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Bourkiza R, Vakros G, Tarafdar S, Yang E, Charteris DG. Scleral sutured aniridia intraocular lens (Morcher ®): indications and long-term outcomes. Eye (Lond) 2024; 38:1642-1646. [PMID: 38388833 PMCID: PMC11156894 DOI: 10.1038/s41433-024-02982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND/OBJECTIVE To evaluate the outcomes of trans-scleral sutured posterior chamber black diaphragm intraocular lens (BDIOL) (Morcher®) implantations over 11 years. SUBJECTS/METHODS Retrospective case-series of patients, who underwent BDIOL implantation, identified from electronic patient records system from 2006 to 2016, Moorfields Eye Hospital. Demographics, pre/post-operative, final best-corrected visual acuity (BCVA), diagnosis, symptomatic improvement, intraoperative and postoperative complications immediate or late were collected and analysed to relate outcomes to surgical indication. RESULTS Forty eyes of 38 patients (F:M 1:2.8) underwent BDIOL implantation with a mean surgical age of 46.6 years and follow-up of 44.5 months (range of 8-132 months). Indications included 23(57%) ocular trauma, 7(17%) congenital aniridia, 7(17%) iatrogenic lens and/or iris loss, and 3(7%) infectious keratitis. Mean preoperative BCVA was 1.64 logMAR and mean final postoperative BCVA was 0.94 logMAR with an average improvement in BCVA of 0.23 logMAR, equivalent to 1.5 lines of Snellen visual acuity. Visual results varied according to indications. Infectious cause patients had the greatest vision improvement (-0.7 logMAR), followed by trauma (-0.3 logMAR), and 25% of these achieved vision of 0.3 logMAR (6/12 in Snellen acuity) or better. Conversely, the aniridia group had the least improvement (worsened vision of 0.01 logMAR), 17 patients (42%) reported subjective improvement. CONCLUSION BDIOLs achieve reasonably good visual outcomes in eyes with complex vision threatening pathology. No significant intra-operative complications are documented and most post-operative complications are related to the pre-existing pathology. Post - trauma and iatrogenic aniridia have better outcomes compared to congenital aniridia.
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Affiliation(s)
- Rabia Bourkiza
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
| | - Georgios Vakros
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
| | - Sonali Tarafdar
- Department of Ophthalmology, Ninewells hospital, James Arrott drive, Dundee, DD2 1SG, UK
| | - Elizabeth Yang
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
| | - David G Charteris
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, EC1V 2PD, UK
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Chantarasorn Y, Pokawattana I, Silpa-Archa S, Ratprasatporn N, Saovaprut C. RELAY INTRASCLERAL 6-0 POLYPROPYLENE-ASSISTED INTRAOCULAR LENS FIXATION: A Retrospective Comparison With Modified Yamane Technique. Retina 2024; 44:455-464. [PMID: 37903460 DOI: 10.1097/iae.0000000000003971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/21/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To describe a new surgical technique that uses a relay suture to optimize sutureless scleral fixation of intraocular lens in eyes with capsular insufficiency and to evaluate the outcomes of this technique versus Flanged, double needle-guided, scleral fixation of intraocular lens with haptic trimming (modified Yamane approach). METHODS Relay intrascleral 6-0 polypropylene sutures with flanges generated at the intraocular ends were used to fixate and securely hold a rigid intraocular lens with haptic eyelets against the inner scleral wall. The results were analyzed at 3-, 6-, and 12-month follow-up. RESULTS This retrospective cohort study found that compared with the control group (n = 27), the relay-sutured group (n = 26) had greater mean changes in corneal astigmatism (0.44 vs. -0.52 diopters [D]) and fewer mean degrees of intraocular lens astigmatism (0.62 vs. 1.1 D). The mean intraocular lens decentration was comparable between both the groups; however, in the control group, there was a significant increase in intraocular lens tilt degrees from 3 to 12 months. Moreover, significantly higher proportions of patients with persistent macular edema and iris-optic capture were seen in the control group. CONCLUSION The relay-sutured technique may be an alternative to flapless scleral fixation of intraocular lens and provides a stable intraocular lens position with acceptable complication rates.
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Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Itsara Pokawattana
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sukhum Silpa-Archa
- Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok, Thailand; and
| | - Nitee Ratprasatporn
- Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok, Thailand; and
| | - Chairat Saovaprut
- Department of Medical Services, Rajavithi Hospital, Minister of Public Health, Bangkok, Thailand
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Parkash RO, Gurnani B, Kaur K, Parkash TO, Vajpayee RB. Novel trocar assisted intraocular lens and capsular bag complex fixation. Eur J Ophthalmol 2024; 34:583-588. [PMID: 37882171 DOI: 10.1177/11206721231208662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE To describe the innovative technique of trocar-assisted intraocular lens (IOL) and capsular bag complex fixation. METHODS In this technique, initial pupil dilatation is achieved either with intracameral adrenaline or with the help of iris hooks. Automated anterior vitrectomy is performed in cases with vitreous prolapse. A 25 G trocar cannula is placed at the limbus through a paracentesis opposite the zonular dialysis area. The cannula lumen act as a guide to pass the double-arm polypropylene suture attached to the needle. This prevents any inadvertent corneal injury and acts as a perpendicular tract to pass the needle through IOL capsular bag complex. RESULTS We performed this technique in 9 cases with an excellent outcome with a minimum of 3 months of follow-up. All patients had well-centred IOL. There was no incidence of corneal injury, Descemet membrane detachment, iris trauma, IOL tilt, decentration, dislocation, vitreous prolapse or retinal detachment. All patients achieved excellent visual acuity ranging from 6/12-6/6 postoperatively. CONCLUSION The novel trocar-assisted IOL bag complex fixation technique is very effective and allows smooth IOL fixation in technically challenging cases with IOL subluxation. The trocar acts as a guide to prevent injury to the surrounding tissue, and IOL fixation is achieved with minimal manipulations in the anterior chamber. It also prevents the need for IOL explantation in these cases.
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Affiliation(s)
| | - Bharat Gurnani
- Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
- Sadguru Netra Chikitsalya, Chitrakoot, Madhya Pradesh, India
- ASG Eye Hospitals, Jodhpur, Rajasthan, India
| | - Kirandeep Kaur
- Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
- Sadguru Netra Chikitsalya, Chitrakoot, Madhya Pradesh, India
- ASG Eye Hospitals, Jodhpur, Rajasthan, India
| | | | - Rasik B Vajpayee
- Vision Eye Institute, Melbourne, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- University of Melbourne, Australia
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Cheng CY, Chou YB, Tsai CY, Hsieh MH, Hsiao CC, Lai TT. Management of complications of sutureless intrascleral intraocular lens fixation. Taiwan J Ophthalmol 2024; 14:95-101. [PMID: 38654989 PMCID: PMC11034692 DOI: 10.4103/tjo.tjo-d-23-00163] [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: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The purpose of the study was to report the complications of sutureless intrascleral (SIS) intraocular lens (IOL) fixation and its management. MATERIALS AND METHODS A multicenter, retrospective, consecutive interventional case series of patients with intra or postoperative complications after SIS IOL fixation during the technical learning curve of vitreoretinal surgeons from three Taiwanese referral hospitals. The used surgical techniques were the Scharioth technique for intrascleral tunnel fixation, Yamane technique (double-needle scleral fixation), and modified Yamane technique (double-needle flanged haptic scleral fixation). The IOL models and surgical instruments used as well as each patient's ocular characteristics and complication management were recorded. RESULTS Of the eight included patients, the complications of 3 (37.5%) and 5 (62.5%) were noted intraoperatively and postoperatively, respectively. Haptic-related complications, including haptic breakage, slippage, and haptic disinsertion, occurred in six eyes. Other complications included uveitis-glaucoma-hyphema syndrome, retinal detachment, and IOL tilt. For the two patients with haptic slippage, repositioning was achieved using a modified cow-hitch technique that resulted in favorable IOL centration and restored visual acuity. CONCLUSION Most complications surgeons encountered during their early exposure to SIS IOL fixation were haptic related. Surgeons should be aware of such complications to prevent and manage them during surgery. Our modified cow-hitch technique could be used to reposition IOLs with unilateral haptic slippage.
