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Evaluations of bridging sutures in preventing iris capture in eyes with intrascleral fixation of implanted intraocular lens. Graefes Arch Clin Exp Ophthalmol 2023; 261:427-434. [PMID: 36042055 DOI: 10.1007/s00417-022-05816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The study aims to determine the effectiveness of bridging sutures in preventing iris capture and a subsequent reverse pupillary block after an intrascleral fixation of an implanted intraocular lens (IOL). METHODS We studied 6 eyes that had an iris capture with reverse pupillary block due to a dislocated IOL after an intrascleral fixation. After the dislocated IOL was repositioned, 10-0 polypropylene sutures were inserted 1.5 mm posterior to the limbus and directed to run between the iris and the IOL. The sutures were placed orthogonal to the haptics of the IOL. Anterior segment optical coherence tomography (AS-OCT) was used in 4 eyes to evaluate the degree of iridodonesis before and after the bridging sutures. The heights of the temporal and nasal sectors of the middle iris from the iris plane (the line between anterior chamber angles) were compared for each 0.2-s AS-OCT image taken immediately after the eye moved from a lateral to a primary position. RESULTS None of the eyes had a recurrence of the iris capture after the bridging sutures. The refractive error, anterior chamber depth, and vision were not significantly altered after the bridging sutures were placed. The AS-OCT images showed that the height of the nasal iris was decreased more at 0 s postoperatively blocking the excessive downward movement of the nasal iris but not the iridodonesis. CONCLUSION Bridging sutures were effective in preventing iris capture and subsequent reverse pupillary block after an intrascleral fixation of an IOL.
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Malach DS, Guest JM, Adam C, Joffe J, Le K, Kim C, Lin X. Intraocular Lens Formula Comparison of Flanged Intrascleral Intraocular Lens Fixation with Double Needle Technique. Clin Ophthalmol 2023; 17:837-842. [PMID: 36960323 PMCID: PMC10029932 DOI: 10.2147/opth.s389325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/02/2023] [Indexed: 03/13/2023] Open
Abstract
Purpose To analyze visual outcomes and accuracy of intraocular lens (IOL) calculation formulas in predicting postoperative outcomes in patients undergoing flanged intrascleral IOL fixation. Design Case Series. Subjects Twenty-three patients who had undergone secondary IOL placement using flanged intrascleral fixation technique. Methods Retrospective chart review. Main Outcome Measures Corrected distance visual acuity (CDVA) and postoperative spherical equivalent based on manifest refraction. Results Visual acuity improved from 20/577 to 20/58. Overall, the actual refraction was 0.06 D more myopic than predicted. Holladay 2, Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II resulted in mild myopic surprise (-0.55, -0.18 and -0.20 D). Haigis and Hill-RBF (Radial Basis Function) resulted in mild hyperopic surprise (+0.28 and +0.28 D). Hoffer Q and Holladay 1 were the most accurate (-0.02D and -0.08 D). Conclusion Flanged intrascleral IOL fixation improved vision even in patients with other posterior segment pathologies. The effective lens positioning is likely similar to in-the-bag positioning. Hoffer Q and Holladay 1 formulas with in-the-bag calculations were the most accurate.
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Affiliation(s)
- Daniel S Malach
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - John Michael Guest
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - Christopher Adam
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - Jonah Joffe
- Henry Ford Hospital Department of Ophthalmology, Detroit, MI, USA
| | - Kim Le
- Henry Ford Hospital Department of Ophthalmology, Detroit, MI, USA
| | - Chaesik Kim
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - Xihui Lin
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
- Correspondence: Xihui Lin, Kresge Eye Institute/Wayne State University Department of Ophthalmology, 4717 St. Antoine, Detroit, MI, 48201, USA, Email
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Large Amplitude Iris Fluttering Detected by Consecutive Anterior Segment Optical Coherence Tomography Images in Eyes with Intrascleral Fixation of an Intraocular Lens. J Clin Med 2022; 11:jcm11154596. [PMID: 35956211 PMCID: PMC9369625 DOI: 10.3390/jcm11154596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Saccadic eye movements induce movements of the aqueous and vitreous humor and iris fluttering. To evaluate iris fluttering during eye movements, anterior segment optical coherence tomography (AS-OCT) was used in 29 eyes with pars plana vitrectomy (PPV) and intrascleral fixation of an intraocular lens (ISF group) and 15 eyes with PPV and an IOL implantation into lens capsular bag (control group). The height of the iris from the iris plane (the line between the anterior chamber angles) was compared every 0.2 s after the eye had moved from a temporal to the primary position (time 0). The height of the nasal iris in the ISF group decreased to −0.68 ± 0.43 mm at 0 s (p < 0.001) and returned to −0.06 ± 0.23 mm at 0.2 s. The height of the temporal iris increased to 0.45 ± 0.31 mm at 0 s (p < 0.001) and returned to −0.06 ± 0.18 mm at 0.2 s. The height of the nasal iris at 0 s in the ISF group was significantly lower, and that of the temporal iris was significantly higher than the control (−0.05 ± 0.09 mm, 0.03 ± 0.06 mm, p < 0.001, respectively). Iris fluttering can act as a check valve for aqueous and vitreous humor movements and can be quantified by consecutive AS-OCT images. Large amplitude iris fluttering in eyes with intrascleral fixation is important because it can lead to a reverse pupillary block.
