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Levy-Neuman S, Mendel L, Achiron A, Bukelman A, Weinberg T, Avizemer H, Schlesinger M, Marcovich AL, Kleinmann G. Comparison of flanged polypropylene scleral intraocular lens fixation with scleral sutured fixation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00093-0. [PMID: 38636552 DOI: 10.1016/j.jcjo.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket. METHODS Retrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center. RESULTS A total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (-0.63 ± 2 and -2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29). CONCLUSION Comparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.
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Affiliation(s)
| | - Liat Mendel
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Bukelman
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Tamir Weinberg
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Haggay Avizemer
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel
| | - Mor Schlesinger
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Arie L Marcovich
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Guy Kleinmann
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kabata Y, Oki T, Nakano T. Comparison of Refractive Prediction Error by Axial Length in Flanged Intrascleral Intraocular Lens Fixation. Clin Ophthalmol 2024; 18:895-900. [PMID: 38529004 PMCID: PMC10962658 DOI: 10.2147/opth.s455178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To evaluate the refractive prediction error in flanged intrascleral intraocular lens (IOL) fixation using the SRK/T formula and compare the axial length using a single IOL. Methods Seventy-six eyes from 70 patients (45 males and 25 females) were included in this study. The mean age at the time of surgery was 73.4 ±12.3 years. The patients underwent flanged IOL fixation using a PN6A (Kowa). All surgeries were performed by two surgeons (Y. K. and T. O.) between Jan 2020 and Dec 2022 at Jikei University Daisan Hospital. IOL power was calculated using the SRK/T formula with IOL Master 700 (Carl Zeiss) as the bag power. The recommended value of 119.0 was used for the A-constant. The actual refractive spherical equivalent was calculated and compared with preoperative predictions. Refractive prediction errors were defined as the deviation of the actual postoperative spherical equivalent refraction in diopters from the predicted preoperative spherical equivalent refraction. The patients were divided into three groups according to axial length: <22.0 mm (short eyes), 22.0-24.5 mm (medium eyes), and >24.5 mm (long eyes), and the refractive prediction errors and mean absolute errors were compared. Results The mean refractive prediction error was -0.20 ± 0.52D. The mean absolute error was 0.44 ± 0.33D. The mean refractive prediction errors were not significantly different between the 22.0-24.5 mm (medium eyes) and >24.5 mm (long eyes) groups. (P=0.06) The mean absolute errors were not significantly different between the two groups (P=0.10). Conclusion The SRK/T formula worked well regardless of whether the eyes were medium or long according to the axial length in the flanged intrascleral IOL fixation.
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Affiliation(s)
- Yoshiaki Kabata
- Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Tetsutaro Oki
- Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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Carcione J, Astafurov K, Prenner J. Secondary IOL’s and Exchanges from a Retina Surgeon’s Perspective. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00286-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muthukumar B, Chhablani PP, Salman A, Bhandari V, Kapoor R. Comparison of retropupillary fixated iris claw lens versus sclera fixated lens for correction of pediatric aphakia secondary to ectopia lentis. Oman J Ophthalmol 2021; 14:20-26. [PMID: 34084030 PMCID: PMC8095304 DOI: 10.4103/ojo.ojo_91_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/24/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022] Open
Abstract
AIM: To evaluate the postoperative visual acuity and complications in eyes with ectopia lentis in children who underwent lens removal and then implantation of retropupillary fixated iris claw lens versus scleral fixated intraocular lens (SFIOL) implantation. MATERIALS AND METHODS: A retrospective analysis of pediatric cases who presented with lens subluxation secondary to ectopia lentis and who underwent lens extraction (57 eyes of 38 patients) with either retropupillary iris fixated intraocular lens (IOL) implantation (Group A – 36 eyes of 20 patients) and SFIOL implantation (Group B – 21 eyes of 18 patients) was done over a period of 5 years from March 2010 to February 2015. The main outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA) and secondary postoperative complications. RESULTS: The study patients were divided into two groups: Group A patients were implanted with retropupillary iris claw lens whereas Group B patients were implanted with SFIOL. The mean age of presentation was 12 years, the mean follow-up period was of 24 months (range 14–36 months), and the median follow-up period was 26 months in both the groups. An improvement in the mean BCVA (LogMAR) was seen in both the groups. In Group A, the mean BCVA improved from 1.5 ± 0.2 preoperatively to 0.3 ± 0.2 postoperatively, whereas in Group B, the mean BCVA improved from 1.5 ± 0.3 preoperatively to 0.3 ± 0.2 postoperatively (P < 0.001). None of the eyes in either of the groups had any serious complications such as glaucoma, uveitis, cystoid macular edema, or endophthalmitis. CONCLUSION: Retropupillary iris fixation and scleral fixation of IOL are both safe and viable options for the correction of ectopia lentis in pediatric age group.
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Affiliation(s)
| | - Preeti Patil Chhablani
- Jasti V Ramanamma, Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Amjad Salman
- Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirappalli, Tamil Nadu, India
| | | | - Rajat Kapoor
- Jasti V Ramanamma, Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
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Bhatia K, Manaktala R, Sachdev M, Tank N, Saha I, Mishra D. MYX technique: A modified adaptation of Yamane and extraocular needle-guided haptic insertion techniques for scleral-fixated intraocular lens implantation. Indian J Ophthalmol 2021; 69:428-431. [PMID: 33463604 PMCID: PMC7933830 DOI: 10.4103/ijo.ijo_728_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Scleral-fixated intraocular lens implantation in an important tool in the armamentarium of an ophthalmologist for managing aphakia. Various techniques have been described in the literature with variable learning curves. Herein, we describe an easy, fast, reproducible technique; the “MYX” technique, which utilizes the advantages of both the Yamane and the X-NIT technique, where the handshaking of the prolene haptic of a 3-piece PMMA IOL into the lumen of a 26-gauge needle is done externally (like in X-NIT technique), and the exteriorized haptic is cauterized to form a flange transconjunctivally, thereby avoiding the scleral pocket tucking (like Yamane technique), to achieve excellent surgical outcomes.