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Affiliation(s)
- Chia-Yi Cheng
- Department of Ophthalmology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Ying Tsai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen University, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ming-Hung Hsieh
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Chia-Chieh Hsiao
- Department of Ophthalmology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Orazbekov LN, Shabanova AA. [Transscleral fixation of intraocular lens in the treatment of lens subluxation in children]. Vestn Oftalmol 2024; 140:27-33. [PMID: 38962976 DOI: 10.17116/oftalma202414003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Congenital subluxation of the lens as a complication of Marfan syndrome, Weill-Marchesani syndrome, microspherophakia, etc. leads to the development of amblyopia and requires timely surgical treatment with removal of the subluxated lens and implantation of an artificial intraocular lens (IOL). IOL implantation in children with pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery due to the lack of a consensus regarding the IOL fixation method among practitioners. PURPOSE This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation. MATERIAL AND METHODS The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated. RESULTS All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors. CONCLUSIONS The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.
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Affiliation(s)
- L N Orazbekov
- Kazakh Research Institute of Eye Diseases, Almaty, Kazakhstan
| | - A A Shabanova
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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Gouvea L, Din N, AlShaker S, Gendler S, Weill Y, Chan CC, Rootman DS. Clinical Outcomes of Transscleral-Sutured Intraocular Lens Combined With Descemet Membrane Endothelial Keratoplasty. Cornea 2023; 42:1497-1502. [PMID: 36729033 DOI: 10.1097/ico.0000000000003215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/05/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of the study was to report clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) combined with transscleral-sutured intraocular lens (IOL) compared with DMEK combined with phacoemulsification and posterior chamber IOL (Phaco-DMEK). METHODS A retrospective chart review of all patients who underwent DMEK combined with transscleral-sutured intraocular lens fixation or combined with phacoemulsification for Fuchs endothelial corneal dystrophy from 2016 to 2021 at the Toronto Western Hospital or the Kensington Eye Institute (Toronto, ON, Canada) and had at least 18 months of follow-up was performed. Main outcomes were postoperative distance-corrected visual acuity, rebubbling rate, graft survival rate, and complications. RESULTS Twenty-one cases of DMEK combined with transscleral-sutured IOL (DMEK-TSS-IOL) and 44 cases of Phaco-DMEK were evaluated. Twelve eyes (57.15%) had a foldable acrylic 3-piece IOL (AR40E) and 9 (42.85%) had a single-piece polymethylmethacrylate (PMMA) IOL (CZ70BD). LogMAR distance-corrected visual acuity improved significantly from 1.48 ± 0.62 (SD) to 0.86 ± 0.82 ( P = 0.01) 12 months after DMEK-TSS-IOL and from 0.41 ± 0.29 logMAR to 0.11 ± 0.11 logMAR ( P < 0.0001) after Phaco-DMEK. No statistically significant differences were observed in donor ( P = 0.97) or 1-year postoperative endothelial cell density ( P = 0.11) between the groups. Rebubbling was necessary in 33.33% of eyes in DMEK-TSS-IOL compared with 25% of Phaco-DMEK eyes ( P = 0.55). Graft survival rate was 76.19% in the DMEK-TSS-IOL group compared with 90.90% in the Phaco-DMEK group ( P = 0.13). CONCLUSIONS Transscleral-sutured IOL combined with DMEK is an option for the management of endothelial diseases in aphakic eyes or those which require IOL exchange for the experienced surgeon. However, when compared with routine Phaco-DMEK, there are higher complication and lower survival rates at 18 months.
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Affiliation(s)
- Larissa Gouvea
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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7
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Khoramnia R, Baur ID, Auffarth GU. Aetiology and Management of IOL Dislocations. Klin Monbl Augenheilkd 2023; 240:971-980. [PMID: 37494272 DOI: 10.1055/a-2074-9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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Narayanan N, Ravi P, Toshwani N. A long-term clinical outcome of Hoffmann pocket four-point scleral fixated intraocular lens implantation combined with penetrating keratoplasty - A single corneal surgeon's report. Indian J Ophthalmol 2023; 71:2722-2726. [PMID: 37417111 PMCID: PMC10491041 DOI: 10.4103/ijo.ijo_58_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/14/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods Forty-two eyes of 42 patients, aged between 11 and 84 years, had a mean follow-up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre-op, 1.802 at the final follow-up, and 0.52 after excluding preexisting retinal pathologies. At the last follow-up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than -5.00 D and seven needed more than -3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four-point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow-ups will help understand the technique better.
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Affiliation(s)
- Niveditha Narayanan
- Senior Consultant, Cornea and Refractive Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pranessh Ravi
- Medical Research Foundation, Sankara Nethralaya, Nungambakkam, Chennai, Tamil Nadu, India
| | - Nikhil Toshwani
- Senior Consultant, Cornea and Refractive Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Jin H, Zhang Q. Flapless Intrascleral Knotting Technique for Suture Fixation of Intraocular Implants. Retina 2023; 43:1031-1034. [PMID: 32568983 DOI: 10.1097/iae.0000000000002895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We will describe a flapless/grooveless/pocketless and minimally invasive technique for scleral suture fixation of intraocular implants. METHODS After introducing the suture into the eye, the two ends of the suture were left exterior to the globe, the free end and the end connected to a curved needle (the needle side). A back-and-forth intrascleral suture passage was performed with the aid of a curved needle. The suture was thus supported by adequate scleral tissue. The suture was fixated to the sclera by knotting it into the sclerotomy. The ends of the suture were finally anchored intrasclerally with the aid of a 30-gauge needle. RESULTS The technique was used in 15 eyes of 15 patients. The mean postoperative follow-up period was 9.1 ± 4.6 months. Postoperatively, the intraoperative lenses of all the eyes remained well-positioned and stable. The postoperative visual acuities for all of the eyes were also improved. No suture erosion, suture loosening, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. CONCLUSION The present technique provides minimal surgical invasion for the scleral suture fixation of intraocular implants.
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Affiliation(s)
- Haiying Jin
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated to Shanghai Tongji University, School of Medicine, Shanghai, China; and
| | - Qi Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Pardini D, Lucatto LF, Junior OM, Maia A, Hammamji K, Dirani A, Rezende FA, Maia BT, Rodrigues EB, Roizenblatt M, Maia M. Outcomes of Pars Plana Vitrectomy and 4-Point Sutured Scleral Fixation of Akreos AO60 Intraocular Lens in Clinical Settings: A Case Series. Ophthalmol Retina 2023; 7:59-66. [PMID: 35850442 DOI: 10.1016/j.oret.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/26/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine the long-term anatomic outcomes and surgical complications of pars plana vitrectomy (PPV) and 4-point Gore-Tex-sutured Akreos AO60 intraocular lens (IOL) scleral fixation. DESIGN Retrospective, multicenter, multisurgeon case series. PARTICIPANTS Ninety-seven patients in tertiary eye care centers. METHODS The patients underwent PPV and intraocular fixation of the Akreos AO60 IOL using Gore-Tex CV-8 sutures between January 2015 and April 2020. The inclusion criteria were aphakia, no capsular support, and a minimal 1 year of follow-up. MAIN OUTCOME MEASURES Uncorrected visual acuity (VA), complication rates or types, and refraction. RESULTS Data from 101 eyes of the 97 patients were analyzed (mean follow-up duration, 33.4 months; range, 12-62 months). The mean ± standard deviation uncorrected logarithm of the minimum angle of resolution VA improved from 1.04 ± 0.73 (20/200 Snellen equivalent) before surgery to 0.66 ± 0.65 (20/80) at 6 months after surgery (P < 0.001). The most prevalent complications included hypotony (12.9%), ocular hypertension (12.9%), corneal edema (8.9%), cystoid macular edema (6.9%), and vitreous hemorrhage (5.9%). Refraction was measured between 3 and 6 months after surgery, and 61.8% of the patients had spherical equivalent of ± 2.0 diopters. Most complications occurred in the first postoperative month and resolved spontaneously or with medical treatment. CONCLUSIONS The results demonstrated that this surgical technique is well tolerated by the eyes, with a low complication rate in the long term. The rates of IOL opacification were infrequent for up to 62 months of follow-up.
