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Noguchi S, Nakakura S, Tabuchi H, Noguchi A. Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps. J Clin Med 2024; 13:2938. [PMID: 38792480 PMCID: PMC11122020 DOI: 10.3390/jcm13102938] [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: 04/05/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.
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Affiliation(s)
- Santaro Noguchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan; (S.N.); (H.T.)
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan; (S.N.); (H.T.)
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan; (S.N.); (H.T.)
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Ahmed A, Malik B, Khan M. An Unusual Case of Opacified Intraocular Lens Exchange After 50 Months: A Case Report. Cureus 2021; 13:e20193. [PMID: 35004015 PMCID: PMC8727333 DOI: 10.7759/cureus.20193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/05/2022] Open
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Visual outcomes after optic exchange of a modular intraocular lens. J Cataract Refract Surg 2021; 47:1441-1447. [PMID: 34675152 DOI: 10.1097/j.jcrs.0000000000000654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness of the Harmoni Modular IOL (HMIOL). SETTING 3 study sites. DESIGN Prospective, multicenter clinical study. METHODS HMIOL is a foldable, posterior chamber lens with separate base and exchangeable optic components. Eligible adults undergoing cataract surgery received HMIOL in the study eye (monovision target -1.50 diopters [D]) and standard monofocal IOL in contralateral eye (control). After 3 months, subjects could undergo optic exchange based on visual outcomes. End points included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refractive spherical equivalent (MRSE). Follow-up was 12 months or greater postoperatively. RESULTS 114 subjects had successful HMIOL implantation in study eye and control IOL in contralateral eye. At 3 months, subjects could undergo optic exchange if unsatisfied with monovision; 65 eyes had optic exchange (exchange cohort), and 49 eyes had no exchange (no exchange cohort). In exchange cohort, the proportion of eyes with UDVA of 20/40 or greater and of 20/20 or greater increased 3 months after optic exchange vs preexchange levels by 23% (97% vs 74%) and 40% (49% vs 9%), respectively. In all cohorts, 95% of subjects or greater achieved UDVA of 20/40 or greater after 12 months or greater. Control and no exchange cohorts achieved CDVA of 20/40 or greater by 3 months; 97% of eyes or greater had CDVA of 20/40 or greater at 12 months after optic exchange. In exchange cohort, the proportion of eyes with MRSE within ±0.50 D and ±1.00 D of target changed by 57% and 36%, respectively, from preexchange (20% and 59%, respectively) to 12 months postexchange (77% and 95%, respectively), reaching levels similar to control subjects (72% and 97%, respectively). CONCLUSIONS HMIOL provided visual outcomes comparable with standard monofocal IOLs.
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Batkov YN, Mikhaylova VI, Aleksandrova KA, Terentyeva AE, Antoshin AV. [Justification for the use of modular intraocular lens (experimental study)]. Vestn Oftalmol 2021; 137:84-88. [PMID: 33881267 DOI: 10.17116/oftalma202113702184] [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: 06/12/2023]
Abstract
UNLABELLED The rising number of cases requiring intraocular lens (IOL) exchange, including those for refractive reasons, drives the search for methods to minimize the trauma of the procedure. Lens implants with modular optics may lower complication risks. PURPOSE To test the use of modular IOL on a laboratory animal in an experiment. MATERIAL AND METHODS A novel modular IOL was implanted into rabbit eyes in disjointed form with subsequent intraocular assembling. Presence of long-term side effects of implantation and possibility of atraumatic optical disk exchange were evaluated 4 months after the surgery. RESULTS A total of 3 rabbit eyes underwent IOL implantation surgery, no technical difficulties were encountered. Postoperatively two eyes were quiet with proper central IOL position and no deformations in the haptic and optical parts. Epithelial cell proliferations did not hinder intraocular disassembly/assembly of the modular IOL. Optical disk spontaneously dislocated into anterior chamber in one eye, with subsequent chronic inflammation and corneal edema. In the late postoperative period, no difficulties were observed in disconnecting the optical part from the haptic ring and their coupling. Optical disk exchange did not require extensive handling of the haptic, except that of fixation leaflets during release/capture of the optics. Mechanical impact of the procedure on the lens capsule and Zinn's zonule fibers was minimal. CONCLUSION The experiment has validated the functionality and feasibility of the modular IOL principle designed to lower the threshold for decisions on IOL exchange in postoperative correction of clinical refraction. In most cases, rabbit eyes were demonstrated to exhibit long-term stable fixation, relative ease and safety of optical disk exchange eliminating the need for traumatic capsular bag manipulations.