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Affiliation(s)
- Karan Bhatia
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | - Ruchita Manaktala
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | | | - Nikunj Tank
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | - Indranil Saha
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | - Deepak Mishra
- Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Standardized Flanged Intrascleral Intraocular Lens Fixation with the Double-Needle Technique for Cataract Luxation in the Vitreous Chamber during Phacoemulsification. J Ophthalmol 2021; 2021:9998482. [PMID: 34007485 PMCID: PMC8099526 DOI: 10.1155/2021/9998482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the visual and refractive outcome of immediate intraoperative vitrectomy and intrascleral intraocular lens implantation using a “standardized” sutureless Yamane technique during cataract luxation in the vitreous chamber as a complication of phacoemulsification. Design A prospective, interventional, consecutive case series. Materials and Methods Twelve patients underwent vitrectomy and intrascleral intraocular lens fixation using a standardized Yamane technique as the primary procedure during complicated phacoemulsification. Patients were evaluated preoperatively and 6 months postoperatively for best-corrected distance visual acuity, correspondence to the preoperative refractive target in the spherical equivalent, endothelial cell count, and complications. Results Mean preoperative best-corrected visual acuity was 1.16 ± 0.3 logarithm of the minimum angle of resolution (logMAR), the endothelial cell count was 1910.5 ± 297.64, and target refraction at baseline was −0.197 ± 0.087. Postoperatively, best-corrected visual acuity was significantly improved; the mean value was 0.05 logMAR ± 0.06. Mean baseline target refraction in the spherical equivalent was −0.20 ± −0.09 (range: −0.08 to −0.37), and mean final refraction was −0.44 ± −0.14 (range: −0.25 to −0.75) with no significant difference (p=0.87). No complication was registered intra- and postoperatively. Conclusion Standardization of the Yamane technique seemed a valuable option for patients who had complicated phacoemulsification to achieve a predictable refractive outcome. Synopsis. The predictable refractive outcome could be achieved with the immediate standardized Yamane technique in patients with intraoperative cataract luxation in the vitreous chamber during phacoemulsification.
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Muth DR, Wolf A, Kreutzer T, Shajari M, Vounotrypidis E, Priglinger S, Mayer WJ. Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview. Klin Monbl Augenheilkd 2021; 238:868-874. [PMID: 33853190 DOI: 10.1055/a-1333-3199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique. MATERIAL AND METHODS Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z). RESULTS Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up. CONCLUSION The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.
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Affiliation(s)
- Daniel Rudolf Muth
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Armin Wolf
- Augenklinik des Universitätsklinikums Ulm, Deutschland
| | - Thomas Kreutzer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Mehdi Shajari
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | | | - Siegfried Priglinger
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Wolfgang J Mayer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
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Intraocular Suture Looping and Overhand Friction Knot: A Flapless Technique to Refixate Dislocated Intraocular Lenses. Retina 2020; 39 Suppl 1:S62-S67. [PMID: 30161097 DOI: 10.1097/iae.0000000000002291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A NOVEL APPROACH TO SCLERAL FIXATION OF POSTERIOR CHAMBER INTRAOCULAR LENSES AND CAPSULAR TENSION RINGS AND SEGMENTS IN DEEP-SET EYES. Retin Cases Brief Rep 2020; 16:379-381. [PMID: 32118809 DOI: 10.1097/icb.0000000000000988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To demonstrate a novel approach to scleral fixation of posterior chamber intraocular lenses and capsular tension rings and segments in deep-set eyes using the Finesse FlexLoop (Alcon Laboratories). METHODS The technique described herein, based on previous approaches to scleral fixation of posterior chamber intraocular lenses, uniquely employs the FlexLoop to "lasso" Gore-Tex sutures that have already been threaded through the eyelets of a CZ70BD (Alcon Laboratories) IOL and externalize them. RESULTS All patients who underwent surgery with this technique experienced visual improvement. The only complication was of mild hyphema in the patient who had a capsular tension segment placed, which resolved with medical therapy. CONCLUSION The advantages of this procedure include a smaller diameter instrument (FlexLoop) as compared to the 25-gauge forceps typically employed, an easier to perform surgical maneuver that alleviates the need for both precise placement and constant tension to be exerted by the surgeon to grasp the sutures, as well as an instrument that can function when bent up to 45° to help accommodate deep-set eyes requiring this procedure.
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Recep ÖF. Skleraya sabitlenen göz içi lensi uygulama teknikleri. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.547659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kelkar A, Kelkar J, Kothari A, Mehta H, Chitale S, Fogla R, Kelkar S. Comparison of Two Modified Sutureless Techniques of Scleral Fixation of Intraocular Lens. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e129-e134. [PMID: 30395673 DOI: 10.3928/23258160-20181002-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/13/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the visual outcome and complications of two different sutureless scleral-fixated intraocular lens (IOL) implantation techniques, that is, intrascleral IOL fixation technique and modified Yamane's technique of scleral fixation of IOL. PATIENTS AND METHODS Patients who underwent scleral fixation of IOL (SFIOL) from June 2015 to February 2017 with more than 6 months of follow-up were examined retrospectively. Improvement in visual acuity (VA), intraocular pressure (IOP) measurements, endothelial cell count, central macular thickness (CMT), and intraoperative/postoperative complications were compared at 6 months follow-up. RESULTS Seventy eyes were analyzed. The mean follow-up was 10.5 months ± 1.5 months. The final visual outcomes in both groups, modified intrascleral IOL fixation technique (Group A, n = 30) and modified Yamane's technique (Group B, n = 40), were comparable. The indications for surgery were aphakia (n = 15), subluxated/dislocated cataract (n = 31), and dislocated/subluxated IOL (n = 24). The majority of the eyes (92%) improved to VA 0.3 logMAR units or better. The uncorrected distance visual acuity (UDVA), endothelial cell density, and CMT at the 6-month follow-up were comparable in both groups. Postoperatively, transient IOP rise occurred in 18 eyes, retinal detachment in one eye, vitreous hemorrhage in one eye, cystoid macular edema in two eyes, and mild IOL decentration in two eyes. CONCLUSION Both techniques have favorable visual outcomes; however, modified 27-gauge needle-assisted Yamane's technique is technically superior because of its transconjunctival approach and less surgical time, and its needle-assisted approach for haptic externalization prevents haptic damage during externalization. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e129-e134.].