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Affiliation(s)
- Denise Pardini
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, Brazil.
| | - Luiz Filipe Lucatto
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; COLP Eye Hospital, Salvador, Brazil
| | - Octaviano Magalhães Junior
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; OFT Ophthalmic Clinic, São Paulo, Brazil
| | - André Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Retina Clinic, São Paulo, Brazil
| | - Karim Hammamji
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Ali Dirani
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Flavio A Rezende
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Bruna Trench Maia
- Brazilian Institute of Fight Against Blindness (INBRACE), Assis and Presidente Prudente, São Paulo, Brazil
| | | | - Marina Roizenblatt
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Maurício Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Brazilian Institute of Fight Against Blindness (INBRACE), Assis and Presidente Prudente, São Paulo, Brazil
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11
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Cheng KKW, Tint NL, Sharp J, Alexander P. Surgical management of aphakia. J Cataract Refract Surg 2022; 48:1453-1461. [PMID: 36449676 DOI: 10.1097/j.jcrs.0000000000000954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022]
Abstract
Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.
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Affiliation(s)
- Kelvin K W Cheng
- From the Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom (Cheng, Tint); Cambridge University Hospitals, Cambridge, United Kingdom (Sharp, Alexander)
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12
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Toropygin SG. Intrascleral anchoring knot on the double suture without peritomy for fixation of intraocular lens. J Cataract Refract Surg 2022; 48:1211-1215. [PMID: 35786810 DOI: 10.1097/j.jcrs.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
Abstract
A new minimally invasive technique for universal fixation of any posterior chamber intraocular lens (IOL), iris prosthesis or capsular tension device (CTD), both for rescuing in case of dislocation and for secondary implantation, is described. It uses intrascleral anchoring knot on the reinforced double 9-0 polypropylene suture without conjunctival opening or scleral dissection. The technique was applied for scleral fixation of the S-shaped monoblock acrylic IOL dislocated into the vitreous cavity in 1 eye, and decentered IOL-CTD-capsular bag complexes in 3 eyes. In none of the cases, complications including knot slippage, suture exposure or hypotony were observed. All patients were followed up for 6 months. The uncorrected distance visual acuity was significantly improved and the IOLs positions remained stable. The described technique might be a simple, effective and safe alternative to flanged scleral fixation approaches.
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Affiliation(s)
- Sergey G Toropygin
- From the Department of Ophthalmology, Tver State Medical University, Tver, Russia
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Ye H, Zhang S, Mi W, Fei P, Zhao P. One-Year Outcomes of Modified Technique for Scleral Fixation of a Three-Piece Intraocular Lens Without Conjunctival Opening. Front Med (Lausanne) 2022; 9:856800. [PMID: 35721099 PMCID: PMC9200955 DOI: 10.3389/fmed.2022.856800] [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: 01/17/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to present the 1-year follow-up of a modified technique for scleral fixation of three-piece intraocular lens (IOLs) without conjunctival incision. Materials and Methods A retrospective chart review of a consecutive series of 10 eyes of nine patients who underwent scleral IOL fixation using the modified technique was performed. Data were collected 1 year after surgery for all patients. Results The range of follow-up time was between 1 year and 31 months. At the last follow-up point, the IOL was well-positioned and the visual acuity was good (as limited by primary diseases). Short-term complications included pupillary IOL capture (n = 1) and decreased intraocular pressure (n = 1), and no long-term complications were observed. Conclusion Outcome data support this technique as a viable option for the management of secondary IOL fixation with flexible usage of more designs of IOLs.
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Affiliation(s)
- Hongfei Ye
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiguang Zhang
- Department of Ophthalmology, Zhenjiang Ruikang Hospital, Zhenjiang, China
| | - Wei Mi
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fei
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Novel surgical technique of sutureless artificial iris and intraocular lens scleral fixation using Yamane technique. Am J Ophthalmol Case Rep 2022; 26:101502. [PMID: 35387386 PMCID: PMC8978273 DOI: 10.1016/j.ajoc.2022.101502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To describe a novel surgical technique of a combined implantation of an artificial iris and a scleral fixated intraocular lens (IOL) using flanged IOL haptics (“Yamane” technique). Observations The suturelessly implanted artificial iris-IOL-sandwich was stable with good functional as well as aesthetic results. However, our case showed a postoperative intraocular pressure rise. Conclusions The presented case demonstrates that a visual as well as cosmetical rehabilitation seems to be possible even after severe, penetrating ocular trauma with profound iris defects. Importance The sutureless IOL scleral fixation technique can also be used in combination with a sutureless artificial iris implantation. Further studies are needed to evaluate the long-term safety profile and rates of postoperative complications.
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15
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Single-string, Closed-loop Fixation Technique as a Modified Approach to Repositing a Dislocated Triple-looped Haptic Intraocular Lens: Local Experience. J Cataract Refract Surg 2022; 48:859-862. [PMID: 35546428 DOI: 10.1097/j.jcrs.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT A technique using the single-string, closed-loop fixation method to reposit dislocated triple-looped haptic IOL-capsular bag complexes is described. The long needle or curved needle with 10-0 / 8-0 polypropylene suture and 27 / 30g needle were used as the guide needle to pass through the fenestrated haptics for two times. The scleral interlaminar course was used as the fixed point. last, A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached needle.Four eyes from 4 consecutive patients were studied retrospectively; During all follow-up visits, the IOLs were well centered and stable, No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed.
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16
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Potemkin V. Limbal mini-pockets for transscleral IOL fixation. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100044. [PMID: 37846224 PMCID: PMC10577843 DOI: 10.1016/j.aopr.2022.100044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2023]
Affiliation(s)
- Vitaly Potemkin
- Department of Ophthalmology, First Pavlov State Medical University of St. Petersburg, 197089, St. Petersburg, Lev Tolstoy Str., 6-8, Building 16, Russia
- City Ophthalmologic Center of City Hospital, № 2, St. Petersburg, Uchebniy Pereulok, 5, 194354, Russia
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17
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Lin Z, Song Z, Zhao Z, Ke Z. Reversed scleral tunnel technique for repair of iridodialysis after blunt force trauma: a retrospective clinical study. BMC Ophthalmol 2022; 22:171. [PMID: 35428283 PMCID: PMC9011996 DOI: 10.1186/s12886-022-02394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To investigate the efficacy and safety of reversed scleral tunnel technique for repairing iridodialysis after blunt force trauma.
Methods
A total of 51 eyes of 51 patients with iridodialysis undergoing surgery were included in this study. Patients were divided into 2 groups: group A (the reversed scleral tunnel technique) and group B (the control group). Before the procedure and at 1, 3, and 6 months afterward, data on the patients’ age, gender, treatments, diagnosis, mechanism of injury, best-corrected visual acuity (BCVA), intraocular pressure (IOP), degree of iridodialysis, lens status, concomitant ocular damage, number of sutures, complications, and follow-up time were collected and compared between the 2 groups.
