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Toptan M, Yilmaz OF, Oguz H. Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes. Int Ophthalmol 2024; 44:269. [PMID: 38914871 PMCID: PMC11196301 DOI: 10.1007/s10792-024-03187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/15/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. METHODS A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior-posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). RESULTS There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). CONCLUSION In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.
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Affiliation(s)
- Müslüm Toptan
- Department of Ophthalmology, School of Medicine, Harran University, Sanlıurfa, Turkey.
| | - Omer Faruk Yilmaz
- Department of Ophthalmology, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Halit Oguz
- Department of Ophthalmology, Medeniyet University Göztepe Prof. Dr. Süleyman Yalçin City Hospital, Istanbul, Turkey
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Zaleski M, Stahel M, Eberhard R, Alexander Blum R, Barthelmes D. OUTCOMES OF RETROPUPILLARY IRIS CLAW INTRAOCULAR LENS IMPLANTATION COMBINED WITH PARS PLANA VITRECTOMY. Retina 2022; 42:1284-1291. [PMID: 35174810 PMCID: PMC9200228 DOI: 10.1097/iae.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report 12-month visual outcomes, incidence of intraocular pressure (IOP) changes and postoperative complications after pars plana vitrectomy with retropupillary implantation of an iris claw intraocular lens (IOL) in aphakic eyes after complicated cataract surgery and eyes with a dislocation of the IOL. METHODS This is a retrospective analysis of eyes undergoing implantation of an iris claw IOL combined with pars plana vitrectomy from 1st of January 2009 until 30th of June 2018 after complicated cataract extraction with capsular loss (Group A) or dislocation of an IOL (Group B). Corrected distance visual acuity was analyzed in logarithm of the minimum angle of resolution (logMAR) units, IOP was recorded in mmHg. RESULTS Eyes in Group A (n = 49) improved from a preoperative median visual acuity of 0.523 logMAR (Snellen 20/65) to 0.201 logMAR (Snellen 20/30), P < 0.01. Eyes in Group B (n = 126) showed stable median visual acuity, preoperative 0.301 logMAR (Snellen 20/40) versus postoperative 0.222 logMAR (Snellen 20/30), P > 0.05. During 12 months in Group A, IOP >21 mmHg occurred in 9 (18.4%) eyes; no eye had an IOP <6 mmHg. In Group B, IOP >21 mmHg occurred in 15 (11.9%) eyes, IOP <6 mmHg in 5 (4%) cases. None of the eyes in Group A and B had IOP >21 mmHg or <6 mmHg at 12 months follow-up. CONCLUSION The retropupillary implantation of an iris claw IOL with pars plana vitrectomy provides adequate visual rehabilitation and seems to be safe in IOP changes.
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Affiliation(s)
- Marta Zaleski
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marc Stahel
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roman Eberhard
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Alexander Blum
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
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Fernández Berdasco K, Castro Navarro J, González Castaño CN, Rodríguez Villa S, García Fernández M. Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:317-322. [PMID: 35676024 DOI: 10.1016/j.oftale.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.
