques for secondary IOL implantation. In-the-bag IOL implantation was possible if the posterior capsule was complete. If the lens capsule remnants were sufficient to provide secure IOL support, an in-the-sulcus IOL implantation was performed. Scleral fixation was offered in eyes with extensive capsular deficiency or the presence of the vitreous body in anterior chamber. BCVA and expected and achieved refraction were evaluated; we included using two biometry devices, and results were compared. Results The corrected distance visual acuity (CDVA) before surgery ranged from 0.1 to 0.8 (mean 0.54 ± 0.17). After secondary IOL implantation, CDVA ranged from 0.2 to 0.8 (mean 0.43 ± 0.14) at postoperative 1 month and from 0.3 to 0.9 (mean 0.55 ± 0.15) at postoperative 6 months (p < 0.05). Comparison of the final refraction using two methods of biometry showed no statistically significant difference in the group that underwent scleral fixation of the IOL, similar to the findings for the in-the-bag and in-the-sulcus IOL implantation groups. In the scleral-fixation group, p=0.55 for the USG biometry technique and p=0.22 for the OB technique. p values for the IOL-implantation group were p=0.49 and p=0.44, respectively. Conclusion Both implantation methods are safe for the patients. Final refraction is depending on the technique and indication to keratoplasty. Both biometry techniques deliver precise data for IOL choice.
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Kang HG, Choi EY, Lee SC, Kim M. A Modified Technique for Easier Enclavation of Retropupillary Iris Claw Intraocular Lens. J Refract Surg 2018; 34:564-566. [DOI: 10.3928/1081597x-20180703-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/20/2018] [Indexed: 01/14/2023]
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Davvalo Khongar P, Pralits JO, Soleri P, Romano M, Repetto R. A study of the mechanical forces on aphakic iris-fixated intraocular lenses. J Biomech Eng 2018; 140:2686535. [PMID: 30029265 DOI: 10.1115/1.4040588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/08/2022]
Abstract
Iris-fixated aphakic intraocular lenses (IFIOL) are used in cataract surgery, when more common intraocular lenses cannot be adopted because of the absence of capsular bag support. These lenses can be implanted either on the poste- rior or the anterior surface of the iris. In this work we study whether one of these options is preferable over the other from the mechanical point of view. In particular, we focus on the forces that the IFIOL transmits to the iris, which are asso- ciated with the risk of lens dislocation. We study the prob- lem numerically and consider aqueous flow induced by sac- cadic rotations in the cases of an IFIOL in the anterior and posterior side of the iris. The IFIOL considered is the Arti- san Aphakia +30.0 D lens (IFIOL) produced by Ophtec BV. We perform the simulations in OpenFOAM. We find that the forces transmitted by the aphakic IFIOL to the iris are sig- nificantly higher in the case of posterior implantation. This suggests that lens implantation on the posterior surface of the iris might be associated with a higher risk of lens disloca- tion, when an inadequate amount of iris tissue is enclavated during implantation.
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Affiliation(s)
- Peyman Davvalo Khongar
- Deptartment of Civil, Chemical and Environmental Engineering, University of Genoa, 16145, Genoa, Italy
| | - Jan O Pralits
- Deptartment of Civil, Chemical and Environmental Engineering, University of Genoa, 16145, Genoa, Italy
| | | | - Mario Romano
- Department of Biomedical Sciences, Humanitas University, Rozzano - Milano, Italy
| | - Rodolfo Repetto
- Deptartment of Civil, Chemical and Environmental Engineering, University of Genoa, 16145, Genoa, Italy
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Peng RM, Guo YX, Qiu Y, Hao YS, Hong J. Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation. Int J Ophthalmol 2018; 11:607-611. [PMID: 29675378 DOI: 10.18240/ijo.2018.04.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity (BCVA), IOP and mean central endothelial cell density (ECD) were recorded. RESULTS Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.