Results
Iridodialysis was repaired and the pupil shape was restored to nearly round in all eyes. Standard phacoemulsification or lens removal was performed in all eyes. A final BCVA ≥20/60 was achieved in 13 eyes (48.1%) in Group A and 13 eyes (54.2%) in Group B. The IOP remained stable during the follow-up period in all eyes except 2 eyes (7.4%) in Group A and 3 eyes (12.5%) in Group B with angle recession. There were no statistically significant differences in BCVA and IOP between group A and group B. Intraoperatively, A significantly lower percentage of extensive subconjunctival hemorrhage occurred in Group A compared to Group B (1 eye versus 24 eyes, χ2 = 47.1, P = 0.00). Hyphema was observed in 2 eyes (7.4%) in Group A and 1 eye (4.2%) in Group B. Postoperatively, two eyes (7.4%) in Group A and 2 eyes (8.3%) in Group B developed retinal detachment. No other complications were noted during the follow-up period.
Conclusions
The reversed scleral tunnel technique is a safe and effective approach for repairing iridodialysis after blunt force trauma with few complications, favorable cosmetic and visual outcomes.
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18
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Intracorneal Knot or Flange Depot Fixation: a New Transscleral Technique for Intraocular Implant Fixation. J Cataract Refract Surg 2022; 48:745-749. [DOI: 10.1097/j.jcrs.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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19
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Yilmaz S, Mavi Yildiz A, Avci R. A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation. Indian J Ophthalmol 2021; 70:131-137. [PMID: 34937224 PMCID: PMC8917568 DOI: 10.4103/ijo.ijo_551_21] [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] [Indexed: 11/30/2022] Open
Abstract
Purpose: To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques. Methods: In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared. Results: The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2). Conclusion: Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.
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Affiliation(s)
- Sami Yilmaz
- Department of Ophthalmology, Bursa Retina Eye Hospital, Bursa, Turkey
| | | | - Remzi Avci
- Department of Ophthalmology, Bursa Retina Eye Hospital, Bursa, Turkey
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20
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Gabai A, Zeppieri M, Toneatto G, Salati C. Enhanced surgical technique for sutureless intrascleral fixation of intraocular lenses. J Cataract Refract Surg 2021; 47:e75-e79. [PMID: 34016822 DOI: 10.1097/j.jcrs.0000000000000700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023]
Abstract
A simplified intrascleral fixation technique involving implantation of the Carlevale intraocular lens (IOL) in the posterior chamber is described, which lodges the T-shaped IOL haptics in the scleral wall, not requiring scleral flaps. This surgical modification reduces operative time, limits iatrogenic damage to the sclera, and avoids friction between haptics and the conjunctiva, which may cause conjunctival erosion and infection in the long term. 13 patients with crystalline lens or IOL dislocation/subluxation had surgery to implant the Carlevale IOL in the posterior chamber. Mean corrected distance visual acuity preoperatively was 0.75 ± 0.5 logMAR (range, 0.2 to 1.5 logMAR) and improved to 0.28 ± 0.3 logMAR (range, 0 to 1.0 logMAR) postoperatively. Complications rarely occurred and were not sight-threatening. The sutureless scleral fixation of the Carlevale IOL using the modified surgical technique may represent a safe and effective procedure to restore visual function in patients with damaged zonular-capsular support.
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Affiliation(s)
- Andrea Gabai
- From the Department of Ophthalmology, University Hospital of Udine, Udine, Italy
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21
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Shahid SM, Flores-Sánchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, Charteris DG. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond) 2021; 35:2930-2961. [PMID: 34117388 PMCID: PMC8526814 DOI: 10.1038/s41433-021-01571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/08/2022] Open
Abstract
Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.
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Affiliation(s)
- S M Shahid
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK.
| | | | - E W Chan
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - R Anguita
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - S N Ahmed
- Ophthalmology Department, Northampton General Hospital, Cliftonville, Northampton, UK
| | - L Wickham
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - D G Charteris
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
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22
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Yuan A, Ma K, Sharifi S, Pineda R. Biomechanical Testing of Flanged Polypropylene Sutures in Scleral Fixation. Am J Ophthalmol 2021; 230:134-142. [PMID: 33945819 PMCID: PMC10560604 DOI: 10.1016/j.ajo.2021.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To optimize the flanged belt-loop technique of scleral fixation through biomechanical testing and report clinical outcomes of resultant modifications. DESIGN Experimental study. METHODS The force to disinsert flanged polypropylene suture from human cadaveric sclera was assessed using a tensile testing machine and compared to the breaking strengths of 9-0 and 10-0 polypropylene. The effects of modifying suture gauge (5-0, 6-0, 7-0, or 8-0), amount of suture cauterized (0.5 or 1.0 mm), and sclerotomy size (27, 30, 32, 33 gauge) were investigated. Belt-loop intrascleral fixation using 6-0 and 7-0 polypropylene with 30 and 32 gauge needles, respectively, was performed in 4 patients. Main outcome measures were flanged suture disinsertion forces in cadaveric sclera. RESULTS The average force to disinsert a flange created by melting 1.0 mm of 5-0, 6-0, 7-0, and 8-0 polypropylene suture from human cadaveric sclera via 27, 30, 32, and 33 gauge needle sclerotomies was 3.0 ± 0.5 N, 2.1 ± 0.3 N, 0.9 ± 0.2 N, and 0.4 ± 0.1 N, respectively. The disinsertion forces for flanges formed by melting 0.5 mm of the same gauges were 72%-79% lower (P < .001). In comparison, the breaking strengths of 9-0 and 10-0 polypropylene were 0.91 ± 0.4 N and 0.52 ± 0.03 N. Belt-loop fixation using 6-0 and 7-0 polypropylene with 30 and 32 gauge sclerotomies demonstrated good outcomes at 6 months. CONCLUSIONS The flanged belt-loop technique is a biomechanically sound method of scleral fixation using 1.0 mm flanges of 5-0 to 7-0 polypropylene paired with 27, 30, and 32 gauge sclerotomies. In contrast, 8-0 polypropylene and 0.5 mm flanges of any suture gauge will likely be unstable with this technique.
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Affiliation(s)
- Amy Yuan
- From the Department of Ophthalmology, University of Washington, Seattle, Washington, USA (A.Y.)
| | - Kevin Ma
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (K.M., R.P.)
| | - Sina Sharifi
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA (S.S.)
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (K.M., R.P.).
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23
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Bonnet C, Vazirnia P, Deng SX, Aldave AJ, Miller KM. Sutured Custom Foldable Silicone Artificial Iris Implantation Combined With Intraocular Lens Implantation and Penetrating Keratoplasty: Safety and Efficacy Outcomes. Cornea 2021; 40:1236-1247. [PMID: 33086281 PMCID: PMC8423143 DOI: 10.1097/ico.0000000000002564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess safety and efficacy outcomes of sutured custom silicone artificial iris and intraocular lens implantation combined with penetrating keratoplasty (triple procedure). METHODS Prospective consecutive surgical case series of patients who underwent the triple procedure between 2010 and 2019 at Stein Eye Institute, UCLA, followed up for 1 year minimum. Safety outcomes were changes from preoperative to last follow-up in corrected distance visual acuity (CDVA), endothelial cell count, intraocular pressure (IOP), and postoperative complications. Efficacy outcomes included changes in subjective glare (none to severe), cosmetic appearance (worse to very much improved), and visual function as assessed by the Visual Function Questionnaire-25 at 1-year follow-up. RESULTS Among 82 eyes implanted with an artificial iris, 14 eyes (17.1%) underwent the triple procedure. The median follow-up was 18.1 months (range 12.0-54.9 months). The median CDVA improved from 2.0 log of minimum angle of resolution (logMAR) (range 0.9-2.3 logMAR) to 0.7 logMAR (range 0.2-2.6 logMAR) (P = 0.02). Average endothelial cell count decreased 57.6% (P < 0.01). Six eyes (42.9%) experienced IOP elevations, 13 eyes (92.3%) developed iritis, and 11 eyes (78.6%) underwent secondary surgery. Graft rejection or secondary graft failure occurred in 7 eyes each (50.0%). Cosmesis improved in 12 eyes (85.7%; P < 0.01). The Visual Function Questionnaire-25 score improved from 72 to 77 (P < 0.01). Glare symptoms did not change significantly. CONCLUSIONS The triple procedure was effective at improving CDVA, cosmesis, and quality of life; however, it was associated with frequent postoperative complications, of which iritis, IOP elevation, and secondary graft failure were the most common.
