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Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis. Int Ophthalmol 2023; 43:131-140. [PMID: 35794404 DOI: 10.1007/s10792-022-02395-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis. METHODS Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180° were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated. RESULTS The mean age of the patients was 57.4 ± 15.1 years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 ± 6.5 months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 ± 0.16 logMAR and 0.13 ± 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 ± 1.4 D and 1.0 ± 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7° ± 5.2°. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%). CONCLUSION The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.
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Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s) to Reconstruct Capsular Support for Out-of-the-Bag Intraocular Lens Fixation in Vitrectomized Eyes. Retina 2022; 42:1816-1821. [PMID: 31021902 DOI: 10.1097/iae.0000000000002554] [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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3
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Sutureless technique for repositioning and scleral fixation of the capsular bag-intraocular lens complex with permanent use of iris retractors. J Cataract Refract Surg 2022; 48:118-124. [PMID: 34855644 DOI: 10.1097/j.jcrs.0000000000000838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
A new sutureless technique used for repositioning and scleral fixation of the capsular bag-intraocular lens (IOL) complex in the surgical treatment of subluxated lenses is described. Iris retractors were used not only to induce a tent effect on the capsule but also to permanently fix the capsular bag to the sclera in this method, without the need to prepare scleral or conjunctival flaps. Surgery with the use of a capsular tension ring (CTR) and iris retractors, the ends of which were brought out through the sclera and cauterized, was performed in 7 eyes of 7 patients with moderate or severe subluxation of the crystalline lens. In all cases, simultaneous use of a CTR and iris retractors ensured good centration of the capsular bag-IOL complex. The method was safe and effective in fixing the capsule to the sclera in the case of significant damage to the ligamentous apparatus of the lens.
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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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Wang Z, Lu Y, Xiao K, Gao Y, He J, Zhang S, Wang G, Zhang M. Bimanual irrigation-aspiration for ectopia lentis and use of a small incision for 4-point scleral-sutured foldable intraocular lens and anterior vitrectomy in patients with Marfan syndrome. Indian J Ophthalmol 2020; 67:1629-1633. [PMID: 31546497 PMCID: PMC6786229 DOI: 10.4103/ijo.ijo_250_19] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose: This study evaluated bimanual intracapsular irrigation-aspiration for ectopia lentis with use of a small incision for 4-point scleral fixation of a foldable posterior-chamber intraocular lens (IOL) and anterior vitrectomy in patients with Marfan syndrome. Methods: We performed a retrospective study of 18 eyes from 10 patients with Marfan syndrome who underwent surgical intervention for ectopia lentis at our clinic between July 2012 and September 2018. In this study, intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent, intraocular pressure, and endothelial cell density were evaluated. Results: No intraoperative complications were reported. In all cases, early postoperative evaluation revealed a clear cornea, round pupil, and well-centered IOL. Mean logMAR uncorrected visual acuity improved from 1.09 preoperatively to 0.56 postoperatively (P < 0.05). Mean logMAR best-corrected visual acuity improved from 0.45 preoperatively to 0.17 postoperatively (P < 0.05). Aside from transient ocular hypertension, no postoperative complications were reported. Conclusion: The combined surgical technique presented above yields excellent visual outcomes with an extremely low incidence of complications. This approach is simple, safe, and effective in the treatment of ectopia lentis in patients with Marfan syndrome.