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Behera UC, Thakur PS. Scleral Fixation of Intraocular Lens in Aphakic Eyes without Capsular Support: Description of a New Technique. Clin Ophthalmol 2021; 15:4689-4696. [PMID: 34949910 PMCID: PMC8689012 DOI: 10.2147/opth.s344506] [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: 10/21/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the efficacy and safety of a modified trans-scleral intraocular lens (IOL) fixation technique in aphakic eyes when performed by ophthalmologists in training. Methods The study was conducted in an institutional setting that included 43 surgeries performed by surgeons training in small incision cataract surgeries. The data were analyzed for stability and position of IOL, refractive changes, best-corrected vision, and associated complications. Results Mean age of the subjects was 53.8 ± 18.5yrs (range 6–81yrs). Surgical aphakia (58.14%) was the most common cause. The corrected distance visual acuity improved significantly at six weeks (p = 0.0003). The mean residual spectacle correction was +0.74 ± 1.2D spherical equivalent (cylinder −1.6±1.5D at 84 ± 50°) at the 6th-month follow-up (24.35 ± 6.71wks). Lens tilt on ultrasound biomicroscopy (kappa 0.762; p < 0.001) and the IOL centration (kappa 0.411; p = 0.001), assessed by two independent masked observers, were satisfactory at the 6th-month visit. Transient postoperative vitreous hemorrhage was the most common complication (46.5%). Cellular deposits on the IOL surface (18.6%), cystoid macular edema (11.6%), subconjunctival haptic exposure (4.66%), and haptic slippage (2.33%) were the other complications. Conclusion This method of trans-scleral IOL fixation is an effective rescue procedure for eyes with deficient capsular support when ophthalmologists perform in training.
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Affiliation(s)
- Umesh Chandra Behera
- Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, India
| | - Pratima Singh Thakur
- Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, India
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Standardized Flanged Intrascleral Intraocular Lens Fixation with the Double-Needle Technique for Cataract Luxation in the Vitreous Chamber during Phacoemulsification. J Ophthalmol 2021; 2021:9998482. [PMID: 34007485 PMCID: PMC8099526 DOI: 10.1155/2021/9998482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the visual and refractive outcome of immediate intraoperative vitrectomy and intrascleral intraocular lens implantation using a “standardized” sutureless Yamane technique during cataract luxation in the vitreous chamber as a complication of phacoemulsification. Design A prospective, interventional, consecutive case series. Materials and Methods Twelve patients underwent vitrectomy and intrascleral intraocular lens fixation using a standardized Yamane technique as the primary procedure during complicated phacoemulsification. Patients were evaluated preoperatively and 6 months postoperatively for best-corrected distance visual acuity, correspondence to the preoperative refractive target in the spherical equivalent, endothelial cell count, and complications. Results Mean preoperative best-corrected visual acuity was 1.16 ± 0.3 logarithm of the minimum angle of resolution (logMAR), the endothelial cell count was 1910.5 ± 297.64, and target refraction at baseline was −0.197 ± 0.087. Postoperatively, best-corrected visual acuity was significantly improved; the mean value was 0.05 logMAR ± 0.06. Mean baseline target refraction in the spherical equivalent was −0.20 ± −0.09 (range: −0.08 to −0.37), and mean final refraction was −0.44 ± −0.14 (range: −0.25 to −0.75) with no significant difference (p=0.87). No complication was registered intra- and postoperatively. Conclusion Standardization of the Yamane technique seemed a valuable option for patients who had complicated phacoemulsification to achieve a predictable refractive outcome. Synopsis. The predictable refractive outcome could be achieved with the immediate standardized Yamane technique in patients with intraoperative cataract luxation in the vitreous chamber during phacoemulsification.