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Affiliation(s)
- Clemence Bonnet
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
- Université de Paris, AP-HP Hôpital Cochin, Paris, France
| | - Parsia Vazirnia
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Sophie X. Deng
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Anthony J. Aldave
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Kevin M. Miller
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
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Chee SP, Ti SE, Chan NSW. Management of the subluxated crystalline lens: A review. Clin Exp Ophthalmol 2021; 49:1091-1101. [PMID: 34264007 DOI: 10.1111/ceo.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Cataract surgery for the subluxated crystalline lens is challenging. A thorough preoperative evaluation is important to determine the appropriate surgical approach for lens removal and the subsequent technique of intraocular lens placement. Important considerations include the extent and location of zonular weakness, and whether the zonular deficiency is caused by a static or progressive disease. The capsular bag should be preserved where possible. Creating a good-sized and centred continuous curvilinear capsulorhexis is crucial to facilitate the use of capsular retractors and capsular tension devices, which provide capsular stability. Nucleus sculpting and rotation should be minimised to reduce zonular stress. Being cognisant of the possible intraoperative complications that may occur at each stage of the surgery and knowing how to reduce the risk of these complications occurring will enable surgeons to perform safe cataract surgery in these complex cases.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
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May consultation #2. J Cataract Refract Surg 2021; 47:678-679. [PMID: 33908395 DOI: 10.1097/01.j.jcrs.0000751768.18790.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nowomiejska K, Haszcz D, Onyszkiewicz M, Choragiewicz T, Czarnek-Chudzik A, Szpringer-Wabicz A, Baltaziak K, Brzozowska A, Toro MD, Rejdak R. Double-Needle Yamane Technique Using Flanged Haptics in Ocular Trauma-A Retrospective Survey of Visual Outcomes and Safety. J Clin Med 2021; 10:jcm10122562. [PMID: 34207903 PMCID: PMC8228832 DOI: 10.3390/jcm10122562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/29/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023] Open
Abstract
To evaluate visual outcomes and safety of the double-needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double-needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow-up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow-up at three months. Further studies with longer follow-up evaluations are required to verify long-term complications.
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Affiliation(s)
- Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
- Correspondence: ; Tel./Fax: +48-81-53-248-27
| | - Dariusz Haszcz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Maksymilian Onyszkiewicz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Tomasz Choragiewicz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Aleksandra Czarnek-Chudzik
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Agata Szpringer-Wabicz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Katarzyna Baltaziak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
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Erakgun T, Gobeka HH. The novel haptic-twist method for a sutureless double-needle intrascleral haptic fixation technique. Int Ophthalmol 2021; 41:3013-3020. [PMID: 34014460 DOI: 10.1007/s10792-021-01862-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Description of a novel modified technique known as haptic-twist method for placing a trailing haptic into a 27 G needle during double-needle intrascleral haptic fixation (Yamane technique) in the absence and/or inadequacy of capsular support. METHODS The trailing haptic was threaded into the needle lumen using a haptic-twist method in 12 eyes of 11 patients with aphakia. The haptic was grasped by a forceps 2-3 mm from the tip, while the forceps was rotated by 180° counter-clockwise around its own axis. This maneuver enabled the trailing haptic to be slightly twisted without any deformation and to coordinate with the needle in the proper angle. The surgical technique has also been mentioned in a surgical video. RESULTS Mean age of the patients was 62 years ± 18 (range 46-78 years). Although the mean pre-operative best-corrected visual acuity was 0.70 ± 0.35 logarithm of the minimum angle of resolution (logMAR) (range 1.30-0.20 logMAR), an improvement of up to 0.40 ± 0.32 logMAR (range 1.0-0.1 logMAR) was observed 3 months after surgery. No trailing haptic bending or breakage was observed during the process. Furthermore, no optical tilting or decentralization was observed post-operatively. CONCLUSIONS Although threading the leading haptic into the needle is reasonably straightforward, the trailing haptic positioning can be difficult due to an inappropriate gesture of both the haptic and the needle. We fervently believe that this novel haptic-twist method can provide a much simpler and easier approach, and thus contribute to better surgical outcomes.
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Affiliation(s)
| | - Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Agri Ibrahim Cecen University Rectorate, Erzurum Yolu 4 Km, 04100, Merkez, Agri, Turkey.
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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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Modified Technique for Scleral-Sutured Fixation with the Double Knots Technique for Posterior Chamber Intraocular Lens: Short-Term Observation. J Ophthalmol 2021; 2021:6697230. [PMID: 33728058 PMCID: PMC7937454 DOI: 10.1155/2021/6697230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the short-term safety and efficacy of a novel approach of utilizing the 9-0 looped polypropylene suture with double knots buried into the scleral groove and the scleral tunnel to minimize the risk of the suture erosion and suture knot exposure. Design Clinical-based retrospective study. Methods Records of consecutive patients who had anterior vitrectomy and scleral-fixated posterior chamber intraocular lens (IOL) implantation between July 2018 and April 2020 with a minimum follow-up of 3 months were reviewed. Results This study enrolled a total of 21 eyes from 20 patients (15 male). These patients had a mean age of 58.52 ± 8.55 years and were followed for an average of 1.08 ± 0.58 years postoperatively. Best-corrected visual acuity (BCVA) improved from a preoperative mean of 0.43 ± 0.41 logMAR to a significantly higher mean 3-month postoperative value of 0.09 ± 0.21 logMAR (Z = -3.35, p < 0.01). There were no statistical differences between the preoperative and postoperative corneal endothelial cell density (p=0.71). The postoperative complications included transient increased intraocular pressure in 5 eyes (24%). No other complications were detected during the follow-up. Conclusions The modified technique proposed is a safe, effective, and reliable approach resulting in good visual outcomes. Our procedure might have the potential benefit to avoid suture-related complications in scleral-fixated IOL implantation. Trial registration. Retrospective case series study, not applicable.
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Intraocular Suture Looping Technique for Flapless Four-Point Refixation of Dislocated Intraocular Lenses. J Ophthalmol 2021; 2021:6648777. [PMID: 33628477 PMCID: PMC7884157 DOI: 10.1155/2021/6648777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe a flapless/grooveless technique for four-point refixation of a dislocated intraocular lens (IOL) with four fenestrated haptics. Methods An intraocular suture looping technique was performed with the assistance of two 27-gauge needles. A looping needle was passed into the eye through paracentesis and was used to loop both fenestrated haptics on the same side with an 8-0 polypropylene thread. A guiding needle was used to guide the looping needle out of the eye at the scleral fixation sites. After looping each pair of fenestrated haptics on nasal/temporal sides with 8-0 polypropylene sutures, the IOL was refixated by definitive knotting. The exterior suture ends were buried into the sclera without the creation of scleral flaps/grooves. Results The technique was employed in four eyes (three patients). The mean postoperative follow-up period was 13.8 ± 2.2 months. Postoperatively, the IOLs of all the eyes remained well positioned and stable. The postoperative visual acuities of all the eyes were improved. No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. Conclusion The present technique provides minimal surgical invasion for the transscleral refixation of a dislocated IOL with four fenestrated haptics.