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Ravi Kumar KV. Modified sewing machine technique for iridodialysis repair, intraocular lens relocation, iris coloboma repair, Cionni ring fixation, and scleral-fixated intraocular lens. Indian J Ophthalmol 2018; 66:1169-1176. [PMID: 30038167 PMCID: PMC6080449 DOI: 10.4103/ijo.ijo_1320_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/22/2018] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study is to report the modification of sewing machine technique for iris dialysis repair (MSMT) and its usefulness in managing other conditions such as intraocular lens (IOL) subluxation, iris coloboma, Cionni ring for zonular dialysis, and for scleral-fixated IOL. MSMT was based on sewing machine principle using a prethreaded 26G/30G needle with prolene suture for minimally invasive iris dialysis repair in a closed chamber manner. So far, eight patients (trauma - 3, surgical complication - 5) underwent this procedure. This technique is further modified to extend its use for IOL relocation - 2, iris coloboma repair - 3, and Cionni ring fixation for zonular dialysis - 2, SFIOL - 5 patients. All 20 patients had good visual recovery and cosmetic outcome with minimal morbidity. To conclude, MSMT offers cost -effective, minimally invasive, easy to learn procedure with a potential to tackle several problems related with cataract surgery and iris defects, which even an average cataract surgeon can learn to perform when required. Further comparative studies with conventional techniques with large sample size are required to standardize this procedure.
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Affiliation(s)
- Karamsetty Venkata Ravi Kumar
- Comprehensive Ophthalmologist, Anasuya Rao Eye Clinic, Vijayawada, Ex-C.M.O. Rotary Eye Hospital, Vuyyuru, Andhra Pradesh, India
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Novel Surgical Approach for Fixation of a Posterior Chamber Intraocular Lens Using Gore-Tex Suture. Retina 2018; 37:2362-2364. [PMID: 28301341 DOI: 10.1097/iae.0000000000001595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 16] [Impact Index Per Article: 2.7] [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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Benarous A, Drimbea A, Milazzo S. [Study of the results scleral-fixated intraocular lenses in the absence of capsular support]. J Fr Ophtalmol 2018; 41:1-13. [PMID: 29331294 DOI: 10.1016/j.jfo.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the absence of sufficient capsular support, scleral fixation of the intraocular lens is an interesting alternative. The goal is to evaluate this implantation technique when traditional implantation is impossible. PATIENTS AND METHODS This is an observational, retrospective, monocentric study at the Amiens university medical center between August 2013 and March 2016. Patients all underwent scleral fixation of a three-piece implant without suturing of the haptics, after posterior vitrectomy. All patients requiring implantation in the absence of stable capsular support were included. Patients with adequate iris or capsular support were excluded from our study. RESULTS Eighteen patients were included, with an average age of 69.3±16.9 years. The surgical indications were: complicated surgery, trauma and endothelial decompensation. The preoperative mean corrected visual acuity was 1.2±0.4 LogMAR while the postoperative acuity was 0.7±0.5 LogMAR. The mean postoperative corneal astigmatism was 1.9±1.9 diopters. The main complications observed were ocular hypertension, macular edema, retinal detachment, iris incarceration and exteriorization of the haptic. DISCUSSION There are two alternatives when faced with lack of a sufficient capsular support: scleral fixation or iris fixation. Our technique is the only one achievable in the presence of iris atrophy. Furthermore, it induces less astigmatism and enables the repositioning of a three-piece implant dislocated into the vitreous. CONCLUSION Scleral fixation is a technique allowing both a satisfactory and a lasting functional result and is to be considered when faced with a lack of sufficient capsular support.
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Affiliation(s)
- A Benarous
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens-Picardie, chemin de Longpré, 80080 Amiens, France; Université de Picardie-Jules-Verne, 80080 Amiens, France.
| | - A Drimbea
- Institut ophtalmologique de Picardie, 80080 Amiens, France
| | - S Milazzo
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens-Picardie, chemin de Longpré, 80080 Amiens, France; Université de Picardie-Jules-Verne, 80080 Amiens, France; Centre européen n(o) 86 EVICR.net, chemin de Longpré, 80080 Amiens, France
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Kelkar AS, Fogla R, Kelkar J, Kothari AA, Mehta H, Amoaku W. Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience. Indian J Ophthalmol 2017; 65:1450-1453. [PMID: 29208833 PMCID: PMC5742981 DOI: 10.4103/ijo.ijo_659_17] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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 the study was to report our initial experience with the transconjunctival Intrascleral Intraocular Lens (SFIOL) fixation with modified Yamane's double-needle technique and flanged haptics. METHODS This was a prospective interventional study that enrolled 31 consecutive patients undergoing SFIOL with the modified Yamane's technique. All patients underwent comprehensive evaluation including uncorrected and best-corrected vision, intraocular pressure, ultrasound biomicroscopy, endothelial cell density, and macular thickness using optical coherence tomography (OCT). We excluded patients with visually significant coexistent pathology such as corneal scars, macular pathology, and glaucoma. RESULTS The mean age of subjects was 57 ± 16.9 years and 23 were men (74%). Surgery was performed for aphakia following complicated cataract surgery in 10 eyes (32%), with lensectomy for subluxated/dislocated cataract in 6 eyes (19%), and with IOL explantation for subluxated/dislocated IOL in 15 eyes (48%). There were no intraoperative complications. Uncorrected visual acuity improved from median of 1.48 logarithm of minimum angle of resolution (logMAR) units (interquartile range [IQR] = 1.3-2 logMAR) at baseline to 0.3 logMAR (IQR = 0.2-0.4 logMAR) at 6 weeks (P < 0.001) which was maintained at 6 months. There were no significant changes in endothelial cell density (P = 0.34) and OCT-based macular thickness (P = 0.31) at 6 months. Two eyes had slight IOL decentration. CONCLUSION Our initial experience suggests that the Yamane's technique for SFIOL is a simple procedure with a short-learning curve and is independent of scleral flaps, tunnels, sutures, and fibrin glue. Using widely available 27-gauge needle instead of 30-gauge thin wall needle as originally described by Yamane makes it possible for the use of various three-piece IOLs available globally. Further studies are required for widespread acceptance of this technique.