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Affiliation(s)
- Y N Batkov
- Cheboksary branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Cheboksary, Russia
| | - V I Mikhaylova
- Cheboksary branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Cheboksary, Russia
| | - K A Aleksandrova
- Cheboksary branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Cheboksary, Russia
| | - A E Terentyeva
- Cheboksary branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Cheboksary, Russia
| | - A V Antoshin
- Cheboksary branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Cheboksary, Russia
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Yusef YN, Yusef SN, Ivanov MN, Vvedenskiy AS, Fokina ND, Alkharki L, Shashorina SA. [Evolution of IOL exchange. Part 1. Development of methods for IOL exchange]. Vestn Oftalmol 2020; 136:248-253. [PMID: 33063973 DOI: 10.17116/oftalma2020136052248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review presents the history of development and improvement of methods for intraocular lens (IOL) exchange. Existing techniques of IOL exchange are comparatively analyzed.
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Affiliation(s)
- Yu N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - S N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - M N Ivanov
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - L Alkharki
- Research Institute of Eye Diseases, Moscow, Russia
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Anisimova NS, Malyugin BE, Arbisser LB, Sobolev NP, Kirtaev RV, Nazirov AA, Popov IA. Femtosecond Laser-Assisted Intraocular Lens Fragmentation: Low Energy Transection. J Refract Surg 2018; 33:646-648. [PMID: 28880341 DOI: 10.3928/1081597x-20170721-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/20/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a case of femtosecond laser-assisted hydrophobic intraocular lens transection. METHODS Case report. RESULTS Femtosecond laser-assisted transection of a one-piece acrylic hydrophobic intraocular lens for explantation via a small surgical incision was successfully performed with low energy parameters. CONCLUSIONS This case illustrates a novel and effective clinical application of the femtosecond laser. [J Refract Surg. 2017;33(9):646-648.].
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Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes. Eye (Lond) 2017; 31:802-809. [PMID: 28106890 DOI: 10.1038/eye.2016.310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/30/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeManagement of refractive errors after cataract surgery includes spectacles or contact lens, secondary laser vision correction, intraocular lens (IOL) exchange, or piggyback lens implantation. We evaluated for the first time a single-piece hydrophilic acrylic IOL designed for supplementary sulcus fixation in postmortem pseudophakic human eyes.MethodsPseudophakic human cadaver eyes were imaged by anterior segment optical coherence tomography (AS-OCT) to assess position of the primary IOL. Eyes were prepared as per the Miyake-Apple technique. The supplementary IOL (Medicontur A4 Addon IOL family) was then inserted into the ciliary sulcus. AS-OCT and photographs from anterior and posterior views were used to assess IOL centration, tilt, and interlenticular distance from the primary IOL.ResultsData were obtained from 12 eyes having primary IOLs of varying materials and designs in the bag and representing different sizes of eyes and severity of Soemmering's ring formation. The A4 Addon IOL was successfully inserted into the ciliary sulcus and was well centered in all cases. Four cases of tilt were observed on AS-OCT: three with mild tilt due to pre-existing zonular dehiscence, and one due to a localized area of Soemmering's ring formation. Interlenticular distance ranged from 0.34 to 1.24 mm and was not dependent on severity of Soemmering's ring or type of primary IOL.ConclusionsThe A4 Addon IOL was designed for sulcus fixation as a supplementary lens, with a large diameter, a square-shaped optic, four smooth loop haptics, and a convex-concave optical surface. It exhibited appropriate centration and interlenticular distance with different primary in-the-bag IOLs.
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Roelofs K, Rudnisky C. In-the-bag intraocular lens exchange 13 years after refractive lens extraction. Can J Ophthalmol 2016; 51:e161-e163. [PMID: 27938971 DOI: 10.1016/j.jcjo.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/19/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Kelsey Roelofs
- Department of Ophthalmology, University of Alberta, Edmonton, Alta
| | - Chris Rudnisky
- Department of Ophthalmology, University of Alberta, Edmonton, Alta.
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Lee MH, Webster DL. Intraocular lens exchange-removing the optic intact. Int J Ophthalmol 2016; 9:925-8. [PMID: 27366699 DOI: 10.18240/ijo.2016.06.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022] Open
Abstract
Current practice for intraocular lens (IOL) exchange is to cut the optic of the posterior chamber intraocular lens (PCIOL) prior to removing it. Great care must be taken during this maneuver to avoid a posterior capsular tear. Removing the haptics from the fibrosed capsule can also be hazardous, as it may result in zonular stress and dehiscence. A technique is described for performing foldable (one-piece acrylic) IOL removal without cutting the optic. Careful visco-dissection of the haptics with a low viscosity ophthalmic viscosurgical device (OVD) in the fibrosed peripheral capsular tunnel avoids zonular or capsular stress. Internal wound enlargement permits foldable IOL removal in one piece, whilst preserving a self-sealing sutureless corneal wound. This technique may enhance the safety and efficacy of foldable IOL exchange.