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Affiliation(s)
- K Fernández Berdasco
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - J Castro Navarro
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - C N González Castaño
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - S Rodríguez Villa
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - M García Fernández
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
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Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
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Kang HG, Jun JW, Choi EY, Byeon SH, Kim SS, Koh HJ, Kim M. Comparison of long-term surgical outcomes for scleral-fixated versus retropupillary iris-claw intraocular lens. Clin Exp Ophthalmol 2021; 49:686-695. [PMID: 34185377 DOI: 10.1111/ceo.13965] [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: 01/12/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To compare the clinical features and long-term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral-fixated (SFIOL) versus retropupillary iris-claw IOL (RPICIOL). METHODS Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best-corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation. RESULTS This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (p = 0.76) or endothelial cell density (ECD) (p = 0.39). Compared with the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, p = 0.005) sustained to over 36 months (p = 0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, p = 0.027), and shorter operation times (52.7 vs. 60.9 min, p = 0.015). There was no difference in ECD after 12 months (P = 0.282). Over a mean follow-up duration of 33 months (152 cases >3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, p = 0.006), suture exposure (7 vs. 0, p = 0.045), and redislocation (17.7% vs. 10.1%, p < 0.001). Multivariable regression showed that a final BCVA below 20/40 was associated with SFIOL (P = 0.007), older age (p = 0.001), intraoperative complications (p = 0.002), past history of vitrectomy/glaucoma surgery or uveitis (p = 0.046), and surgically induced astigmatism >1D (p = 0.029). CONCLUSIONS RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long-term follow-up, comparing favourably against conventional SFIOL.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Won Jun
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Sumitha CV, Pai V, Thulasidas M. Retropupillary iris-claw intraocular lens implantation in aphakic patients. Indian J Ophthalmol 2021; 68:597-602. [PMID: 32174577 PMCID: PMC7210845 DOI: 10.4103/ijo.ijo_1043_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose: To evaluate the outcomes of implantation of an iris-claw intraocular lens (IC-IOL) in retropupillary position in aphakic patients. Methods: We conducted a prospective interventional study, including 36 aphakic eyes with inadequate capsular support. The postoperative examination included best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, central corneal thickness (CCT), and anterior segment examination with emphasis on the anterior chamber reaction and shape of pupil. Follow-up was done for 3 months. Results: Thirty-six eyes of 34 patients, including 22 right eyes and 14 left eyes were included. Indications for surgery were complicated cataract surgery in 38.9% (n = 14), aphakia in 27.8% (n = 10), pseudophakic bullous keratopathy in 16.7% (n = 6), dislocated posterior chamber IOL (PCIOL) in 11.1% (n = 4), IC drop in 2.8% (n = 1), and subluxated PCIOL in 2.8% (n = 1). Postoperatively, the visual acuity improved by at least two lines in 32 (88.9%) and worsened in four (11.1%) eyes at the end of three months. Mean postoperative IOP at the end of the third month was 12.42 mmHg (standard deviation [SD] 2.57; range 11.55–13.29 mmHg). The mean postoperative CCT at the end of the third month was 542.42 microns (SD 13.77; range 537.76–547.07 microns). Sixteen eyes (44.4%) had horizontally oval pupil, eleven eyes (30.6%) had round pupil, and nine eyes (25%) had irregular pupil. Twenty-three eyes (63.9%) presented with significant anterior chamber reaction and seven eyes (19.4%) had corneal stromal edema on postoperative day 1. Conclusion: Our study demonstrated that retropupillary IC-IOL implantation in eyes without adequate capsular support is an effective and safe procedure with a good visual outcome and fewer complications.
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Affiliation(s)
- C V Sumitha
- Department of Ophthalmology, K.S Hegde Charitable Hospital, Deralakatte, Mangalore, Karnataka, India
| | - Vijay Pai
- Department of Ophthalmology, K.S Hegde Charitable Hospital, Deralakatte, Mangalore, Karnataka, India
| | - Mithun Thulasidas
- Centre for Sight Eye Institute, Plot No. 9, Sector 9, Dwarka, New Delhi, India
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Iris-Claw Intraocular Lens Implantation in Various Clinical Indications: A 4-Year Study. J Clin Med 2021; 10:jcm10061199. [PMID: 33805747 PMCID: PMC7998776 DOI: 10.3390/jcm10061199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included 132 patients subjected to primary IOL implantation during complicated cataract surgery with damage to the posterior capsule (I), secondary implantation in aphakia (II), secondary implantation during penetrating keratoplasty (III), and secondary implantation during pars plana vitrectomy with luxated IOL extraction (IV). We analyzed the records of best-corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and corneal endothelial cell count (cECC), taken before and 1, 2, 3, and 4 years after the surgery. BCVA depended on the time after IOL implantation and the primary indication. Four years post-surgery, the SE values were the lowest in group III. IOP was the same in all groups both before and after the surgery, but 4 years after the surgery IOP values in group IV were higher than in group III. The cECC decreased every year after the surgery in all groups, but four years after the IOL implantation, the lowest cECC values were observed in group IV. At the same time, all groups of patients showed improved BCVA, stable refraction, and a low percentage of postoperative complications.