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Affiliation(s)
- Aditya Shrikant Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Rajesh Fogla
- Department of Ophthalmology, Apollo Health City, Hyderabad, Telangana, India
| | - Jai Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Akshay Anil Kothari
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal Mehta
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Winfried Amoaku
- Department of Ophthalmology, University of Nottingham, Nottingham, UK
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Mantopoulos D, Fine HF, Prenner JL. Navigating the Options for the Treatment of Intraocular Lens Malposition. Ophthalmic Surg Lasers Imaging Retina 2017; 48:876-880. [PMID: 29121355 DOI: 10.3928/23258160-20171030-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Endoscopic-Assisted Scleral Fixated IOL in the Management of Secondary Aphakia in Children. J Ophthalmol 2016; 2016:8501842. [PMID: 27595016 PMCID: PMC4995346 DOI: 10.1155/2016/8501842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/13/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate the short-term postoperative outcomes in endoscopic-assisted sclera fixation intraocular lens (IOL) for the management of secondary aphakia in children. Methods. This is a prospective study, whereas 40 aphakic eyes with absence of a good capsular support were implanted by endoscopy-assisted sclera fixation technique. Results. No major intraoperative complications were recorded. All cases were followed up for 6 months. Only transient ocular hypertension occurred in 10 (25%) eyes. Lens decentration and/or tilting were clinically detected in 2 eyes (5%). Ultrasonic biomicroscopic (UBM) examination revealed lens tilting in 2 (5%) of the operated eyes, despite the proper haptics positioning in the ciliary sulcus. Postoperative vitreous hemorrhage was reported in 5 eyes (12.5%) in the early postoperative period and retinal detachment in one eye. A postoperative refractive astigmatism ranging from 0.75 D to 3.75 D (mean 1.7 D ± 0.79) was recorded, as compared to mean preoperative values of 2.00 D, with no statistically significant differences being recorded (p ≥ 0.05). An improvement of BCVA, 1-2 lines on Snellen chart at the end of the follow-up period, was detected in 23 eyes (57.5%) with a mean of 0.6 ± 0.08 SD, as compared to a preoperative mean values of 0.5 ± 0.07 SD (p ≥ 0.05). Conclusion. Using an endoscope for transscleral suturing of intraocular lenses in aphakic pediatric eyes might be considered as being an effective technique that can reduce surgical complications, especially postoperative lens decentration.
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Is an iris claw IOL a good option for correcting surgically induced aphakia in children? A review of the literature and illustrative case study. Eye (Lond) 2016; 30:1155-9. [PMID: 27391934 DOI: 10.1038/eye.2016.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/13/2016] [Indexed: 11/08/2022] Open
Abstract
Refractive correction of aphakia in childhood can be a complex management issue following lensectomy for congenital cataract or ectopia lentis. Some children have inadequate capsular support to allow an 'in the bag' or sulcus fixated intra-ocular lens (IOL). In such cases, options for refractive correction include spectacles, contact lenses, or surgically fixed IOLs. Many methods of IOL fixation have been described, but none are widely adopted in children. In recent years, the iris-fixated Artisan Aphakic IOL has gained popularity, but there is still significant concern about the rate of corneal endothelial cell loss and IOL de-enclavation. Here, we review the current literature on the use of iris-fixated IOLs in children, the published data on endothelial cell loss and de-enclavation rates. We present a case illustrating the significant improvements in quality of life, which can be seen in selected children, and also the rate of endothelial cell loss, which can be encountered after initial surgery, and a re-enclavation event. We make the case that until more data are available on normal endothelial cell decline in early childhood, in addition to age-specific rates of endothelial cell loss and de-enclavation rates following surgery, the use of iris-fixated IOLs in children will continue to be a moot point and is unlikely to be widely adopted.
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20
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Haszcz D, Nowomiejska K, Oleszczuk A, Forlini C, Forlini M, Moneta-Wielgos J, Maciejewski R, Michalska-Malecka K, Jünemann AG, Rejdak R. Visual outcomes of posterior chamber intraocular lens intrascleral fixation in the setting of postoperative and posttraumatic aphakia. BMC Ophthalmol 2016; 16:50. [PMID: 27145831 PMCID: PMC4857430 DOI: 10.1186/s12886-016-0228-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 04/28/2016] [Indexed: 11/22/2022] Open
Abstract
Background Several techniques for fixation of the posterior chamber intraocular lens (IOL) have been developed. We evaluate long-term functional outcomes and safety of posterior chamber IOL implantation using Hoffman scleral haptic fixation and sutureless Sharioth technique in patients with posttraumatic and postoperative aphakia. Methods This retrospective case-series included 42 eyes operated by one surgeon. The data including demographic data, ocular history, preoperative, early postoperative and final best corrected visual acuity (BCVA), rate of complications as well as postoperative IOL position were collected. The mean follow-up was 14.5 months. Hoffman haptic scleral fixation was performed in 31 eyes, Sharioth technique—in 11 eyes. Aphakia was due to eye trauma (19) or complicated cataract surgery (23). Results Overall, the final BCVA improved in 26 eyes, did not change in 5 eyes, and worsened in 11 eyes. No significant differences in BCVA were found between groups operated with Hoffman scleral fixation and Sharioth technique. Postoperatively, we noticed two dislocations of IOL fixated using Sharioth technique and none after Hoffman technique. No severe complications were observed. Conclusion Both transscleral fixation techniques are feasible methods of secondary IOL implantation in posttraumatic and postoperative aphakia. with low incidence of complications, however visual outcomes are diverse.