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Scleral fixation of a single-piece foldable acrylic IOL through a 1.80 mm corneal incision. J Cataract Refract Surg 2021; 46:662-666. [PMID: 32358257 DOI: 10.1097/j.jcrs.0000000000000138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A new scleral fixation technique of a single-piece acrylic foldable intraocular lens (IOL) (enVista MX60, Bausch & Lomb, Inc.) through a 1.80 mm corneal incision, using the IOL eyelets as anchoring point, is described. It was a retrospective review of 26 cases. The preoperative mean corrected distance visual acuity was 0.51 ± 0.21 logarithm of the minimum angle of resolution (logMAR). It improved significantly to 0.25 ± 0.27 logMAR (P < .01), 0.18 ± 0.16 logMAR (P < .01), and 0.17 ± 0.16 logMAR (P < .01) (at 1 month, 3 months, and 6 months postoperatively, respectively, repeated measures analysis of variance, P < .0001). No astigmatism increase of more than 0.75 diopters was recorded at any time point. In all 26 patients, the IOL was well centered and stable for the entire monitoring period. No complications were observed during follow-up. Scleral fixation of the foldable IOL through a 1.80 mm corneal incision provided excellent IOL stability during the 6-month follow-up of this study and might be an effective and safe surgical technique.
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Surgical Outcome of Refixation versus Exchange of Dislocated Intraocular Lens: A Retrospective Cohort Study. J Clin Med 2020; 9:jcm9123868. [PMID: 33260686 PMCID: PMC7760674 DOI: 10.3390/jcm9123868] [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: 11/10/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/28/2022] Open
Abstract
We compared the surgical outcomes and complications of refixation vs. exchange of dislocated intraocular lenses (IOLs) in patients who underwent transscleral suture fixation combined with pars plana vitrectomy for the treatment of IOL dislocation. A total of 83 eyes (n = 83 patients) with postoperative follow-up of ≥6 months were evaluated: 40 received refixation of dislocated IOL (refixation group) while 43 received IOL exchange (exchange group) treatment. Treatment outcomes, including best-corrected visual acuity (BCVA), spherical equivalent, corneal cylinder, intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial cell density (ECD), and postoperative complications were retrospectively reviewed. BCVA improvement at 6 months after surgery was comparable between the groups. Postoperative decrease in corneal ECD was significantly greater in the exchange group than in the refixation group, but no significant differences were found in spherical equivalent, corneal cylinder, IOP, or CMT changes. The exchange group experienced significantly more frequent postoperative vitreoretinal complications, such as retinal detachment, choroidal effusion, cystoid macular edema, and secondary epiretinal membrane, than the refixation group. Without any reason to extract the dislocated IOL, reuse of the dislocated IOL would be a better surgical option for transscleral suture fixation to protect corneal endothelial cells and prevent postoperative vitreoretinal complications.
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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: 32] [Impact Index Per Article: 8.0] [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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Kandemir Besek N, Erdogan G, Gumus G, Kepez Yildiz B, Aygit E, Yildirim Y, Agca A. Comparative evaluation of re-use or replacement of dislocated 3-piece intraocular lenses with a scleral fixation technique. J Fr Ophtalmol 2020; 43:139-144. [DOI: 10.1016/j.jfo.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/24/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
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Li B, Zhang Y, Gao X. Simple Technique for Transscleral Fixation of a Foldable Posterior Chamber Intraocular Lens Using a Single Suture. J INVEST SURG 2019; 33:446-452. [PMID: 30884995 DOI: 10.1080/08941939.2018.1535011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To explore the simplified technique for transscleral fixation of a foldable posterior chamber intraocular lens (IOLs) in patients with aphakia or inadequate posterior capsule support. Methods: A review was conducted of 18 eyes of eighteen patients with the absence of-or inadequate-capsule support, after the simplified technique of using a foldable posterior chamber intraocular lens (PC IOLs) with stable four-point transscleral fixation, as performed by a skilled surgeon. This technique uses only a single suture and a knot to fix a PC IOL firmly without creating a scleral flap. The mean follow-up time was 18 ± 5.8 months (ranging from 12 to 24 months). Results: All patients exhibited improved visual acuity. No IOL tilt or dislocation or iris capture was observed, and all patients exhibited stable and centered IOL after surgery. No complex complications, such as suture shedding and exposure, corneal endothelial decompensation, persistent uveitis, or retinal detachment and endophthalmitis were observed. Conclusion: The simplified technique proposed here is a reliable, economical, and reproducible method of treating patients with aphakia or inadequate posterior capsule support. It provides excellent IOL stability, reduces surgical duration and complexity, and prevents certain complications.