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Longitudinal corneal endothelial cell loss after corrective surgery for late in-the-bag IOL dislocation: a randomized clinical trial. J Cataract Refract Surg 2020; 46:1030-1036. [DOI: 10.1097/j.jcrs.0000000000000213] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Mansoori T, Agraharam SG, Sannapuri S, Manwani S, Balakrishna N. Surgical Outcomes of Retropupillary-Fixated Iris-Claw Intraocular Lens. J Curr Ophthalmol 2020; 32:149-153. [PMID: 32671297 PMCID: PMC7337027 DOI: 10.4103/joco.joco_92_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose: To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation. Methods: For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted. Results: One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis. Conclusions: Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.
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Affiliation(s)
- Tarannum Mansoori
- Sita Lakshmi Glaucoma Center, Anand Eye Institute, Hyderabad, Telangana, India
| | | | | | - Sunny Manwani
- Vitreo-Retinal Department, Anand Eye Institute, Hyderabad, Telangana, India
| | - Nagalla Balakrishna
- Department of Statistics, National Institute of Nutrition, Hyderabad, Telangana, India
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Touriño Peralba R, Lamas-Francis D, Sarandeses-Diez T, Martínez-Pérez L, Rodríguez-Ares T. Iris-claw intraocular lens for aphakia: Can location influence the final outcomes? J Cataract Refract Surg 2019; 44:818-826. [PMID: 30055690 DOI: 10.1016/j.jcrs.2018.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). SETTING Complejo Hospitalario Universitario de Santiago de Compostela, Spain. DESIGN Retrospective case series. METHODS Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. RESULTS The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n = 24), lens luxation or subluxation (n = 17), trauma (n = 15), aphakia (n = 30), and other (n = 9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3 months and 8 months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. CONCLUSIONS Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME.
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Affiliation(s)
- Rosario Touriño Peralba
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain.
| | - David Lamas-Francis
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Teresa Sarandeses-Diez
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Laura Martínez-Pérez
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Teresa Rodríguez-Ares
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
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Ersöz MG, Hocaoğlu M, Sayman Muslubaş IB, Arf S, Karaçorlu M. Dislocated Intraocular Lens Extraction and Iris-Claw Lens Implantation in Vitrectomized and Non-vitrectomized Eyes. Turk J Ophthalmol 2019; 49:277-282. [PMID: 31650810 PMCID: PMC6823582 DOI: 10.4274/tjo.galenos.2019.79735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes. Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up. Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p<0.05). Complication rates did not differ between the groups (all p>0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes. Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.
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Affiliation(s)
| | | | | | - Serra Arf
- İstanbul Retina Institute, İstanbul, Turkey
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12
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Comparative Analysis of the Safety and Functional Outcomes of Anterior versus Retropupillary Iris-Claw IOL Fixation. J Ophthalmol 2018; 2018:8463569. [PMID: 30524757 PMCID: PMC6247566 DOI: 10.1155/2018/8463569] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose To compare the functional and clinical outcomes of the iris-claw intraocular lens (IOL) placed on the anterior versus posterior surface of the iris. Patients and Methods A multicenter, retrospective study. Data on eyes that underwent anterior or retropupillary iris-claw IOL implantation because of inadequate capsular support secondary to complicated cataract surgery, trauma, and dislocated/opacified IOLs since January 2015 were analyzed. For study inclusion, evaluation results had to be available in the medical records both preoperatively and at 1 and 12 months after implantation. The following parameters were compared between the groups: best-corrected distance visual acuity (BCDVA), spherical and cylindrical refractive error, endothelial cell density (ECD), central macular thickness (CMT), and percentage and type of postoperative complications. Results In total, 60 eyes of 60 patients aged 73 ± 13 years were included: 28 eyes (47%) involved anterior, and 32 eyes (53%) retropupillary, iris-claw IOL fixations. Preoperatively, the groups were similar in all parameters except for a significantly higher proportion of retropupillary fixations in patients who had previously experienced a closed-globe trauma (p=0.03). The groups showed comparable improvements in BCDVA after surgery (final BCDVA: 0.34 ± 0.45 vs. 0.37 ± 0.50 logMAR in the anterior and retropupillary placement groups, respectively). During follow-up, no group difference was observed in refractive error or CMT. Both groups experienced similarly marked ECD loss and showed similar incidence of postoperative complications, with cystoid macular edema being the most common complication. Multivariable linear regression showed that BCDVA at 1 month was the best predictor of the final BCDVA. Conclusions Anterior chamber and posterior chamber iris-claw IOL fixations proved equally effective and safe for aphakic correction in eyes with inadequate capsular support.