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Affiliation(s)
- Dariusz Haszcz
- Department of General Ophthalmology, Medical University, Lublin, Poland
| | | | | | | | - Matteo Forlini
- Institute of Ophthalmology, University of Parma, Parma, Italy
| | | | | | | | - Anselm G Jünemann
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University, Lublin, Poland.,Department of Experimental Pharmacology, Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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Can E, Koçak N, Yücel ÖE, Gül A, Öztürk HE, Sayin O. Ab-interno scleral suture loop fixation with cow-hitch knot in posterior chamber intraocular lens decentration. Indian J Ophthalmol 2016; 64:124-6. [PMID: 27050346 PMCID: PMC4850806 DOI: 10.4103/0301-4738.179712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim of Study: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). Materials and Methods: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. Results: Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. Conclusions: Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes.
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Affiliation(s)
- Ertuğrul Can
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Can E, Gül A, Birinci H. A safe method of ciliary sulcus fixation of foldable intraocular lens using a ciliary sulcus guide. Int Ophthalmol 2015; 36:463-8. [PMID: 26439372 DOI: 10.1007/s10792-015-0132-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Abstract
To describe a novel technique for implantation of intraocular lens in the absence of capsular support using a ciliary sulcus guide. Based on the anatomic knowledge of the ciliary sulcus and the sclera, a new instrument was developed to pierce the needle safely through the ciliary sulcus and sclera. While the foldable lens is stored inside the cartridge, the leading haptic is sutured with a cow-hitch knot. The needle is then inserted into the ciliary sulcus guide. The tip of the guide is inserted from the corneal incision and proceeded under the iris to touch and fit the ciliary sulcus. The needle is pushed from back side. The needle comes out at precise point at the sclera. Implantation of the lens was performed through a 2.8 mm clear cornea incision using the injector. The trailing haptic is tied after implantation, and then the same procedure is performed at the opposite side. We performed this technique to 15 aphakic eyes without sufficient capsular support. There was no bleeding or other intraoperative complication. All the points coming out the sclera were between 2 and 2.5 mm from the limbus. The ab interno technique for scleral fixation of IOL is quicker, easier and less traumatic then ab externo techniques. A new ciliary sulcus guide which is usable with both straight and curved needles eliminates the blind maneuvers of ab interno technique and makes this technique more safe and precise.
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Affiliation(s)
- Ertuğrul Can
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey.
| | - Adem Gül
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey
| | - Hakkı Birinci
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey
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Gawdat GI, Taher SG, Salama MM, Ali AA. Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support. J AAPOS 2015; 19:242-6. [PMID: 26059670 DOI: 10.1016/j.jaapos.2015.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/13/2015] [Accepted: 03/22/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. METHODS In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth <3 mm, central endothelial cell density (CECD) <2500 cells/mm(²), uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively. RESULTS A total of 25 aphakic eyes of 18 patients (mean age, 7.86 ± 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P < 0.002) and 0.3 ± 0.2 (P < 0.0001), respectively. One year after surgery the CECD (2892.64 ± 441.79 cells/mm(²)) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 ± 468.9 cells/mm(2), 3081 ± 495 cells/mm(²); P < 0.0001, P < 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%). CONCLUSIONS Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.
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Affiliation(s)
- Ghada I Gawdat
- Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt
| | - Sameh G Taher
- Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt
| | - Marwa M Salama
- Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt.
| | - Adel A Ali
- Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt
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24
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Incidence of cystoid macular edema with iris-fixated posterior chamber intraocular lenses in patients presenting with lens dislocation. Int Ophthalmol 2014; 34:1153-8. [DOI: 10.1007/s10792-014-9964-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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25
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Gimbel HV, Amritanand A. Suture refixation and recentration of a subluxated capsular tension ring-capsular bag-intraocular lens complex. J Cataract Refract Surg 2014; 39:1798-802. [PMID: 24286838 DOI: 10.1016/j.jcrs.2013.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
We describe a 3-point ab externo technique to refixate and recenter a subluxated Cionni capsular tension ring (CTR)-intraocular lens (IOL)-capsular bag complex to the sclera. A 9-0 polypropylene suture on a curved needle is looped through the eyelet of the CTR and back through a Hoffman scleral tunnel. Two other sutures passed in a similar fashion through the fibrotic continuous curvilinear capsulorhexis (CCC) edge are used to complete a tripod fixation, which centers and stabilizes the IOL. This surgical approach avoids the surgical trauma of removing and replacing a subluxated CTR-IOL-capsular bag complex, retains the optimal anatomical position, and ensures centration of the IOL.
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Affiliation(s)
- Howard V Gimbel
- From the Gimbel Eye Centre (Gimbel, Amritanand), Calgary, Alberta, Canada, and Loma Linda University (Gimbel), Loma Linda, California, USA.
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Abstract
Achieving a cosmetic and functional outcome from iris defect repair is a surgical challenge. We describe an adaptation of techniques to address a case of 2.5 clock hours of sectoral iris tissue defect. Our method combines Siepser's modified closed-chamber sliding knot technique with the placement of a double-armed iris mattress suture to approximate iris tissue to the scleral wall and thereby create a pseudo-iris root. This technique reduces glare and achieves a cosmetic outcome for the patient.