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Affiliation(s)
- Zhenmao Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Yan Lu
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Kailin Xiao
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Ying Gao
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Jing He
- Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Shaobin Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Geng Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Guangdong Province, China
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Castaldelli GB, Firmino GDC, Castaldelli VA, Costa RDS, Ribeiro JC. Use of Techniques for Scleral and Iris Fixation in Secondary Implantation of Intraocular Lenses. Ophthalmic Res 2020; 64:1-9. [PMID: 32163944 DOI: 10.1159/000507120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/08/2020] [Indexed: 11/19/2022]
Abstract
Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does not present appropriate capsular support. However, there is no consensus in the literature about which of these 2 methods is safer and better. The authors performed a literature review searching the main postoperative outcomes obtained with the use of each surgical method. Scleral and iris fixation of IOL are efficient in correction of the patients' visual acuity, even though each technique presents distinct complications which depend especially on the experience of the surgeon with the performed surgical method. It is important to understand that individuals submitted to scleral or iris fixation present previous preoperative complications in their eyes. Besides, both procedures are very complex, involving intense manipulation of the eye globe. The success rate of these surgical techniques is highly variable and has a close relation to the preoperative conditions of the patient's eye and the improvement of the surgeon's learning curve.
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Affiliation(s)
| | | | | | - Rafael de Souza Costa
- Department of Ophthalmology, Instituto Cearense de Oftalmologia (ICO), Fortaleza, Brazil
| | - João Crispim Ribeiro
- Department of Ophthalmology, Christus University Center (Unichristus), Fortaleza, Brazil.,Department of Ophthalmology, Instituto Cearense de Oftalmologia (ICO), Fortaleza, Brazil
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Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s): A Sutureless Technique to Fixate the Capsular Bag for Intraocular Lens Implantation in Subluxated Lenses. Retina 2018; 39 Suppl 1:S33-S38. [PMID: 30586352 DOI: 10.1097/iae.0000000000002425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Intrascleral Fixation of Implantable Polypropylene Capsular Hook(s): A New Sutureless Technique to Reposition Dislocated Intraocular Lens-Capsular Bag Complex. Retina 2017; 39 Suppl 1:S44-S49. [PMID: 29135890 DOI: 10.1097/iae.0000000000001915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Karadag R, Sari U, Gunes B. Intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis. Int Ophthalmol 2017; 38:1765-1768. [PMID: 28676990 DOI: 10.1007/s10792-017-0623-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To report a technique of intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis. METHODS Two scleral flaps, two scleral tunnels and two sclerotomies were formed. The anterior capsule was captured and pulled by the iris hooks resulting in the IOL adopting an appropriate position at which point the iris hooks extracted from the sclerotomies. The tips of the iris hooks were implanted into the scleral tunnels. Each of them was fixed with a 10.0 nylon suture to the scleral bed. The scleral flaps and conjunctiva were sutured. One of the iris hooks was seen loosened at the first-week postoperative examination but the IOL remained centralized. The loosened hook was removed. RESULTS No complications were witnessed during the patient's 24-month follow-up. CONCLUSION Intra-scleral fixation using iris retractors in the capsular bag for patients having suffered dislocation of IOL despite the attachment of a capsular hook because of zonular dialysis can be safely implemented.
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Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey.
| | - Unsal Sari
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
| | - Bahar Gunes
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
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Yaguchi S, Yaguchi S, Yagi-Yaguchi Y, Kozawa T, Bissen-Miyajima H. Objective classification of zonular weakness based on lens movement at the start of capsulorhexis. PLoS One 2017; 12:e0176169. [PMID: 28426745 PMCID: PMC5398681 DOI: 10.1371/journal.pone.0176169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/06/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To quantify zonular weakness based on lens movement at the start of continuous curvilinear capsulorhexis (CCC) and establish a classification system for it. Setting Kozawa Eye Hospital and Diabetes Center, Mito, Japan. Design Retrospective interventional case series. Methods We examined 402 consecutive eyes of 316 patients who underwent CCC, phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. The movement of the lens capsule was measured using images from video recordings of the CCC procedure. Zonular weakness was classified based on the shifted distance: Grade I, less than 0.20 mm; Grade II, 0.20–0.39 mm; and Grade III, greater than 0.40 mm. For each of these grades, we examined the use of the capsule stabilization device during PEA, the surgical procedure for lens removal, and IOL fixation. Results We classified 276 eyes (68.6%) as Grade I, 102 eyes (25.4%) as Grade II, and 24 eyes (6.0%) as Grade III. As the grade increased, the use of the capsule stabilization device in PEA and scleral suture fixation of IOL increased. Conclusions Zonular weakness was quantified by measuring the movement of the lens capsule. An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery.