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Massa HF, Gobej I, Jacquier P, Jonescu-Cuypers C, Le Quoy O. Cystoid macular oedema and iris-fixated intraocular lens treated with intraocular lens exchange: A case series and review. J Int Med Res 2018; 47:188-195. [PMID: 30270801 PMCID: PMC6384471 DOI: 10.1177/0300060518799004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This series of case reports describes six eyes from five patients that underwent intraocular lens (IOL) exchange with scleral-fixated IOLs for cystoid macular oedema associated with iris-fixated IOLs between 2005 and 2015. Macular oedema was assessed using ocular coherence tomography (OCT). The six eyes in this series were treated by IOL removal and implantation of a scleral-sutured IOL with four points of fixation in the sulcus. Visual acuity improved in all six eyes. On OCT, macular oedema resolved after 3 months in all eyes. There were no surgical complications from the IOL exchange. One eye had a pupilloplasty and another had a diaphragm IOL to treat a major iris impairment from prior surgeries. The cause of cystoid macular oedema in these cases remains controversial but has been well recognized in eyes with iris-sutured IOLs. The absence of sutures with posterior fixation of an iris claw IOL prevents progressive corneal endothelial cell loss but does not prevent macular oedema, even in vitrectomized eyes. In conclusion, macular oedema resolved and visual acuity improved after implant exchange with a secondary scleral-fixated IOL in these cases. This procedure should be considered as a solution to persistent symptomatic cystoid macular oedema from an iris-fixated implant.
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Affiliation(s)
- Horace F Massa
- 1 Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,2 Fondation Ophthalmologique Rothschild, Paris, France
| | - Iona Gobej
- 2 Fondation Ophthalmologique Rothschild, Paris, France
| | - Paul Jacquier
- 1 Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Jonescu-Cuypers
- 1 Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Căciulă D, Gavriș M, Tămășoi I. Penetrating corneal wound with traumatic cataract and intraocular foreign body-case report. Rom J Ophthalmol 2018; 61:54-59. [PMID: 29450372 PMCID: PMC5710054 DOI: 10.22336/rjo.2017.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Open globe injuries complicated with the presence of an intraocular foreign body mostly affect young males and represent a vision threatening condition. We presented the case of a 48-year-old male who presented to our emergency service due to ocular pain and blurred vision in his right eye. A metallic foreign body situated between 1 and 12 o'clock, near the corneoscleral limbus, that perforated the cornea, the iris, the anterior capsule of the lens and the lens, was detected at the slit-lamp examination. We decided to immediately remove the foreign body that was approximately 20 mm long. The following day, traumatic cataract had already developed, so we performed cataract extraction. Despite the dimensions of the intraocular foreign body, the retina was attached and there were no sign of retinal tears or vitreous haemorrhage. The proper management in this case led to good results in spite of the dimensions of the intraocular foreign body. Abbreviations: IOFB = Intraocular Foreign Body, IOL = Intraocular Lens, PVR = Proliferative Vitreo-Retinopathy.