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Affiliation(s)
- Sean W Tsao
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York, USA
| | - Huck A Holz
- Department of Ophthalmology, Santa Clara Kaiser Permanente, Santa Clara, California, USA
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Sekundäre Intraokularlinsenimplantation von Sklera-nahtfixierten Intraokularlinsen. Ophthalmologe 2014; 111:217-23. [DOI: 10.1007/s00347-013-2847-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hu XT, Zhang ZD, Zhou R, Pan QT. Cauterization technique for suture erosion in transscleral fixation of intraocular lenses. Int J Ophthalmol 2014; 6:892-4. [PMID: 24392344 DOI: 10.3980/j.issn.2222-3959.2013.06.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 06/27/2013] [Indexed: 11/02/2022] Open
Abstract
Transscleral suturing is a commonly applied technique to fix intraocular implants in the sulcus. A major problem after transscleral implantation is suture erosion that normally happens in the late post-surgery period and may result in an increased incidence of endophthalmitis. Here we describe an original cauterization method by using a glass rod to melt the exposed suture end without damaging the suture knot in the sclera to avoid suture exposure in sclera-fixed IOL implantation. This is a simple, quick and effective technique that can be performed without conjunctiva incisions and will help to reduce suture erosion related complications.
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Affiliation(s)
- Xu-Ting Hu
- The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zong-Duan Zhang
- The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Rong Zhou
- The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Qin-Tuo Pan
- The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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29
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Seki M, Yamamoto S, Abe H, Fukuchi T. Modified ab externo method for introducing 2 polypropylene loops for scleral suture fixation of intraocular lenses. J Cataract Refract Surg 2013; 39:1291-6. [PMID: 23988241 DOI: 10.1016/j.jcrs.2013.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 05/07/2013] [Accepted: 05/23/2013] [Indexed: 11/16/2022]
Abstract
We describe a method that enables the introduction of 2 suture loops for scleral fixation of an intraocular lens (IOL) by a single ab externo procedure. A long needle carrying a polypropylene suture loop is inserted through the scleral fixation site and docked with a hollow needle inserted through the opposite fixation site. The hollow needle pulls the suture needle out, but the suture loop end is left external. Another polypropylene suture loop is placed through the first loop. As the first (leading) suture is pulled, the second (trailing) suture is drawn into the eye. The suture loops are retrieved through the main incision. The IOL haptics are secured with a polypropylene loop by cow hitches. After the IOL is placed in the eye, the sutures are fixated to the sclera. This technique enhances efficiency and control during the introduction of suture loops for scleral fixation of IOLs.
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Affiliation(s)
- Masaaki Seki
- Seki Eye Clinic, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
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Emanuel ME, Randleman JB, Masket S. Scleral fixation of a one-piece toric intraocular lens. J Refract Surg 2013; 29:140-2. [PMID: 23380416 DOI: 10.3928/1081597x-20130117-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/14/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a novel technique for toric intraocular lens (IOL) repositioning and fixation in the absence of adequate capsular support. METHODS Case report and literature review. RESULTS Two cases are presented with scleral fixation of a one-piece toric IOL (SN6AT series; Alcon Laboratories, Inc., Fort Worth, TX). In both cases, toric IOLs initially placed within the capsular bag became decentered due to poor capsular support. To avoid the potential complications of lens explantation and maintain the astigmatic benefits of the toric IOL, scleral fixation of the lenses was performed. The Hoffman technique was used to create reverse scleral pockets without conjunctival dissection. A 10-0 non-dissolvable suture was used to capture and then secure the lens haptics in a lasso-type fashion. Sutures were then buried within the previously created scleral pockets. Both patients had well-centered lenses postoperatively that remained stable at last follow-up, 30 months postoperatively. CONCLUSION In the absence of adequate capsular support, scleral fixation is a viable option for one-piece toric IOL fixation to avoid IOL explantation.
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Koytak A, Sari ES, Altinisik M. Scleral fixation underneath an intact conjunctiva. J Refract Surg 2013; 29:220-3. [PMID: 23446020 DOI: 10.3928/1081597x-20130129-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/03/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a technique for the fixation of intraocular lenses or capsular tension rings through the ciliary sulcus or pars plana. METHODS This alternative technique allows burial of the knot and the free suture ends within the sclera, without using a scleral flap or pocket or even a conjunctival opening. RESULTS No suture exposure has occurred with the use of the suture burial technique in approximately 25 eyes in 4 years. Additional benefits include less patient discomfort and an improved anatomic and cosmetic outcome starting from the first postoperative day. CONCLUSIONS This technique causes minimal tissue damage and scarring with almost no postoperative discomfort.
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Affiliation(s)
- Arif Koytak
- Bexmialem Vakif University, Istanbul, Turkey.
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One-Haptic Fixation of Posterior Chamber Intraocular Lenses without Scleral Flaps. J Ophthalmol 2012; 2012:891839. [PMID: 22919463 PMCID: PMC3420135 DOI: 10.1155/2012/891839] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess visual results and complications of a modified technique of posterior chamber intraocular lenses (PC IOLs) in aphakic eyes without scleral flaps. Methods. Modified one-haptic scleral fixation was performed in one eye each of 25 patients with aphakia and insufficient capsule support. Follow-up period was six months. Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), and postoperative complications. Results. The study included 15 males and 10 females. The preoperative best-corrected visual acuity (BCVA) ranged from 5/60 to 6/9. The operation time ranged from 25 to 45 minutes (mean 35.25 ± 5.34 min). Anterior vitrectomy was performed in 12 cases (48%). There was no major IOL decentration. The final BCVA ranged from 6/36 to 6/9. Seven cases (28%) showed postoperative glaucoma, five cases (20%) had temporary hypotony, and hyphema in 2 eyes (8%). No cases of suture erosion, postoperative endophthalmitis, retinal detachment, or IOL dislocation were detected. Conclusion. This technique of one-haptic scleral fixation of posterior chamber IOLs is a good choice in presence of insufficient capsule support. It reduces the operation time, achieves the IOL stability, and minimizes postoperative suture-related complications.