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Affiliation(s)
- Saori Yaguchi
- Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
- Kozawa Eye Hospital and Diabetes Center, Mito, Japan
| | - Shigeo Yaguchi
- Kozawa Eye Hospital and Diabetes Center, Mito, Japan
- * E-mail: ,
| | - Yukari Yagi-Yaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Thapa BB, Agarwal A, Singh R, Gupta PC, Ram J. Phacoaspiration with a Cionni ring versus pars plana lensectomy, vitrectomy and sutureless transscleral IOL fixation in pediatric patients with a subluxated lens. Graefes Arch Clin Exp Ophthalmol 2016; 254:901-9. [PMID: 26899898 DOI: 10.1007/s00417-016-3297-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare outcomes of phacoaspiration (PA) with Cionni ring-assisted posterior-chamber intraocular lens implantation (PCIOL) versus pars plana lensectomy (PPL) with anterior vitrectomy (AV) and sutureless transscleral fixation of the IOL (TSFIOL) assisted with fibrin glue in the management of a subluxated lens. METHODS In this prospective and comparative interventional study, one eye of children with a bilateral subluxated lens was randomized to undergo PA with PCIOL using a Cionni ring (group A: n = 14 eyes), and the other eye underwent PPL + AV with glue-assisted TSFIOL (group B: n = 14 eyes). The outcome measures included best-corrected visual acuity (BCVA) in logMAR units and rates of complications at 12-month follow-up visits. RESULTS 28 eyes of 14 children (age: 8.06 ± 4.49 years) were included in the study. BCVA improved from preoperative value of 1.21 to 0.4 (p = 0.001) in group A and from 1.53 to 0.31 (p = 0.001) in group B at month 12. There was no significant difference in the BCVA on comparing the two groups at month 12 (p > 0.411). Postoperative complications in group A included corneal edema (two eyes), Cionni hook capture (one eye), elevated IOP (one eye), and posterior capsular opacification (five eyes). In group B, corneal edema was seen in two eyes, hypotony in one eye, vitreous hemorrhage in one eye and pupillary optic capture in four eyes. CONCLUSION Head-to-head comparison of the two techniques demonstrates no significant difference in the rates of complications at month 12. The decision to choose either technique may be based on the operating surgeon's skill, experience and preference.
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Affiliation(s)
- Bikram Bahadur Thapa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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12
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Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: intermediate-term results. J Cataract Refract Surg 2015; 41:598-606. [PMID: 25708209 DOI: 10.1016/j.jcrs.2014.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/22/2014] [Accepted: 06/24/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To report the intermediate-term results of capsule stabilization for scleral fixation with implantation of the Yaguchi hook, a modified capsule expander stabilization hook. SETTING Department of Ophthalmology, School of Medicine, University of Showa, Fujigaoka Rehabilitation Hospital, Yokohama, Japan. DESIGN Retrospective case series. METHODS Patients with zonular dialysis and phacodonesis were followed postoperatively for at least 2 years. All eyes had phacoemulsification and aspiration using an ordinary capsule expander and in-the-bag implantation of an intraocular lens (IOL). Capsule expanders were removed after the residual cortex was removed, and the capsular bag was fixated to the scleral wall via the ciliary sulcus using the modified capsule expander stabilization hook. Preoperative findings, intraoperative complications, and postoperative courses were examined. RESULTS The mean age of the 11 patients (11 eyes) was 72.2 years ± 10.5 (SD); 5 patients were men. The mean postoperative follow-up was 48.6 ± 13.6 months. The zonular dialysis range was 90 to 180 degrees in 1 eye, 180 degrees in 4 eyes, and 180 to 270 degrees in 1 eye. In 5 eyes, severe phacodonesis was observed without obvious zonular dialysis. In all eyes, the capsular bag and IOL were well centered without severe intraoperative or postoperative complications. CONCLUSION The modified capsule expander stabilization hook provided good centration and stabilization of the capsule-IOL complex in eyes with severely weak zonular fibers. FINANCIAL DISCLOSURE Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.