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Affiliation(s)
- Baojiang Li
- Department of Opthalmic Center, the 474th Hospital of Chinese PLA, XinJiang, China
| | - Yangjing Zhang
- Department of Opthalmic Center, the 474th Hospital of Chinese PLA, XinJiang, China
| | - Xiaowei Gao
- Department of Opthalmic Center, the 474th Hospital of Chinese PLA, XinJiang, China
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Zhang Y, He F, Jiang J, Li Q, Wang Z. Modified technique for intrascleral fixation of posterior chamber intraocular lens without scleral flaps. J Cataract Refract Surg 2017; 43:162-166. [DOI: 10.1016/j.jcrs.2016.10.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
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Sindal MD, Nakhwa CP, Sengupta S. Comparison of sutured versus sutureless scleral-fixated intraocular lenses. J Cataract Refract Surg 2016; 42:27-34. [PMID: 26948775 DOI: 10.1016/j.jcrs.2015.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the intermediate-term anatomic and visual results of scleral-fixated intraocular lens (IOL) implantation using 4-point suture fixation or transscleral sutureless fixation. SETTING Tertiary referral eye care center in South India. DESIGN Retrospective case series. METHODS Medical records of consecutive patients who had scleral-fixated IOL surgery from January 1, 2010, to March 31, 2014, with more than 1 year of follow-up were retrospectively analyzed. Indication for scleral-fixated IOL implantation was aphakia after cataract extraction or trauma. The surgical technique was based on individual surgeon preference. The uncorrected distance visual acuity (UDVA), previous surgery, type of trauma, surgical technique, and complications were analyzed. RESULTS One hundred nine cases were analyzed. The mean follow-up was 18.9 months ± 8.7 (SD). The majority of eyes experienced an improvement in UDVA after surgery; 93 eyes (86%) had a Snellen equivalent corrected distance visual acuity of 6/12 or better. The baseline characteristics and final visual outcomes in the sutured scleral-fixated IOL group (n = 52) and sutureless scleral-fixated IOL group (n = 59) were comparable. Patients with previous trauma (n = 52) were predominantly men and were significantly younger than those in the cataract group. The visual and refractive outcomes were comparable between eyes with previous trauma and eyes with previous cataract surgery. Transient cystoid macular edema was the most common complication (12%); retinal detachment occurred in 5 cases (4.5%). CONCLUSIONS Scleral-fixated IOLs provided excellent visual rehabilitation of aphakic eyes without capsular support. The sutured technique and sutureless technique appear to be equally good in eyes with aphakia after cataract surgery or trauma. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Manavi D Sindal
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India.
| | - Chinmay P Nakhwa
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Sabyasachi Sengupta
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
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Yang JM, Yoon KC, Ji YS. Transscleral fixation of single-piece foldable acrylic lens with eyelets at the optic-haptic junction. Can J Ophthalmol 2016; 50:367-72. [PMID: 26455972 DOI: 10.1016/j.jcjo.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/06/2015] [Accepted: 07/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the clinical outcomes of transscleral fixation using a single-piece foldable acrylic intraocular lens (IOL) with eyelets at the optic-haptic junction (enVista; Bausch & Lomb). DESIGN Retrospective, noncomparative case series. PARTICIPANTS Sixty eyes of 60 patients who underwent transscleral fixation with an enVista IOL were reviewed. METHODS Preoperative patient status, postoperative visual and refractive outcomes, and postoperative complications were analyzed. RESULTS The study included 60 eyes of 60 patients (52 males, 8 females) with a mean age of 56.65 ± 15.57 years. At final follow-up visit, the mean follow-up was 11.40 ± 4.24 months. The mean uncorrected visual acuity (logMAR) improved from 1.95 ± 0.90 to 0.85 ± 0.77 (p < 0.001), and best corrected visual acuity (logMAR) improved from 1.11 ± 1.13 to 0.64 ± 0.70 (p = 0.006). The mean spherical equivalent improved significantly from 6.90 ± 6.10 to 0.21 ± 2.10 D postoperatively (p < 0.001). Complications included transient ocular hypertension (15%), transient hypotony (7%), and hyphema (5%), but no serious complications were observed. In all cases, the IOL remained stable and well centred. CONCLUSIONS Transscleral fixation using a foldable acrylic IOL with eyelets at the optic-haptic junction can be a safe and effective alternative technique to manage cases with broken capsular bag or weak zonular support.
