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Chen L, Wang Z, Sun L, Tang Y, Sui W, Bian A, Zhang X, Zhong Y, Zhang S. Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique. BMC Ophthalmol 2023; 23:481. [PMID: 37996816 PMCID: PMC10668428 DOI: 10.1186/s12886-023-03235-2] [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: 09/23/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND IOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags. METHODS A bent 30-gauge needle threaded with 8 - 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 - 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment. RESULTS UCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks. CONCLUSIONS We presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.
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Affiliation(s)
- Lulu Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Zaowen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China.
| | - Lu Sun
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Yongxiang Tang
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, 563000, Zunyi, Guizhou, China
| | - Wenda Sui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
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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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Knot-free suture scleral fixation of dislocated intraocular lenses: clinical results of a novel surgical technique. J Cataract Refract Surg 2021; 47:898-901. [PMID: 33315738 DOI: 10.1097/j.jcrs.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe and report surgical outcomes of a novel, knot-free technique to manage dislocated intraocular lenses (IOLs). SETTING Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. DESIGN Retrospective observational clinical study. METHODS The files of 47 patients were retrospectively reviewed, and the patients who had a follow-up time of 6 months or more were included in this study. The surgery of every case was watched for the surgical complications and calculation of the surgical time. The postoperative complications and success rate were specifically tabulated. RESULTS Thirty-five eyes of 35 patients were included in this study (23 men, 12 women; mean age 63.1 ± 19.2 years). The mean follow-up time was 22.5 ± 9.9 months. The mean surgical time was 28.2 ± 6.8 minutes. Corrected distance visual acuity improved significantly after surgery (P = .001). Anatomic success rate was 97.1% after a single surgery. Most common complications included transient intraocular pressure (IOP) elevation (n = 2), persistent IOP elevation (n = 1), mild IOL tilt (n = 1), mild IOL decentration (n = 1), secondary IOL dislocation requiring intervention (n = 1), transient corneal edema (n = 1), and bullous keratopathy (n = 1). DISCUSSION Knot-free suture scleral fixation of dislocated IOLs was a minimally invasive approach for the management of dislocated IOLs and required only two 20-gauge corneal incisions without the need for scleral flaps or incisions. This technique had a low complication rate and delivered successful results in most cases.
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Unsal U, Akmaz B, Kilic D. Outcomes of a new suture technique for the treatment of dislocated intraocular lenses: locked loop on the haptic. Int Ophthalmol 2021; 41:3663-3673. [PMID: 34173904 DOI: 10.1007/s10792-021-01927-6] [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: 12/23/2020] [Accepted: 06/19/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate surgical and refractive outcomes of a new sutured scleral fixation technique in the management of subluxated intraocular lenses (IOLs). METHODS Nineteen eyes treated with the new scleral fixation technique were included. The mean corrected distance visual acuity (CDVA), postoperative refraction error, mean endothelial cell count (ECC), and complications were recorded. All patients were evaluated immediately postoperatively, at 1 and 7 days, and then at 1, 3, and 6 months. RESULTS The mean duration of follow-up of the patients was 10 months (range, 6-15 months). The mean CDVA was 0.41 ± 0.1 logMAR (logarithm of minimum angle of resolution) preoperatively and was 0.08 ± 0.07 logMAR postoperatively. The mean astigmatism was - 2.22 ± 1.86 D preoperative and was - 0.86 ± 0.58 D postoperative. The mean preoperative and postoperative ECC was 2455 ± 288 and 2352 ± 288, respectively. One patient (5.26%) experienced vitreous hemorrhage, and two (10.52%) experienced intraocular pressure elevation. IOL tilt and decentralization, conjunctival erosion, and cystoid macular edema were not observed in any eyes during follow-up. CONCLUSION This new IOL repositioning technique can be applied in a short surgical time and provides a stable IOL centration on long-term follow-up.
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Affiliation(s)
- Ugur Unsal
- Department of Ophthalmology, Batigoz Eye Health Center, Izmir, Turkey
| | - Berkay Akmaz
- Department of Ophthalmology, Manisa City Hospital, Izmir, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Kayseri City Training and Research Hospital, Health Science University, Kayseri, Turkey.