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Anterior chamber intraocular lens, sutured posterior chamber intraocular lens, or glued intraocular lens: where do we stand? Curr Opin Ophthalmol 2012; 23:62-7. [PMID: 22081029 DOI: 10.1097/icu.0b013e32834cd5e5] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the recent literature addressing the surgical approaches to intraocular lens (IOL) fixation in the setting of inadequate capsular support. RECENT FINDINGS Lack of capsular support is a commonly encountered problem facing the anterior segment surgeon. Recent reports suggest that visual outcomes are generally good with modern IOLs and surgical approaches. More recently described techniques include sutureless scleral fixation and intraocular endoscopy-guided suture placement. SUMMARY Many clinical circumstances require extracapsular IOL fixation and multiple options exist in the setting of inadequate capsular support. Ultimately, there are many factors that must be considered in selecting an appropriate surgical approach. These include ocular history as well as the skill, experience, and comfort level of the individual surgeon. The myriad of options that now exist for IOL fixation increases the likelihood that patients with a wide variety of pathologic states will attain their best possible visual outcome.
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Ma DJ, Kim MK, Wee WR. Knotless External Fixation Technique for Posterior Chamber Intraocular Lens Transscleral Fixation: A 5-Case Analysis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.11.1609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dae Joong Ma
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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35
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Falavarjani KG. August consultation #9. J Cataract Refract Surg 2010. [DOI: 10.1016/j.jcrs.2010.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chang DF, Masket S, Miller KM, Braga-Mele R, Little BC, Mamalis N, Oetting TA, Packer M. Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg 2009; 35:1445-58. [PMID: 19631134 DOI: 10.1016/j.jcrs.2009.04.027] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 04/16/2009] [Accepted: 04/22/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe complications arising from sulcus placement of single-piece acrylic (SPA) intraocular lenses (IOLs), evaluate IOL options for eyes that lack adequate capsule support, and examine the appropriateness of various IOL designs for sulcus placement. SETTING University and private anterior segment surgery practices. METHODS Patients referred for complications of SPA IOLs in the ciliary sulcus from 2006 and 2008 were identified. Demographic information, examination findings, and complications of the initial surgery were recorded. Details of surgical interventions and the most recent corrected distance visual acuity (CDVA) were noted. A thorough review of the literature was undertaken to analyze options for IOL placement. RESULTS Complications of sulcus SPA IOLs included pigment dispersion, iris transillumination defects, dysphotopsia, elevated intraocular pressure, intraocular hemorrhage, and cystoid macular edema. Two patients in the series of 30 patients experienced 1 complication; 8 experienced 2 complications; 13 experienced 3 complications; 4 experienced 4 complications; and 2 experienced 5 complications. Twenty-eight eyes (93%) required surgical intervention; IOL exchange was performed in 25 (83%). Postoperatively, the mean CDVA improved, with most eyes attaining 20/20. CONCLUSIONS Intraocular lenses designed solely for the capsular bag should not be placed in the ciliary sulcus. Backup IOLs in appropriate powers, sizes, and designs should be available for every cataract procedure. The development, investigation, and supply of IOLs specifically designed for placement in eyes that lack adequate capsule support represent clinically important endeavors for ophthalmology and the ophthalmic industry.
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Affiliation(s)
- David F Chang
- Altos Eye Physicians, Los Altos, California 94024, USA.
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Monteiro M, Marinho A, Salgado-Borges J, Ribeiro L, Castro-Correia J. Evaluation of a new scleral fixation foldable IOL in the absence of capsule support. J Fr Ophtalmol 2007; 30:791-7. [DOI: 10.1016/s0181-5512(07)92612-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Han Q, Chu Y. Combined suture-in-needle and scleral tunnel technique for scleral fixation of intraocular lens. J Cataract Refract Surg 2007; 33:1362-5. [PMID: 17662424 DOI: 10.1016/j.jcrs.2007.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
We describe an intraocular lens (IOL) fixation technique that combines suture-in-needle and scleral tunnel techniques. A 10-0 polypropylene suture is inserted into the barrel of a 27-gauge sharp needle to tie the IOL haptic, and scleral tunnels are created to bury the knots for transscleral IOL fixation. The modification of the traditional scleral fixation technique simplifies the creation of a scleral covering and decreases harmful manipulations of the needle passing through the vitreous cavity.
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Affiliation(s)
- Quanhong Han
- Department of Vitreous and Retina, Tianjin Eye Hospital, Tianjin, China.
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Monteiro M, Marinho A, Borges S, Ribeiro L, Correia C. Scleral fixation in eyes with loss of capsule or zonule support. J Cataract Refract Surg 2007; 33:573-6. [PMID: 17397726 DOI: 10.1016/j.jcrs.2006.10.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 10/24/2006] [Indexed: 11/20/2022]
Abstract
We describe a new scleral fixation technique for posterior chamber intraocular lens (IOL) implantation in eyes with partial or total loss of the posterior capsule or zonule support. This technique uses a scleral incision that can be completed in less time than a conventional scleral flap and prevents unnecessary trauma to the eye. A double-thread, 10-0 polypropylene suture loop is introduced once through a scleral layer pathway inside the eye. The free ends of the polypropylene suture are buried between the 2 edges of the scleral incision. This technique was used in 15 eyes, with a follow-up of 6 to 30 months. Complications included iris capture, irregular pupil, hyphema, vitreous hemorrhage, choroidal hemorrhage, localized peripheral anterior synechias, and retinal detachment. The mean postoperative visual acuity was 20/40 at the last follow-up. This modified technique is an easy and effective way to achieve scleral fixation of the IOL.