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Kannan NB, Sen S, Mishra C, Lalitha P, Rameshkumar G, Kumar K, Rajan RP, Ramasamy K. Ten-year trends in the incidence, clinical profile and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and sutureless, glueless and flapless scleral fixation of intraocular lenses. Int Ophthalmol 2021; 41:1651-1658. [PMID: 33511515 DOI: 10.1007/s10792-021-01715-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the frequency and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and scleral fixation of intraocular lens. METHODS We evaluated patients undergoing a sutureless, glueless, flapless technique of scleral fixation of intraocular lenses (SFIOL) implantation for various causes of aphakia and documented the clinico-demographic data, microbiological profile and final outcome after acute endophthalmitis in this cohort of eyes. RESULTS The frequency of suspected acute endophthalmitis diagnosed post-surgery was 0.112% (4/3541 eyes), with culture-positive endophthalmitis frequency being 0.028% (1 eye), showing growth of Pseudomonas aeruginosa. Mean age of patients with endophthalmitis was 51.75 ± 9.28 years, and mean interval between surgery and acute endophthalmitis presentation was 10.25 ± 9.6 days. Patients were managed with intravitreal antibiotics with or without core vitrectomy. Visual acuity of patients increased from baseline 1.43 ± 0.32 logMAR (Snellen equivalent = 6/150) to 0.79 ± 0.16 logMAR (Snellen equivalent = 6/36) after an average follow-up of 11 ± 2 weeks. CONCLUSION Endophthalmitis is a rare complication following SFIOL surgery, and all ophthalmic surgeons must be aware of this inadvertent possibility, since SFIOLs are gaining wider acceptability recently. Moreover, these cases of endophthalmitis may show a different pattern of microorganisms than post-cataract surgery endophthalmitis; however, with prompt diagnosis and effective timely management, favorable outcomes can be achieved.
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Affiliation(s)
| | - Sagnik Sen
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India.
| | | | - Prajna Lalitha
- Department of Microbiology, Aravind Eye Hospital, Madurai, India
| | | | - Karthik Kumar
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India
| | - Renu P Rajan
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India
| | - Kim Ramasamy
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India
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Kannan NB, Sen S, Damodaran S, Debbarma M, Rajan RP, Kumar K, Ramasamy K. Sutureless Scleral-Fixated Intraocular Lens Implantation for Refractive Rehabilitation in Eyes With Spherophakia. JOURNAL OF VITREORETINAL DISEASES 2020; 4:479-483. [PMID: 37007655 PMCID: PMC9976072 DOI: 10.1177/2474126420936187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE Spherophakia is a rare, debilitating congenital ocular disorder. METHODS This institution-based, retrospective, interventional study evaluated medical records of 16 patients with spherophakia with a median age of 19.5 years. Twenty-six eyes underwent scleral-fixated intraocular lens implantation. The technique involved 2 parallel-to-limbus scleral tunnels fashioned using a microincision vitrectomy blade, followed by lensectomy, core vitrectomy, externalization of haptics through 2 separate diametrically opposite sclerotomies, and tucking in of the haptics into the tunnels. Anterior and posterior segment examination, visual acuity, and intraocular pressure (IOP) were noted at baseline and final follow-up. RESULTS Baseline best-corrected visual acuity (BCVA) of all eyes was 0.49 ± 0.51 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 6/18). BCVA of more than 6/60 was present in 28 of 32 (87.5%) eyes, and 13 of 26 (50%) eyes that were operated on had a baseline BCVA of more than 6/18. Postoperative BCVA in 26 eyes improved from 0.43 ± 0.32 logMAR to 0.19 ± 0.21 logMAR (Snellen equivalent, 6/9) (P = .002). Postoperative BCVA was more than 6/18 in 20 of 26 (76.9%) operated-on eyes (P = .046), and all eyes had a final BCVA of more than 6/60. In 20 of 26 (76.9%) eyes, BCVA improved from preoperative status. Postoperatively, spherical equivalent improved from -9.55 ± 5.17 diopters to -0.29 ± 1.45 diopters (P < .001). Apart from 2 patients with Marfan syndrome, 1 with Weill-Marchesani syndrome, and 1 with homocystinuria, the remaining patients had isolated spherophakia. Six eyes presented with an IOP greater than 21 mm Hg, and 50% of these eyes had a final IOP that decreased to less than 15 mm Hg after lensectomy. CONCLUSIONS Lensectomy with pars plana vitrectomy and scleral-fixated intraocular lens is an effective method of refractive rehabilitation for patients with spherophakia presenting with visual disability.
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Affiliation(s)
| | - Sagnik Sen
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, TN, India
| | - Sourav Damodaran
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, TN, India
| | - Meri Debbarma
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, TN, India
| | - Renu P. Rajan
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, TN, India
| | - Karthik Kumar
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, TN, India
| | - Kim Ramasamy
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, TN, India
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Sindal MD, Arthi M. Outcomes of sutureless and sutured scleral fixated intraocular lens in paediatric population. Eur J Ophthalmol 2020; 31:3379-3385. [PMID: 33073609 DOI: 10.1177/1120672120965493] [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: 11/16/2022]
Abstract
PURPOSE To analyse the outcomes of sutureless and sutured scleral fixated intraocular lenses (SFIOL) in paediatric population. SETTING Vitreoretina department of a tertiary eye care institute in Southern India. DESIGN Retrospective case series. METHODS Data were collected from January 2010 to December 2018 for children less than 18 years of age, based on the following parameters: demographics, pre-operative characteristics, duration between aphakia and surgery, previous amblyopia treatment, the uncorrected (UCVA) and the best corrected visual acuity (BCVA) at baseline and, 1,6 and 12 months or final visit. Early and late post-operative complications along with details of any resurgery was recorded. RESULTS The study included 45 eyes of 43 patients. The mean age when children became aphakic was 8.8±3.6 years and the mean age at SFIOL implantation 10.1 ± 3.9 years. Sutureless SFIOL was performed for 36 (80%) eyes. The improvement in UCVA was statistically significant at 1-month follow up. Transient hypotony (n = 3), vitreous hemorrhage (n = 7) and raised IOP (n = 4) were the most observed early post-operative complications, while haptic exposure or disinsertion (n = 4, 9%) was a delayed postoperative complication. The mean spherical equivalent at the last follow up was 1.96 ± 0.83D and mean postoperative cylinder 2.32 ± 1.3D. The children were followed up for a mean duration of 20 ± 21.7 months. History of previous vitrectomy was found to be associated with two line reduction in UCVA (95% CI = 0.03-0.5 logMAR, p = 0.008). CONCLUSION SFIOLs- sutured and sutureless; both were suitable for the rehabilitation of paediatric aphakia. Sutureless scleral fixation is a safe alternative for children but prospective studies with longer follow-up are needed.
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Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - M Arthi
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Mo B, Li SF. Novel use of an adjustable single 8-0 polypropylene suture of scleral fixation without conjunctival dissection. BMC Ophthalmol 2020; 20:304. [PMID: 32711502 PMCID: PMC7382057 DOI: 10.1186/s12886-020-01558-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background This report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach. Methods In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8–0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8–0 polypropylene sutures were inserted into the eye guided by 10–0 polypropylene sutures of a long straight needle. The 8–0 suture was then used to fix the haptic IOs. Finally, these 8–0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence. Results For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up. Conclusions An adjustable single 8–0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation. Trial registration Retrospective case series study, not applicable. NCT04476264.
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Affiliation(s)
- Bin Mo
- Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
| | - Song-Feng Li
- Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China.