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Affiliation(s)
- Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yu-Xin Guo
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yuan Qiu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yan-Sheng Hao
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
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Chantarasorn Y, Techalertsuwan S, Siripanthong P, Tamerug A. Reinforced scleral fixation of foldable intraocular lens by double sutures: comparison with intrascleral intraocular lens fixation. Jpn J Ophthalmol 2018; 62:365-372. [PMID: 29464488 DOI: 10.1007/s10384-018-0579-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 01/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study is to describe a new technique for small-incision scleral fixation of intraocular lens (IOL) using double 10-0 polypropylene sutures, and to report the outcomes of IOL position compared with intrascleral IOL fixation at 12-month follow-up. STUDY DESIGN A retrospective comparative study. METHOD This new technique, called double sutured scleral fixated-IOL (DSF-IOL), was created to help with long-term knots strengthening by applying double sutures to each IOL haptic using an augmented Clove-hitch knot instead of the conventional knots tied by single suture. The tilt and decenter of IOL were measured by Scheimpflug camera and other refractive outcomes were compared between two groups at 12-month follow-up. RESULTS This study consisted of 26 eyes (54.2%) from the DSF-IOL group, and 22 eyes (45.8%) from the intrascleral fixated IOL (ISF-IOL) group. No significant differences of mean absolute degree of IOL tilt (2.90 ± 0.77 vs 2.82 ± 0.72; p = 0.633) and IOL decenter (151.90 ± 59.80 vs 175.0 ± 73.14 microns; p = 0.265) were found between the two groups. Post-operative LogMAR visual acuity was not statistically different between the two groups (0.32 ± 0.17 vs 0.41 ± 0.19, p = 0.089). Early post-operative hypotony was only present in the ISF-IOL group (13.6%). CONCLUSION This study shows that DSF-IOL is as effective as ISF-IOL. This technique can be a simpler approach to optimize small-incision scleral fixation of IOL without the complications associated with intrascleral IOL fixation.
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Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Dusit, Bangkok, 10300, Thailand.
| | - Settapong Techalertsuwan
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| | - Pongsavit Siripanthong
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| | - Anurak Tamerug
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
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Jare NM, Kesari AG, Gadkari SS, Deshpande MD. The posterior iris-claw lens outcome study: 6-month follow-up. Indian J Ophthalmol 2017; 64:878-883. [PMID: 28112126 PMCID: PMC5322700 DOI: 10.4103/0301-4738.198843] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate functional and anatomical outcomes of posterior iris-claw intraocular lens (IOL) implant for correction of aphakia in eyes with inadequate capsular support. Materials and Methods: Prospective case series of 108 aphakic eyes with inadequate capsular support which underwent posterior iris-claw IOL with a 6-month follow-up period was conducted. The cases belonged to two clinical settings: elective secondary implantation and those with intraoperative posterior dislocation of cataractous lens or IOL. Main outcome measures were visual acuity, anterior chamber reaction, stability of IOL, endothelial cell count, intraocular pressure (IOP), and cystoid macular edema (CME). Results: The mean best-corrected visual acuity was LogMAR 0.25. None had chronic anterior chamber inflammation. The mean difference in central endothelial counts before surgery and 1 month after surgery was 104.21 cell/mm2 (4.92%). There was no statistically significant difference in central endothelial cell count at 1 and 6 months (P = 0.91) and also in the central macular thickness at preoperative and after 6 months suggestive of CME (P = 0.078). Three eyes had raised IOP which were managed with neodymium-doped yttrium aluminum garnet laser peripheral iridotomy. There were no IOL dislocations or other adverse events in our series. Conclusion: Posterior chamber iris-claw lenses are a good option in eyes with inadequate posterior capsular support. Chronic inflammation, poor lens stability, or significant central endothelial cell loss was not observed during the 6-month follow-up period.
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Affiliation(s)
- Nana Madhukar Jare
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Ashwini Ganesh Kesari
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Salil S Gadkari
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Madan D Deshpande
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
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Fiorentzis M, Viestenz A, Heichel J, Seitz B, Hammer T, Viestenz A. Methods of fixation of intraocular lenses according to the anatomical structures in trauma eyes. Clin Anat 2017; 31:6-15. [DOI: 10.1002/ca.22898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Miltiadis Fiorentzis
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Anja Viestenz
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Jens Heichel
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Berthold Seitz
- Department of Ophthalmology; Saarland University Medical Center; Homburg/Saar Germany
| | - Thomas Hammer
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Arne Viestenz
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
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Català-Mora J, Cuadras D, Díaz-Cascajosa J, Castany-Aregall M, Prat-Bartomeu J, García-Arumí J. Anterior iris-claw intraocular lens implantation for the management of nontraumatic ectopia lentis: long-term outcomes in a paediatric cohort. Acta Ophthalmol 2017; 95:170-174. [PMID: 27535343 DOI: 10.1111/aos.13192] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the feasibility and long-term safety of lensectomy and iris-claw intraocular lens (IOL) implantation to treat children with severe ectopia lentis in a paediatric tertiary hospital. METHODS Prospective cohort study of 21 eyes from 12 patients with severe ectopia lentis and visual acuity <20/63. All eyes underwent 23-gauge pars plana vitrectomy, lensectomy, iridectomy and Artisan IOL implantation in the anterior chamber with iris-claw enclavation via pars plana. Mean age at surgery was 8.0 ± 5.3 yo (range 3-17 years). A full ophthalmologic examination including best-corrected visual acuity (BCVA), biomicroscopy, intraocular pressure (IOP) measurement, fundus evaluation and central endothelial cell count (cECC) was performed pretreatment, at 3 months' postsurgery, and every 6 months thereafter. Ultrasound biomicroscopy (UBM) was performed 12 months after surgery. RESULTS Mean follow-up was 39.3 ± 13.0 months. Best-corrected visual acuity (BCVA) (mean ± SD) improved from 0.91 ± 0.29 logMar preoperatively to 0.18 ± 0.23 logMar at final follow-up (p < 0.0001). Mean distance from the endothelium to the anterior IOL surface after surgery was 3.11 ± 0.61 mm. Postsurgically, cECC loss was 5.04% ± 9.58% with an annual cECC loss rate of 3.16% ± 4.46%. One patient developed IOL dislocation and retinal detachment after severe ocular contusion requiring vitrectomy, IOL refixation and gas tamponade. Another patient developed cystoid macular oedema, managed with intravitreal dexamethasone. CONCLUSION This technique is both feasible and effective to manage severe ectopia lentis in children. Lifetime ophthalmic follow-up including cECC measurement, IOL position monitoring and fundus examination is mandatory in these patients.