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Affiliation(s)
- Jee Myung Yang
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kyung-Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yong-Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
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Wallmann AC, Monson BK, Adelberg DA. Transscleral fixation of a foldable posterior chamber intraocular lens. J Cataract Refract Surg 2015; 41:1804-9. [DOI: 10.1016/j.jcrs.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/16/2022]
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Comparision of surgical outcomes of intraocular lens refixation and intraocular lens exchange with perfluorocarbon liquid and fibrin glue-assisted sutureless scleral fixation. Eye (Lond) 2015; 29:757-63. [PMID: 25853441 DOI: 10.1038/eye.2015.22] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/23/2015] [Indexed: 11/08/2022] Open
Abstract
AIM The purpose of this study was to compare the surgical outcomes of intraocular lens (IOL) refixation with intraocular lens exchange using perfluorocarbon liquid (PFCL) and fibrin glue-assisted sutureless scleral fixation surgery in patients with dislocation of the IOL. METHODS Twenty-five eyes of 25 patients who underwent surgery for dislocated IOLs with PFCL and fibrin glue-assisted scleral fixation were studied; 13 eyes experienced IOL refixation (in-the-bag and out-of-the-bag), and 12 eyes experienced IOL exchange. Preoperative and postoperative clinical features from patient charts and 25 eyes with >6 months' follow-up information were reviewed and analyzed. RESULTS At postoperative 6 months, best-corrected visual acuity (BCVA) and spherical equivalent of IOL refixation and exchange were significantly improved (P=0.042, P=0.001), and endothelial cell density was significantly decreased in the two groups with no significant difference between them. Surgically induced astigmatism of IOL refixation improved from 0.90±0.47 to 0.61±0.37 (P=0.012), and IOL exchange improved from 1.17±0.64 to 0.73±0.37 (P=0.037) at postoperative 6 months, with no significant difference between the two groups. Complications occurred in four eyes in the IOL refixation group and in three eyes in the IOL exchange group. CONCLUSION PFCL and fibrin glue-assisted IOL sutureless scleral refixation or exchanged fixation was an effective surgical treatment for IOL dislocation. Also, because postoperative BCVA, surgical outcomes, and complications did not differ significantly between IOL refixation and exchange surgery, if IOL exchange surgery is not indicated, IOL refixation surgical techniques should be considered.
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Hazar L, Kara N, Bozkurt E, Ozgurhan EB, Demirok A. Intraocular Lens Implantation Procedures in Aphakic Eyes With Insufficient Capsular Support Associated With Previous Cataract Surgery. J Refract Surg 2013; 29:685-91. [DOI: 10.3928/1081597x-20130723-02] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/13/2013] [Indexed: 01/13/2023]
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Kumar DA, Agarwal A, Packiyalakshmi S, Jacob S, Agarwal A. Complications and visual outcomes after glued foldable intraocular lens implantation in eyes with inadequate capsules. J Cataract Refract Surg 2013; 39:1211-8. [PMID: 23726133 DOI: 10.1016/j.jcrs.2013.03.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/28/2013] [Accepted: 03/06/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the complications and visual outcomes of glued intrascleral-fixated foldable intraocular lens (IOL) in eyes with deficient capsules. SETTING Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN Case series. METHODS Data were evaluated from the records of patients with a primary glued foldable IOL for intraoperative capsular loss or subluxated lens or secondary glued foldable IOL for aphakia. Exclusion criteria included preoperative glaucoma, aniridia, macular scar, traumatic subluxation, combined surgeries, incomplete operative medical records, and postoperative follow-up less than 6 months. The intraoperative and postoperative complication rates, reoperation rate, and visual outcomes were analyzed. RESULTS The study comprised 208 eyes (185 patients). The mean follow-up was 16.7 months ± 10.2 (SD). The intraoperative complications were hyphema (0.4%), haptic breakage (0.4%), and deformed haptics (0.9%). Early complications occurred in 29 eyes (13.9%) and included corneal edema (5.7%), epithelial defect (1.9%), and grade 2 anterior chamber reaction (2.4%). Late complications occurred in 39 eyes (18.7%) and included optic capture (4.3%), IOL decentration (3.3%), haptic extrusion (1.9%), subconjunctival haptic (1.4%), macular edema (1.9%), and pigment dispersion (1.9%). Reoperation was required in 16 eyes (7.7%). Haptic position was altered in eyes with IOL decentration. Corrected distance visual acuity (CDVA) improved or remained unchanged in 84.6% of eyes. The postoperative CDVA was 20/40 or better and 20/60 or better in 38.9% and 48.5% of eyes, respectively. CONCLUSIONS The foldable glued-IOL procedure showed satisfactory visual outcomes without serious complications. Intraocular lens decentration was due to haptic-related problems.