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Taskin I, Altinbay D, Ozdemir VN. A different surgical approach to cases with zonular weakness or dialysis: sutureless transscleral fixated intraocular lens implantation and stabilization of lens capsule. Int Ophthalmol 2020; 40:2315-2323. [PMID: 32419104 DOI: 10.1007/s10792-020-01416-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of sutureless transscleral fixated intraocular lens (IOL) implantation and capsule stabilization of IOL optics on postoperative visual outcomes in cases with zonular dialysis in excess of 70°. METHODS Fifteen eyes of thirteen patients with > 70° zonular dialysis and endothelial cell counts higher than 1500 cells/mm2 who had been followed for at least 6 months were included. A modified surgical approach was applied to these eyes with sutureless transscleral fixated IOL implantation and the IOL was secured to the capsulorhexis to stabilize the lens capsule (optic capture). RESULTS The mean best-corrected visual acuity (BCVA) was 0.21 ± 0.2 on the first day, 0.45 ± 0.33 on the first week, 0.60 ± 0.32 on the first month, 0.80 ± 0.26 on the third month, and 0.82 ± 0.27 on the sixth month. When preoperative BCVA and postoperative BCVA were compared, a statistically significant increase was observed in postoperative BCVA beginning from the seventh postoperative day. There was a statistically significant (p = 0.038) decrease in endothelial cell count at postoperative third and sixth months (1895 ± 65, 1872 ± 376, respectively) compared to preoperative values. CONCLUSIONS The use of this new surgical modification that utilizes capsular tension rings combined with a procedure that secures the sutureless scleral IOL fixation to the capsulorhexis for the treatment of eyes with zonular dialysis in excess of 70° was found to be very successful in the 6 months of follow-up. More cases and longer follow-up periods are required to provide an idea as to whether different complications will develop in such patients.
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Affiliation(s)
- Ibrahim Taskin
- Private Niveye Center, Ophthalmology Clinic, Adana, Turkey
| | - Deniz Altinbay
- Private Niveye Center, Ophthalmology Clinic, Adana, Turkey.
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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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Czajka MP, Frajdenberg A, Stopa M, Pabin T, Johansson B, Jakobsson G. Sutureless intrascleral fixation using different three-piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study. Acta Ophthalmol 2020; 98:224-236. [PMID: 31788964 DOI: 10.1111/aos.14307] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023]
Abstract
We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral (SIS) fixation of a standard three-piece PCIOL. Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL: transient/permanent corneal oedema (9-66.6%), uveitis (1.1-39.3%); iris-fixated IOL: pupil ovalization (16-47.7%); and sutured scleral-fixated IOL: suture breakage/exposure (6.1-11%), vitreous haemorrhage: (5.5-16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony (n = 20; 19.4%), corneal decompensation (n = 7; 6.7%), IOL dislocation (n = 6; 5.8%), cystoid macular oedema (n = 5; 4.8%), vitreous haemorrhage (n = 4; 3.8%) and retinal detachment (n = 4; 3.8%). Mean best corrected visual acuity improved from logMAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.
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Affiliation(s)
- Marcin Piotr Czajka
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Agata Frajdenberg
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Marcin Stopa
- Department of Ophthalmology Chair of Ophthalmology and Optometry Heliodor Swiecicki University Hospital Poznan University of Medical Sciences Poznan Poland
| | - Tomasz Pabin
- Department of Ophthalmology Chair of Ophthalmology and Optometry Heliodor Swiecicki University Hospital Poznan University of Medical Sciences Poznan Poland
| | - Björn Johansson
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology Sahlgrenska University Hospital Gothenburg Sweden
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Pollmann AS, Lewis DR, Gupta RR. Structural integrity of intraocular lenses with eyelets in a model of transscleral fixation with the Gore-Tex suture. J Cataract Refract Surg 2020; 46:617-621. [DOI: 10.1097/j.jcrs.0000000000000129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dhingra D, Malhotra C, Jakhar V, Rohilla V, Negi A, Jain AK. Combination of capsular tension ring and capsular tension segment for the management of lens coloboma >4 clock hours. Indian J Ophthalmol 2019; 67:1684-1687. [PMID: 31546508 PMCID: PMC6786144 DOI: 10.4103/ijo.ijo_1762_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Lens colobomas extending more than 4 clock hours and causing visual impairment require lens extraction along with capsular support devices with scleral fixation for adequate centration of the capsular bag and for prevention of capsular fornix aspiration with inadvertent extension of zonular dialysis intraoperatively. In this case series, we describe a technique for the management of isolated lens colobomas involving 4–5 clock hours by clear lens extraction and intraocular lens implantation using a combination of a capsular tension ring with a capsular tension segment (CTS) for the centration and stability of the capsular bag. Hoffman's corneoscleral pocket and half-bow sliding knot technique were used for scleral fixation of the CTS.
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Affiliation(s)
- Deepika Dhingra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chintan Malhotra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaneet Jakhar
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikash Rohilla
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avinash Negi
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Jain
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Belin PJ, Raouf S, Lieberman RM. Innovations in Secondary Intraocular Lens Placement. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2019; 4:177-191. [DOI: 10.1016/j.yaoo.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Scleral IOL fixation using limbal mini-pockets: description of the method and clinical cases. OPHTHALMOLOGY JOURNAL 2019. [DOI: 10.17816/ov2019285-90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The search for new techniques of fixation intraocular lenses (IOL) cases of its dislocation or inadequate capsular support continues to be an actual problem. The most physiological is the IOL position in the posterior chamber. In this article, a new method for scleral IOL fixation using limbal mini-pockets proposed by the authors will be presented.
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Aaltonen P, Oskala P, Immonen I. Outcomes of intraocular lens scleral fixation with the friction knot technique. Acta Ophthalmol 2019; 97:e506-e513. [PMID: 30298705 DOI: 10.1111/aos.13931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the clinical outcomes of intraocular lens (IOL) scleral fixation with the friction knot technique. METHODS Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot IOL scleral fixation technique by a single surgeon. The fixated IOLs were one-piece or three-piece models all with open loop haptics. Main outcome measures were change in corrected distance visual acuity (CDVA) and postoperative complications. RESULTS The mean follow-up time was 11.7 months (median 4.9, range 0.7-64.8). The mean logarithm of the minimum angle of resolution CDVA improved from preoperative 0.77 ± 0.73 (Snellen 20/118 ± 7.3 lines) to 0.44 ± 0.56 (Snellen 20/55 ± 5.6 lines) at the final visit (p < 0.001). The main postoperative complications were ocular hypertension (30.3%), uveitis-glaucoma-hyphaema syndrome (12.5%; UGHS), vitreous haemorrhage (11.2%) and retinal detachment (8.6%). Two (1.3%) cases of suture breakage were seen. In multivariate Cox regression analysis, age under 60 years [hazard ratio (HR) = 5.41; 95% confidence interval (CI) 1.95-15.01] and scleral fixated one-piece IOL (HR = 4.23; 95% CI 1.44-12.44) were found as significant independent risk factors for developing new UGHS. CONCLUSION The friction knot technique provides a firm scleral fixation. Scleral fixation may successfully be utilized in dislocated three-piece IOLs with loop haptics. We recommend avoiding scleral fixation of one-piece IOLs in young patients due to a high risk of UGHS.