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Glued capsular hook: Technique for fibrin glue–assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses. J Cataract Refract Surg 2014; 40:1958-65. [DOI: 10.1016/j.jcrs.2014.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/03/2014] [Accepted: 06/08/2014] [Indexed: 11/24/2022]
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Miraldi Utz V, Coussa RG, Traboulsi EI. Surgical management of lens subluxation in Marfan syndrome. J AAPOS 2014; 18:140-6. [PMID: 24698610 DOI: 10.1016/j.jaapos.2013.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 12/06/2013] [Accepted: 12/22/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the literature on the surgical management, describe a simplified surgical technique, and to report the postoperative clinical course of ectopia lentis removal in patients with Marfan syndrome. METHODS The medical records of patients with a clinical diagnosis of Marfan syndrome and clinically significant lens subluxation were retrospectively reviewed. Patients underwent lens extraction by a single surgeon via a simplified anterior segment approach. The pre- and postoperative best-corrected visual acuity, biometric measurements, intraocular pressure, and incidence of surgery-related complications were reviewed. RESULTS A total of 42 eyes of 22 patients were included. Mean postoperative follow-up was 4.9 ± 2.9 years (range, 1-10 years). Average age at surgery was 10.2 ± 9.2 years (range, 2-37 years), with 18 patients (36 eyes) ≤ 18 years of age. The average preoperative best-corrected visual acuity was 20/80, and the average postoperative best-corrected visual acuity at last follow-up was 20/25, with an average improvement of 6 lines on the Snellen chart. All eyes had a best-corrected visual acuity > 20/30 at last follow-up with aphakic correction. One eye of 1 patient developed a retinal detachment following blunt trauma. No other intra- or postoperative complications were reported. CONCLUSIONS Anterior lensectomy and limited vitrectomy with aphakic correction is safe and provides a consistent visual outcome in patients with lens subluxation secondary to Marfan syndrome. This is especially important in pediatric patients, in whom long-term follow-up for iris- and scleral-fixated intraocular lenses is limited.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Elias I Traboulsi
- The Cole Eye Institute, Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
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15
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Hoffman RS, Snyder ME, Devgan U, Allen QB, Yeoh R, Braga-Mele R. Management of the subluxated crystalline lens. J Cataract Refract Surg 2013; 39:1904-15. [DOI: 10.1016/j.jcrs.2013.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/14/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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16
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Jacob S, Agarwal A, Agarwal A, Sathish K, Prakash G, Kumar DA. Glued endocapsular hemi-ring segment for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses. J Cataract Refract Surg 2012; 38:193-201. [PMID: 22322161 DOI: 10.1016/j.jcrs.2011.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 09/27/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022]
Abstract
Surgical expertise, prolonged surgical time, suture-related problems, and delayed intraocular lens (IOL) subluxation or dislocation due to broken sutures are limitations of suture fixation of the capsular bag to the scleral wall. We describe a new device made of IOL haptic material (polyvinylidene fluoride) that allows sutureless fibrin glue-assisted transscleral fixation of the capsular bag to address these issues. The device has a hemi-ring portion that lies in the capsular fornix and a double scroll mechanism that engages the capsulorhexis rim. The scroll extends forward as a haptic that is exteriorized through a sclerotomy under a lamellar scleral flap and tucked into a scleral tunnel. The flap is closed with fibrin glue. The device is used for subluxated cataracts and IOLs. It anchors the capsular bag to the sclera, giving vertical and horizontal stability, while providing fornix expansion and allowing stabilization of the bag intraoperatively and postoperatively. The device has been used in 4 patients who had good intraoperative and postoperative courses over a 5-week period.
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Affiliation(s)
- Soosan Jacob
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India
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