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Affiliation(s)
- Jaume Català-Mora
- Hospital Sant Joan de Déu; Esplugues de Llobregat Barcelona Spain
- Ophthalmological Institute del Pilar; Barcelona Spain
- Surgery Department; Universitat Autònoma Barcelona; Barcelona Spain
| | - Daniel Cuadras
- Advisory Service and Statistical Methodology Research; Fundació Sant Joan de Déu; Esplugues de Llobregat Barcelona Spain
| | | | | | | | - José García-Arumí
- Surgery Department; Universitat Autònoma Barcelona; Barcelona Spain
- Hospital Vall d'Hebron; Barcelona Spain
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Faria MY, Pinto Ferreira N, Gama I, Pinto JM, Canastro M, Monteiro Grillo M. Retropupilar positioning of foldable iris-claw intraocular lens for correction of aphakia with no capsular support. Int Med Case Rep J 2016; 9:337-340. [PMID: 27843355 PMCID: PMC5098758 DOI: 10.2147/imcrj.s119347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Summary Iris-claw intraocular lens (ICIOL) for aphakia needs a large 5.4 mm corneal incision for its implantation. The technique needs corneal suture, associated with some postoperative astigmatism. Foldable ICIOL is used in phakic patients undergoing refractive surgery and has the advantage of a sutureless small corneal incision. We report a case of a high myopic patient with dislocated intraocular lens (IOL) and no capsular support. Dislocated IOL with its capsular bag was released with three-port, 23-gauge vitrectomy; placed in the anterior chamber; sliced; and extruded through a 3.2-mm corneal incision, where a foldable ICIOL was introduced and placed retropupillary. This technique achieved a stable fixation of the IOL. Retropupillary implantation of a foldable ICIOL on aphakic patients has advantages over that of a polymethylmethacrylate (PMMA) ICIOL due to smaller corneal incision. The technique may be safe and easy to perform. Purpose The purpose of this report was to describe the technique of retropupillary implantation of a foldable iris-claw intraocular lens (ICIOL) in a patient with dislocated intraocular lens (IOL) in mid vitreous cavity. Methods Foldable ICIOL (Artiflex® Myopia Model 401) is used in phakic patients undergoing refractive surgery and has the advantage of a sutureless small corneal incision. We report a case of a high myopic patient with dislocated IOL and no capsular support. The calculation was a −5.0 D IOL for retropupilar position, and a foldable ICIOL was introduced through a 3.2-mm corneal incision and placed retropupillary. Results The technique was easy to achieve. IOL was properly positioned retropupillary and maintained stable. There was no ocular hypertension and no anterior chamber flare or iris atrophy. Conclusion Retropupillary implantation of a foldable ICIOL on aphakic patients has advantages over that of a PMMA ICIOL due to smaller corneal incision. The technique may be safe and easy to perform.