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Monteiro M, Marinho A, Salgado-Borges J, Ribeiro L, Castro Correia J. Topical plus subconjunctival anaesthesia: foldable intraocular lens implantation in eyes without capsule support through a self-sealing incision. ACTA ACUST UNITED AC 2007; 85:857-61. [PMID: 17542977 DOI: 10.1111/j.1600-0420.2007.00948.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of topical plus subconjunctival anaesthesia for secondary implantation of foldable intraocular lens (IOL) (Ophtec PC 425Y) in eyes without capsule support through a self-sealing incision. METHODS We reviewed the medical records of 22 patients (22 eyes) who received topical plus subconjunctival anaesthesia for scleral fixation of a foldable IOL through small incision. The scleral incision technique was used for IOL scleral fixation. Twelve eyes had traumatic cataract, seven had postphacoemulsification complications and three were aphakic. We studied visual outcome, intraoperative complications and perioperative pain. Autorefractometry and keratometry measurements and central endothelial cell counts were evaluated 1 day preoperatively and 4 months postoperatively. The level of intraoperative pain was scored on a scale of 1-10, where 1 = no pain and 10 = severe pain. RESULTS Nineteen patients (86%) tolerated the procedure well, giving pain scores of 1-3, and none required supplemental anaesthesia. The mean age of the patients was 60 years. The postoperative best-corrected visual acuity (BCVA) ranged between 20/100 and 20/25. Four months postoperatively, the mean myopic shift by autorefractometry was -1.25 dioptre (D) and the mean postoperative astigmatism was 1.75 D. The mean central corneal endothelial loss at 4 months was 12.24% (range 4.5-17.2%). Five microscopic hyphaema occurred intraoperatively. Four cystoid macular oedema and four peripheral anterior synechia were the only complications, each occurring at the final follow-up. CONCLUSION Topical plus subconjunctival anaesthesia and scleral fixation of foldable IOL (Ophtec PC 425Y) was safe, quick, required a small incision, led to favourable visual outcomes and minimized the risk of intraoperative and postoperative complications in eyes without capsule support. However, a long-term study of a large population is required to confirm these findings.
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Affiliation(s)
- Manuel Monteiro
- Department of Ophthalmology, San João University Hospital, Porto, Portugal.
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Monteiro M, Marinho A, Borges S, Ribeiro L, Correia C. Evaluation of a new IOL scleral fixation technique without capsular support. J Fr Ophtalmol 2007; 29:1110-7. [PMID: 17211319 DOI: 10.1016/s0181-5512(06)73906-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to compare a new intraocular lens (IOL) scleral fixation technique (scleral incision) with the scleral flap surgical technique as regards to efficacy, surgical complications, advantages, disadvantages, and surgery costs in cases with no capsular support. MATERIAL AND METHODS This was a retrospective study conducted on thirty patients (30 eyes), ten of whom were aphakic, eleven had traumatic cataract, seven had post-phacoemulsification complications, and two had lens luxation. The patients were divided into two groups (I - scleral incision technique and II - scleral flap technique) of fifteen patients each, during a study period lasting eighteen months. The great majority of the procedures were performed under general anesthesia and by the same surgeon. Statistical analysis was done using SPSS. The numerical variables were compared using the t test and the categorical ones using the Fisher exact test. We performed multifactorial analysis to build a model that could predict and compare the complications associated with each technique. An explicative model was built using logistic regression. RESULTS We observed a threefold higher rate of complications associated with the scleral flap technique when compared to the scleral incision technique. This difference was particularly relevant as regards the occurrence of free scleral flap and hyphema. No statistically significant differences were observed regarding vitreous hemorrhage, choroidal hemorrhage, retinal detachment, difficulty in the external pulling of the Prolene suture, breaking of the Prolene suture, and anterior chamber collapse. We found a significant association between intraoperative complications and the technique used (higher number of complications with the scleral flap) and also with some systemic diseases (patients with hypertension had more intraoperative complications). The number of late complications resulting from the scleral flap technique was much higher than those observed with the scleral incision technique; however, the number of the cases we studied is insufficient to reach statistical significance. CONCLUSION The duration of the procedure using the IOL scleral incision technique is significantly lower than using the scleral flap technique. Intraoperative complications were significantly associated with the technique used: more frequent with scleral flap. Late complications were mainly associated with systemic and previous ocular diseases.
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Affiliation(s)
- M Monteiro
- Department of Ophthalmology, Hospital University of S. João, Porto, Portugal
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Packer M, Fine HI, Hoffman RS, Smith JH. February Consultation # 2. J Cataract Refract Surg 2007. [DOI: 10.1016/j.jcrs.2006.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baykara M. Scleral fixation. J Cataract Refract Surg 2006; 33:3; author reply 3-4. [PMID: 17189774 DOI: 10.1016/j.jcrs.2006.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 08/29/2006] [Indexed: 10/23/2022]
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Hoffman RS, Fine IH, Packer M. Scleral fixation without conjunctival dissection. J Cataract Refract Surg 2006; 32:1907-12. [PMID: 17081894 DOI: 10.1016/j.jcrs.2006.05.029] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 05/20/2006] [Indexed: 11/27/2022]
Abstract
Scleral fixation of intraocular lenses (IOLs) and adjunctive capsular devices can be performed under the protection of a scleral flap. A modification of this technique uses a scleral pocket initiated through a peripheral clear corneal incision. Full-thickness passage of a double-armed suture through the scleral pocket and conjunctiva, with subsequent retrieval of the suture ends through the external incision for tying, facilitates scleral fixation. This modification offers several advantages over traditional methods: It eliminates the need for conjunctival dissection and scleral cauterization; a scleral pocket affords a greater surface area for suture placement through an ab externo or ab interno approach; retrieval of the sutures through the external corneal incision and subsequent tying allows the suture knot to pass under the protective roof of the scleral pocket, negating the need for suture knot rotation; and the architecture of the scleral pocket eliminates the need for sutured wound closure. Suture retrieval and scleral fixation through a corneoscleral pocket offers a refined method for fixation of IOLs and other intraocular adjunctive devices.
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