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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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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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De Novelli FJ, Neto TLG, de Sena Rabelo G, Blumer ME, Suzuki R, Ghanem RC. Net technique for intraocular lens support in aphakia without capsular support. Int J Retina Vitreous 2017; 3:32. [PMID: 28856011 PMCID: PMC5572154 DOI: 10.1186/s40942-017-0085-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background This paper describes a modified surgical technique for intraocular lens implantation in aphakic eyes with no capsular support. Methods Retrospective case series. Seventeen eyes of 17 aphakic patients with no capsule support underwent intraocular lens (IOL) implantation using a standardized technique in which a net was created at the ciliary sulcus plane with two threads forming a net pattern. The net was used as support for the IOL. Follow-up ranged from 6 to 38 months, with an average of 23 months. Results In all cases, the IOL was safely implanted and remained stable during the follow-up. In 16 eyes, the IOL remained well centered; in one eye, slight decentration was observed. Distance-corrected visual acuity improved by a mean of 4 lines, from 1.13 (LogMAR) to 0.52 (P = 0.01). Conclusion This technique might be especially useful in cases of insufficient capsular support associated with tissue loss or iris atrophy. In these cases, iris fixation is not feasible; thus, the only surgical alternative is IOL scleral fixation. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0085-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Marcel Eduardo Blumer
- Sadalla Amin Ghanem Eye Hospital, 35 Camboriu Street, Joinville, SC 89216-222 Brazil
| | - Ricardo Suzuki
- Sadalla Amin Ghanem Eye Hospital, 35 Camboriu Street, Joinville, SC 89216-222 Brazil
| | - Ramon Coral Ghanem
- Sadalla Amin Ghanem Eye Hospital, 35 Camboriu Street, Joinville, SC 89216-222 Brazil
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Gunenc U, Kocak N, Ozturk AT, Arikan G. Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation. Indian J Ophthalmol 2016; 62:876-8. [PMID: 24008801 PMCID: PMC4185167 DOI: 10.4103/0301-4738.116451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o’clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.
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Affiliation(s)
| | | | - A Taylan Ozturk
- Department of Ophthalmology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
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Abstract
BACKGROUND Several techniques for the reposition of a posterior chamber intraocular lens (IOL) posterior dislocating into the vitreous cavity have been developed. However, most of these methods are complicated or include externalizing part of the IOL from a corneal or scleral wound. We here describe a 27-gauge needle-assisted technique for management of a dislocated posterior chamber IOL. METHODS This is a retrospective, noncomparative, interventional case series that discusses the results of 27-gauge needle-assisted reposition of the posterior chamber IOL with transscleral sulcus fixation in 5 consecutive cases with an IOL dislocated into vitreous cavity. These patients underwent IOL reposition with the above-mentioned technique between April 2013 and October 2014 and were followed up for at least two months thereafter. RESULTS The IOLs of the five cases were stable with proper centrations. The postoperative best-corrected visual acuity ranged from 20/30 to 20/20. CONCLUSION The technique of 27-gauge needle-assisted reposition of the posterior chamber IOL with transscleral fixation is effective for reposition of a dislocated IOL. This technique provides good IOL fixation without creating a large corneal wound or scleral flap.
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Kim SI, Kim K. Tram-Track Suture Technique for Pupillary Capture of a Scleral Fixated Intraocular Lens. Case Rep Ophthalmol 2016; 7:290-5. [PMID: 27462257 PMCID: PMC4943309 DOI: 10.1159/000446208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/15/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a new technique using tram-track suture for pupillary capture of a scleral fixated posterior chamber intraocular lens (PC-IOL) to reposition the tilted IOL. Methods In this prospective interventional case series, we describe a tram-track suture for pupillary capture of a scleral fixated PC-IOL. A long straight needle with double-armed 10-0 polypropylene is passed behind the iris and just above the optic portion (tilted forward) of the IOL. The other straight needle with double-armed 10-0 polypropylene is passed just below the optic portion (tilted backward) of the IOL. After the IOL is repositioned properly, the polypropylene sutures are gently pulled and tied. Results Four eyes of 4 patients underwent tram-track suture for pupillary capture of a scleral fixated PC-IOL. No intra- or postoperative complications were noted, and no pupillary captures were detected during the follow-up period. Conclusions The tram-track suture technique provides good centration and stability of a PC-IOL. This technique is an easy and effective way to reposition pupillary capture of an IOL. Further, it is also minimally invasive as it maintains a closed system.
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Affiliation(s)
- Sung In Kim
- Department of Ophthalmology, Saevit Eye Hospital, Goyang, Korea, Republic of
| | - Kiseok Kim
- Department of Ophthalmology, Saevit Eye Hospital, Goyang, Korea, Republic of
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Bellucci R. November consultation #6. J Cataract Refract Surg 2013; 39:1784-6. [PMID: 24160393 DOI: 10.1016/j.jcrs.2013.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ma KT, Kang SY, Shin JY, Kim NR, Seong GJ, Kim CY. Modified Siepser sliding knot technique for scleral fixation of subluxated posterior chamber intraocular lens. J Cataract Refract Surg 2010; 36:6-8. [PMID: 20117698 DOI: 10.1016/j.jcrs.2009.07.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/25/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED We describe a new technique of scleral fixation for the management of dislocated intraocular lenses (IOL). A suture is tied inside the eye around the dislocated haptic to prevent slippage of the IOL after surgery. The technique, which is safe and less invasive than previous methods, was used in 3 patients and the results are presented. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Kyoung Tak Ma
- Department of Ophthalmology, Yonsei University College of Medicine, Siloam Eye Hospital, Seoul, Korea
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