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Affiliation(s)
- Petri Aaltonen
- Vitreoretinal Surgery Unit Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Pertti Oskala
- Vitreoretinal Surgery Unit Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Ilkka Immonen
- Vitreoretinal Surgery Unit Department of Ophthalmology Helsinki University Hospital Helsinki Finland
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Ni S, Wang W, Chen X, Wu X, He S, Ma Y, Xu W. Clinical observation of a novel technique: transscleral suture fixation of a foldable 3-looped haptics one-piece posterior chamber intraocular lens implantation through scleral pockets with intact conjunctiva. BMC Ophthalmol 2019; 19:105. [PMID: 31072310 PMCID: PMC6507106 DOI: 10.1186/s12886-019-1113-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background To present the follow-up outcomes of a modified technique of transscleral suture fixation of posterior chamber intraocular lens (PCIOL) in eyes with inadequate capsule support. Methods A retrospective chart review of 21 patients underwent transscleral suture fixation of a foldable 3-looped haptics one-piece PCIOL implantation through scleral pockets was conducted. Preoperative data and follow-up data for at least 3 months were collected for all patients. Results The mean operative duration was 36.62 ± 10.70 min. The mean pre- and post-operative LogMAR uncorrected distance visual acuity was (1.25 ± 0.50 vs. 0.41 ± 0.22, P < 0.01). The mean pre- and post-operative LogMAR best corrected visual acuity was (0.48 ± 0.25 vs. 0.33 ± 0.24, P < 0.01). The mean proportion of postoperative endothelial cell loss was 11.46 ± 4.78%. The mean postoperative anterior chamber depth was 3.05 ± 0.44 mm. The mean postoperative IOL tilt degree was 2.81 ± 1.41°, and the mean postoperative IOL decentration degree was 0.31 ± 0.13 mm. Four patients with transient corneal edema (19.0%) and three patients with transiently elevated IOP (14.3%) were observed after operation, and such complications were resolved within 1 week. No severe complications were observed. Conclusions The modified technique was a feasible method of PCIOL implantation. Electronic supplementary material The online version of this article (10.1186/s12886-019-1113-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuang Ni
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wang
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Chen
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingdi Wu
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suhong He
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Suichang Hospital of Traditional Chinese Medicine, Suichang, China
| | - Yajuan Ma
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Rongjun Hospital, Jiaxing, China
| | - Wen Xu
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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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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Belkin A, Einan-Lifshitz A, Mathew DJ, Sorkin N, Buys YM, Trope GE, Rootman DS. Intraocular pressure control after trans-scleral intraocular lens fixation in glaucoma patients. Eur J Ophthalmol 2019; 30:685-689. [PMID: 30943784 DOI: 10.1177/1120672119840913] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraocular lens fixation surgery is associated with fluctuations in intraocular pressure. This may be significantly relevant in glaucoma patients. OBJECTIVES To assess short- and medium-term intraocular pressure control after trans-scleral intraocular lens fixation surgery in glaucoma patients. METHODS The charts of all glaucoma patients who underwent trans-scleral intraocular lens fixation surgery with at least 6 months follow-up by a single surgeon between the years 2004 and 2017 were reviewed. Primary outcomes were intraocular pressure at 1 day and 6 months after surgery. Secondary outcome measures were hypotensive medication use and the need for further intraocular pressure lowering interventions. RESULTS Eleven eyes of 10 patients were included in the analysis. Mean follow-up post intraocular lens fixation surgery was 54.6 months. Mean intraocular pressure before, 6 months, and last follow-up after intraocular lens fixation surgery was 15.8 ± 5.3 mmHg (range 10.6-25.3), 13.5 ± 3.8 mmHg (range 8-21, p = 0.2), and 11.8 ± 5.6 (range 6-21, p = 0.09) on a mean of 2.3 ± 1.6, 2 ± 1.6 (p = 0.23), and 1.7 ± 1.5 (p = 0.08) hypotensive medications, respectively. A pressure spike was noted in 5 of the 11 eyes on the first post-operative day (mean spike 15.2 mmHg, range 6-23). Four of 11 eyes in the study (36%) needed additional interventions to control intraocular pressure by the 6-month point. One eye required the addition of two classes of topical medications, one eye required laser trabeculoplasty, and two eyes required trabeculectomy. CONCLUSION Over a third of glaucomatous eyes required a change in the management of their disease in the early post-operative period. Close follow-up of patients undergoing trans-scleral intraocular lens fixation surgery is warranted.
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Affiliation(s)
- Avner Belkin
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Adi Einan-Lifshitz
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Graham E Trope
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
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Sugiura T, Kaji Y, Tanaka Y. Ciliary sulcus suture fixation of intraocular lens using an auxiliary device. J Cataract Refract Surg 2019; 45:711-718. [PMID: 30879719 DOI: 10.1016/j.jcrs.2019.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 12/21/2022]
Abstract
We developed an injector with a tip that matches the shape of the ciliary sulcus (Ciliary Sulcus Pad Injector) and is used in ciliary sulcus suture fixation of intraocular lenses. The injector is inserted through the corneal incisions and slid along the posterior surface of the iris to the opposite side. When the tip of injector is fitted in the ciliary sulcus, the plunger is pressed, causing the needle to pierce the ciliary sulcus. A suture is inserted in the ciliary sulcus without direct observation. In 91.4% of cases, the needle correctly pierced the ciliary sulcus in a single attempt. The difference between the preoperative expected refractive power and the postoperative spherical equivalent power was -0.63 diopter 6 months after surgery.
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Affiliation(s)
| | - Yuichi Kaji
- Department of Ophthalmology, Majors in Clinical Sciences, Tsukuba University, Japan
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Faramarzi A, Feizi S, Yazdani S. Trans-iris fixation of dislocated in-the-bag intraocular lenses. Eur J Ophthalmol 2019; 30:538-542. [DOI: 10.1177/1120672119831161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The aim of this article is to describe the safety and efficacy of trans-iris suture fixation for the management of late dislocation of in-the-capsular-bag intraocular lenses following uncomplicated cataract surgery. Patients and methods: Eleven eyes of 11 patients with late in-the-capsular-bag intraocular lens dislocation following uneventful phacoemulsification cataract surgery were recruited in the study. The dislocated intraocular lens–capsular bag complex was sutured to the iris at two points 180° apart using 9-0 polypropylene sutures on long needles. Results: Mean patient age was 67 ± 6 years. Seven eyes had pseudoexfoliation syndrome, one eye had Marfan syndrome, and another eye had a traumatic cataract; no risk factor was identified for intraocular lens dislocation in two eyes. A capsular tension ring had been implanted during cataract surgery in four eyes. In six eyes, the posterior chamber intraocular lenses were one-piece foldable while the remaining were three-piece intraocular lenses. Compared to the preoperative value, corrected distance visual acuity was significantly improved postoperatively ( p < 0.005). Intraoperative hyphema occurred in two eyes. Pupil ovalization was observed in all eyes. Mean endothelial cell count decreased by 4 ± 1.7% after intraocular lens fixation. The capsular bag–intraocular lens complex was stable and well-centered in the pupillary area in all eyes at the final follow-up examination which was performed 16 ± 4 months postoperatively. Conclusion: Trans-iris fixation is a simple and effective procedure for management of late intraocular lenses–capsular bag complex dislocation, without major complications.
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Affiliation(s)
- Amir Faramarzi
- Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Van Brummen AJ, Crowell EL, Ghergherehchi LM, Wang N. Repositioning a posteriorly dislocated silicone plate-haptic toric intraocular lens. J Cataract Refract Surg 2019; 45:394-397. [PMID: 30713019 DOI: 10.1016/j.jcrs.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
We describe a technique for repositioning an encapsulated, posteriorly dislocated silicone plate-haptic toric intraocular lens (IOL) while preventing further dislocation into the vitreous cavity. Sutures of 10-0 polypropylene were used to ensure safe retrieval of the dislocated IOL. An anterior vitrectomy was then performed to remove the contracted capsular bag around the IOL. The IOL fixation hole was temporarily externalized to allow quick and secure IOL fixation, eliminating the risk for losing the slippery silicone IOL into the vitreous cavity. Using this technique, the IOL was successfully placed in the proper position and resulted in good vision for the patient while avoiding the trauma of lens exchange.
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Affiliation(s)
- Alexandra J Van Brummen
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston, Houston, Texas, USA
| | - Eric L Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston, Houston, Texas, USA; Robert Cizik Eye Clinic, Houston, Texas, USA
| | - Layla M Ghergherehchi
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston, Houston, Texas, USA; Robert Cizik Eye Clinic, Houston, Texas, USA
| | - Nan Wang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston, Houston, Texas, USA; Robert Cizik Eye Clinic, Houston, Texas, USA.
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Hardten DR. Consultation Section: Cataract. February consultation #3. J Cataract Refract Surg 2019; 45:246-247. [PMID: 30704732 DOI: 10.1016/j.jcrs.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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February consultation #4. J Cataract Refract Surg 2019; 45:247. [DOI: 10.1016/j.jcrs.2018.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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