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Affiliation(s)
- Dorin Căciulă
- "Dr. Constantin Papilian" Military Emergency Hospital, Cluj-Napoca, Cluj, Romania
| | - Monica Gavriș
- "Dr. Constantin Papilian" Military Emergency Hospital, Cluj-Napoca, Cluj, Romania
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Jayamadhury G, Potti S, Kumar KV, Kumar RM, Divyansh Mishra KC, Nambula SR. Retropupillary fixation of iris-claw lens in visual rehabilitation of aphakic eyes. Indian J Ophthalmol 2017; 64:743-746. [PMID: 27905336 PMCID: PMC5168915 DOI: 10.4103/0301-4738.195012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Surgical outcome of retropupillary fixation of iris claw lens. AIMS To evaluate the various indications, intra and post-operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes. SETTINGS AND DESIGN The study design is a retrospective study at a tertiary eye care center. METHODS Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow-up duration of at least 1 year. STATISTICAL ANALYSIS USED Data analysis was performed using paired t-test and Chi-square test. RESULTS Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best-corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm2 preoperatively which decreased to 2200 ± 728 cells/mm2 at 1 year follow-up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%. CONCLUSION Iris claw is a safe and an effective method of rehabilitating aphakic eyes.
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Affiliation(s)
- G Jayamadhury
- Department of Vitreoretina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
| | - Sudhakar Potti
- Department of Vitreoretina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
| | - K Vinaya Kumar
- Department of Vitreoretina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
| | - R Madhu Kumar
- Department of Vitreoretina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
| | - K C Divyansh Mishra
- Department of Vitreoretina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
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Kelkar A, Shah R, Vasavda V, Kelkar J, Kelkar S. Primary iris claw IOL retrofixation with intravitreal triamcinolone acetonide in cases of inadequate capsular support. Int Ophthalmol 2017; 38:111-117. [PMID: 28185180 DOI: 10.1007/s10792-017-0467-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the outcomes and analyze complication rates following primary iris claw IOL retrofixation with intravitreal triamcinolone acetonide. METHODS This is a retrospective interventional case series. Patients with poor capsular support-diagnosed preoperatively or owing to intraoperative complications-were treated with iris claw IOL retrofixation with intravitreal triamcinolone acetonide. The data were retrospectively analyzed. RESULTS 104 eyes of 102 patients with poor capsular support who underwent the procedure between 2010 and 2013 were analyzed. The minimum follow-up period was 12 months (ranging from 12 to 36 months). Iris claw IOL was implanted in-traumatic subluxated cataracts-24 cases (23.07%), non-traumatic subluxated cataracts in 16 cases (15.38%), or as a complication of cataract surgery-intraoperative posterior capsular rent in 48 cases (46.15%) and intraoperative nucleus drop in 16 cases (15.38%). The final mean best-corrected logMAR visual acuity improved from 1.36 ± 0.64 preoperatively to 0.36 ± 0.32 at 1-year follow-up. Complications included pupil ovalization in 11 cases (10.57%), transient elevation in intraocular pressure in 7 eyes (6.73%), postoperative hypotony in 5 eyes (4.80%), cystoid macular edema in 2 eyes (1.92%), retinal detachment in 1 eye (0.96%), vitreous hemorrhage in 1 eye (0.96%), and hyphema in 1 eye (0.96%). CONCLUSION Primary iris claw IOL retrofixation provided excellent alternative in patients with inadequate capsular support. The visual outcomes were good along with favorable rates of complications. The addition of triamcinolone acetonide helps in reducing the chances of cystoid macular edema.
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Affiliation(s)
- Aditya Kelkar
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India.
| | - Rachana Shah
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India
| | - Viraj Vasavda
- Raghudeep Eye Clinic, Near Shreeji Complex, Gurukul Road, Memnagar, Ahmedabad, Gujarat, 380052, India
| | - Jai Kelkar
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India
| | - Shreekant Kelkar
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India
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