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Affiliation(s)
- Matthew Hao Lee
- Department of Ophthalmology, Alfred Hospital, Melbourne, VIC 3004, Australia
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Narang P, Steinert R, Little B, Agarwal A. Intraocular lens scaffold to facilitate intraocular lens exchange. J Cataract Refract Surg 2014; 40:1403-7. [DOI: 10.1016/j.jcrs.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/28/2014] [Accepted: 01/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Priya Narang
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom
| | - Roger Steinert
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom
| | - Brian Little
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom
| | - Amar Agarwal
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom.
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Piggybacking technique for vitreous protection during opacified intraocular lens exchange in eyes with an open posterior capsule. J Cataract Refract Surg 2012; 38:1130-3. [PMID: 22727282 DOI: 10.1016/j.jcrs.2012.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 02/14/2012] [Accepted: 02/17/2012] [Indexed: 11/20/2022]
Abstract
UNLABELLED We describe a surgical technique for the safe exchange of opacified 1-piece IOLs in eyes that have had a neodymium:YAG laser posterior capsulotomy. Initially, the opacified IOL is freed from the capsule adhesions using a dispersive ophthalmic viscosurgical device, which is also injected beneath the opacified IOL to protect the vitreous interface. The IOL is then brought into the anterior chamber. A new 3-piece clear IOL is injected before the opacified IOL is removed and is placed behind the opacified IOL, preventing the vitreous from prolapsing. The pupil is constricted pharmacologically, and the opacified IOL is removed through a standard 2.75 mm corneal incision using the hinge technique. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Henderson BA, Yang EB. Intraocular lens explantation technique for one-piece acrylic lenses. J Refract Surg 2012; 28:499-502. [PMID: 22692133 DOI: 10.3928/1081597x-20120531-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/04/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To present a simple technique to remove a one-piece, acrylic AcrySof (Alcon Laboratories Inc) intraocular lens (IOL) via the original incision. METHODS The AcrySof IOL is removed via the original (2.75-mm) incision, without cutting or folding the IOL or widening the incision. After the IOL is viscodissected from the capsular bag and brought into the anterior chamber, toothed forceps hold the optic through the incision while the manipulator enters the side-port incision and hooks onto the optic 180° away. RESULTS With the forceps pulling and the lens manipulator pushing the IOL toward the incision, the IOL will fold and be delivered. CONCLUSIONS A one-piece, acrylic (Acrysof) IOL can be removed without cutting or folding the lens and without widening the original 2.75-mm incision.
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Kubaloglu A, Sari ES, Koytak A, Cinar Y, Erol K, Ozerturk Y. Intraocular lens exchange through a 3.2-mm corneal incision for opacified intraocular lenses. Indian J Ophthalmol 2010; 59:17-21. [PMID: 21157067 PMCID: PMC3032237 DOI: 10.4103/0301-4738.73713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aim: The aim was to evaluate visual and refractive results and complications of intraocular lens (IOL) exchange through a 3.2 mm corneal incision for opacified IOLs. Materials and Methods: This retrospective study comprised 33 eyes of 32 patients with IOL opacification requiring an IOL exchange between July 2003 and March 2007. Exchange surgery was performed through a 3.2-mm temporal clear corneal incision followed by implantation of a new foldable hydrophobic IOL. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), topographical astigmatism, and refractive cylinder were evaluated. Surgically induced astigmatism (SIA) was calculated and complications were recorded. Results: Opacification was observed in 25 eyes (76%) with Aqua-Sense, 3 eyes (9%) with Hydroview, 3 eyes (9%) with MemoryLens IOLs, and 2 eyes (6%) with DgR. The mean follow-up period was 36.54 months. An uneventful IOL exchange was achieved in 18 eyes (55%). Zonular dehiscence occurred in 9 eyes (27%), and posterior capsule tear developed in 4 eyes (12%). The mean preoperative BSCVA (mean ± standard deviation, decimal scale) was 0.13 ± 0.08 (mean: 20/150, range 20/2000 to 20/60) and improved to 0.63 ± 0.18 (mean: 20/32, range 20/60 to 20/20, P < 0.001). The mean SIA was 0.70 D. Seven eyes (21%) had 0.5 D or lower SIA. Conclusion: IOL exchange is a technically challenging procedure with potential risks of reversing the advantages of a prior small-incision cataract surgery. The use of a small corneal incision for IOL exchange could preserve the advantages of modern phacoemulsification surgery with acceptable SIA related to the procedure.
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Affiliation(s)
- Anil Kubaloglu
- Kartal Dr. Lütfi Kirdar Training and Research Hospital, 2nd Eye Clinic, Cevizli, Istanbul, Turkey
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