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Affiliation(s)
- Mun Yueh Faria
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Nuno Pinto Ferreira
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Ivo Gama
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Joana Medeiros Pinto
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon; Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - Mario Canastro
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Manuel Monteiro Grillo
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
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Different preferences between United States and European vitreoretinal surgeons: personal observations. Curr Opin Ophthalmol 2016; 27:196-200. [PMID: 26890405 DOI: 10.1097/icu.0000000000000261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article describes the author's personal observations on different preferences in surgical technique and surgical setting between vitreoretinal specialists in the USA and Europe. These impressions, although clearly subjective, derive from the author's extensive experience with, and connection to, many vitreoretinal centers and surgeons around the world in a wide variety of venues. RECENT FINDINGS Although the results of surgery and the availability of information and instrumentation are quite comparable on both sides, vitreoretinal surgeons in the USA are more likely to use local anesthesia, an outpatient setting, perform phakic vitrectomy, use gas as opposed to oil as a tamponade, use pneumatic retinopexy for certain cases, place an anterior chamber lens for secondary implantation, and perform intravitreal injections in the office or exam room. In addition, European colleagues more commonly perform combined phacoemulsification with intraocular lens implantation at the time of vitrectomy, use perfluorochemicals during retinal detachment surgery, and utilize heavy silicone oils. SUMMARY These observations suggest that many factors, both medical and nonmedical, influence vitreoretinal surgeons and result in differing preferences for surgical techniques and surgical setting.
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Faria MY, Ferreira NP, Pinto JM, Sousa DC, Leal I, Neto E, Marques-Neves C. Retropupillary iris claw intraocular lens implantation in aphakia for dislocated intraocular lens. Int Med Case Rep J 2016; 9:261-5. [PMID: 27621670 PMCID: PMC5010170 DOI: 10.2147/imcrj.s116771] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nowadays, dislocated intraocular lenses (IOLs) and inadequate capsular support are becoming a challenge for every ophthalmic surgeon. Explantation of dislocated IOL and iris claw IOL (ICIOL) are the techniques that have been used in our ophthalmic department. The aim of this study is to report our technique for retropupillar ICIOL. Methods This study is a retrospective case series. A total of 105 eyes with dislocated IOL from the patients at the Department of Ophthalmology in Santa Maria Hospital, a tertiary reference hospital in Lisbon, Portugal, from January 2012 until January 2016, had been analyzed. Of these 105 eyes, 66 eyes had dislocated one-piece IOL and 39 eyes had dislocated three-piece IOL. The latter underwent iris suture of the same IOL and were excluded from this study. The remaining 66 eyes with dislocated one-piece IOL underwent pars plana vitrectomy, that is, explantation of dislocated IOL through corneal incision and an implantation of retropupillary ICIOL. Operative data and postoperative outcomes included best corrected visual acuity, IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and anterior chamber depth. Results The mean follow-up was 23 months (range: 6–48 months). The mean preoperative best corrected visual acuity was 1.260±0.771 logMAR, and postoperative best corrected visual acuity was 0.352±0.400 logMAR units. Mean vision gain was 0.909 logMar units. The patients had the following complications: 1) retinal detachment was found in one patient, 2) corneal edema was found in three patients, 3) high intraocular pressure was observed in twelve patients, 4) subluxation of the IOL was observed in one patient, and 5) macular edema was found in three eyes. Conclusion The results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in complicated cases.
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Affiliation(s)
- Mun Yueh Faria
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Nuno Pinto Ferreira
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joana Medeiros Pinto
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - David Cordeiro Sousa
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ines Leal
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Eliana Neto
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Carlos Marques-Neves
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Outcomes of Sutureless Iris-Claw Lens Implantation. J Ophthalmol 2016; 2016:7013709. [PMID: 27642519 PMCID: PMC5013207 DOI: 10.1155/2016/7013709] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose. To evaluate the indications, refraction, and visual and safety outcomes of iris-claw intraocular lens implanted retropupillary with sutureless technique during primary or secondary operation. Methods. Retrospective study of case series. The Haigis formula was used to calculate intraocular lens power. In all cases the wound was closed without suturing. Results. The study comprised 47 eyes. The mean follow-up time was 15.9 months (SD 12.2). The mean preoperative CDVA was 0.25 (SD 0.21). The final mean CDVA was 0.46 (SD 0.27). No hypotony or need for wound suturing was observed postoperatively. Mean postoperative refractive error was −0.27 Dsph (−3.87 Dsph to +2.85 Dsph; median 0.0, SD 1.28). The mean postoperative astigmatism was −1.82 Dcyl (min −0.25, max −5.5; median −1.25, SD 1.07). Postoperative complications were observed in 10 eyes. The most common complication was ovalization of the iris, which was observed in 8 eyes. The mean operation time was 35.9 min (min 11 min, max 79 min; median 34, SD 15.4). Conclusion. Retropupilary iris-claw intraocular lens (IOL) implantation with sutureless wound closing is an easy and fast method, ensuring good refractive outcome and a low risk of complication. The Haigis formula proved to be predictable in postoperative refraction.
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