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One-Haptic Fixation of Posterior Chamber Intraocular Lenses without Scleral Flaps. J Ophthalmol 2012; 2012:891839. [PMID: 22919463 PMCID: PMC3420135 DOI: 10.1155/2012/891839] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess visual results and complications of a modified technique of posterior chamber intraocular lenses (PC IOLs) in aphakic eyes without scleral flaps. Methods. Modified one-haptic scleral fixation was performed in one eye each of 25 patients with aphakia and insufficient capsule support. Follow-up period was six months. Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), and postoperative complications. Results. The study included 15 males and 10 females. The preoperative best-corrected visual acuity (BCVA) ranged from 5/60 to 6/9. The operation time ranged from 25 to 45 minutes (mean 35.25 ± 5.34 min). Anterior vitrectomy was performed in 12 cases (48%). There was no major IOL decentration. The final BCVA ranged from 6/36 to 6/9. Seven cases (28%) showed postoperative glaucoma, five cases (20%) had temporary hypotony, and hyphema in 2 eyes (8%). No cases of suture erosion, postoperative endophthalmitis, retinal detachment, or IOL dislocation were detected. Conclusion. This technique of one-haptic scleral fixation of posterior chamber IOLs is a good choice in presence of insufficient capsule support. It reduces the operation time, achieves the IOL stability, and minimizes postoperative suture-related complications.
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Vasavada AR, Raj SM, Vasavada V, Shrivastav S. Surgical approaches to posterior polar cataract: a review. Eye (Lond) 2012; 26:761-70. [PMID: 22441026 DOI: 10.1038/eye.2012.33] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study is to provide a comprehensive overview of surgical methods used in the emulsification of posterior polar cataracts (PPCs) that have been devised to minimize the risk of posterior capsule rupture (PCR) and its consequences. A Pubmed and Medline search of relevant literature on PPC was done. Only articles relevant to the treatment of PPC were included. The posterior capsule in eyes with PPC are known to have an abnormal adhesion to the polar opacity or a pre-existing weakness of the capsule that predisposes the eye to PCR. To circumvent the consequences of cleaving the abnormal adhesion, a majority of the surgeons use the anterior approach through the limbus, whereas some advocate the posterior approach through the pars plana. Emulsifying the nucleus and cleaving the central opacity of the PPC off the posterior capsule without disrupting its integrity provides optimal surgical outcomes. To achieve this, various modifications have been applied by surgeons during different phases of surgery. The advantages, disadvantages, complications, and results of each method have been discussed. Phacoemulsification is the preferred technique for removing PPC. This review will provide methods to avoid and /or deal with intraocular surgical difficulties that can arise during emulsification. Employing these would result in least ocular morbidity and satisfactory visual outcomes for the patient. This is particularly relevant given the major advancements in technology and refinements in surgical techniques in phacoemulsification.
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Affiliation(s)
- A R Vasavada
- Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India.
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Ganekal S, Venkataratnam S, Dorairaj S, Jhanji V. Comparative evaluation of suture-assisted and fibrin glue-assisted scleral fixated intraocular lens implantation. J Refract Surg 2012; 28:249-52. [PMID: 22386370 DOI: 10.3928/1081597x-20120221-01] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/10/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the visual outcomes and complications after suture-assisted and fibrin glue-assisted scleral fixated intraocular (IOL) implantation. METHODS Scleral fixated IOL implantation was performed in patients with inadequate capsular support. Intraocular lens fixation was achieved using sutures or fibrin glue. Main parameters evaluated were visual outcomes and complications. RESULTS Fifty patients were included in the study (n=25 suture, n=25 glue). The most common indication for scleral fixated IOL implantation was cataract surgery complicated with posterior capsule rupture (29/50 [58%]). No significant differences were noted between demographic characteristics, surgical indications, and preoperative corrected distance visual acuity (CDVA) in either group (P=.680). No intraoperative complications related to IOL fixation were encountered in any case. At last follow-up (6 months), CDVA was 20/40 or better in 88% and 84% of patients in the suture and glue groups, respectively. Postoperative inflammation (48% vs 16%) and glaucoma (40% vs 16%) were seen more frequently in eyes with sutures as compared to eyes with glue. Overall, a significantly higher number of complications were encountered in eyes with suture fixation (14/25 [56%]) compared to eyes with glue fixation (7/25 [28%]) (P=.045). CONCLUSIONS Although visual outcomes were similar at the end of 6 months in eyes that underwent suture- and glue-assisted scleral fixated IOL implantation, fibrin glue was associated with fewer complications.
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Foldable acrylic intraocular lens with distended haptics for transscleral fixation. J Cataract Refract Surg 2010; 35:2047-50. [PMID: 19969206 DOI: 10.1016/j.jcrs.2009.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 06/21/2009] [Indexed: 11/24/2022]
Abstract
We describe a foldable acrylic intraocular lens (IOL) with distended haptics suitable for transscleral fixation and the insertion procedure. The IOL has an acrylic optic and poly(methyl methacrylate) haptics with a microscopic indentation 1.3 mm from the tip. Transscleral fixation of the IOL was performed through corneal incisions in 22 eyes, and surgical results were retrospectively assessed. The IOL was sutured firmly in position using the cow-hitch procedure, and there was no suture loosening to the distended haptic. The IOL design provided suitable fixation and may be indicated for bag fixation as well as transscleral fixation.
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Kumar DA, Agarwal A, Prakash G, Jacob S, Saravanan Y, Agarwal A. Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye (Lond) 2010; 24:1143-8. [PMID: 20150926 DOI: 10.1038/eye.2010.10] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the post-operative outcome of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation in eyes with deficient capsular support after 1 year. METHODS Eyes operated with fibrin glue-assisted posterior chamber IOL implantation from December 2007 to May 2008 were included. The post-operative best spectacle-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), central macular thickness, and specular count were evaluated. IOL position and centration at 1 year was determined. The 1-year post-operative complications were analysed. RESULTS A total of 53 eyes of 53 patients were analysed. There was significant improvement in UCVA (P=0.000) and BCVA (P=0.000). There was no significant change (P=0.447) in IOP from the pre-operative value. The early post-operative complication was decentration (5.6%). The late complication was pigment dispersion (3.7%) and healed macular oedema (7.5%). No vision threatening complications such as retinal break, retinal detachment, or endophthalmitis were seen. The percentage (%) loss of endothelial cells was 5.23+/-3.4% at 1-year follow-up. No pseudophakodonesis was seen in the follow-up visits. CONCLUSION Results obtained at 1 year after fibrin glue-assisted posterior chamber IOL implantation showed a good visual outcome with minimal complications in eyes with deficient capsular support.
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Affiliation(s)
- D A Kumar
- Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India
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February consultation #4. J Cataract Refract Surg 2009. [DOI: 10.1016/j.jcrs.2008.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Agarwal A, Kumar DA, Jacob S, Baid C, Agarwal A, Srinivasan S. Fibrin glue–assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg 2008; 34:1433-8. [DOI: 10.1016/j.jcrs.2008.04.040] [Citation(s) in RCA: 369] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 04/09/2008] [Indexed: 11/26/2022]
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Baykara M. Scleral fixation technique with scleral cleft. J Cataract Refract Surg 2008; 34:6; author reply 6. [PMID: 18165057 DOI: 10.1016/j.jcrs.2007.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 08/29/2007] [Indexed: 11/17/2022]
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Techniques for scleral fixation of IOLs. J Cataract Refract Surg 2008; 34:6-7; author reply 7. [PMID: 18165059 DOI: 10.1016/j.jcrs.2007.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
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