1
|
Warren A, Kemp PS, Coussa RG, Cheng L, Boldt HC, Russell SR, Johnson AT, Oetting TA, Sohn EH. Comparative long-term outcomes of vitrectomy combined with anterior chamber intraocular lens to intra-scleral haptic fixation of posterior chamber intraocular lens. Int J Retina Vitreous 2024; 10:59. [PMID: 39187860 DOI: 10.1186/s40942-024-00572-2] [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: 04/08/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE To evaluate the long-term clinical outcomes in patients with combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) to intrascleral haptic fixation (ISHF) using the Agarwal technique with fibrin glue to secure the scleral flap of a posterior chamber intraocular lens. METHODS Retrospective, consecutive, single-center, comparative case series. 83 eyes were studied. Patients with < 8 months of follow-up were excluded. Detailed pre-, intra-, and post-operative complications were analyzed using mixed model univariate analysis and t-test. Pre- and post-operative best corrected visual acuity (BCVA) was analyzed. RESULTS Twenty-five subjects met entry criteria. Mean age at time of surgery was 70.4 ± 17.7 years in the ACIOL group (n = 12) and 54.6 ± 21.1 years in the ISHF group (n = 13; p = 0.03). Mean follow-up was 38.2 months. Incidence of corneal decompensation was similar in the ACIOL and ISHF lens group (p = 0.93). There was no difference in the BCVA mean change or cystoid macular edema (CME) at the final visit between the groups (p = 0.47; p = 0.08), but there was a trend toward increased CME in the ACIOL group. CONCLUSIONS PPV with concomitant placement of either ACIOL or ISHF lens result in improvement in BCVA. Both procedures are well tolerated and result in favorable outcomes with long-term follow-up though varying patient populations do not allow precise comparison between the two groups.
Collapse
Affiliation(s)
- Alexis Warren
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Pavlina S Kemp
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Razek G Coussa
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Liang Cheng
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - H Culver Boldt
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Stephen R Russell
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - A Tim Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Thomas A Oetting
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Elliott H Sohn
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA.
| |
Collapse
|
2
|
Aydin E, Kazanci L. Clinical outcomes of iris fixation and sutureless scleral fixation of dislocated foldable posterior chamber intraocular lenses. J Fr Ophtalmol 2024; 47:104237. [PMID: 38917616 DOI: 10.1016/j.jfo.2024.104237] [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: 11/18/2023] [Accepted: 01/25/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Explore the visual outcome and complications of iris fixation intraocular lenses (IFIOL) and sutureless scleral-fixated intraocular lenses (SSFIOL) in the surgical management of patients without exchanging dislocated posterior chamber intraocular lenses (PCIOLs) in the vitreous. METHODS Retrospectively, 14 IFIOL and 15 SSFIOL reimplantations for dislocated PCIOLs were analyzed. Mean follow-up of reIFIOL group and reSSFIOL group: 11.3±2.0 (range: 9-15) months and 11.8±2.2 (range: 9-16) months, respectively. Preoperative and postoperative outcomes, operative indications, and complications were evaluated. RESULTS Primary surgical indications were pseudoexfoliation (PXE) (21.4%), post-cataract surgery (PCS) (35.7%), trauma (42.8%) in the reIFIOL group, and PXE (26.6%), PCS (40%) trauma (33.3%) in reSSFIOL group, respectively. At the latest follow-up, there was an improvement in best-corrected visual acuity (BCVA) (0.053±0.051 to 0.53±0.13, P<0.0001) in reIFIOL group and (0.05±0.02 to 0.64±0.16, P<0.0001) in reSSFIOL group. Postoperative complications of reIFIOL group and reSSFIOL group included corneal edema (14.2%; nil), IOP elevation (21.4%; 7.1%), bullous keratopathy (14.2%; nil), anterior uveitis (35.7%; 13.3%), cystoid macular edema (CME) (21.4%; 7.1%), pupil ovalization (21.4%; nil), broken haptic (none; 13.3%), IOL exchange (nil; 13.3%), and vitreous hemorrhage (nil; 14.2%). CONCLUSIONS Self-dislocated IOL reimplantation may enable much earlier visual rehabilitation in the reSSFIOL group than in the reIFIOL group. Moreover, the 27G trocar-assisted reSSFIOL technique takes a shorter operation time and relatively lower complication rates. However, further prospective studies with larger series and longer follow-up periods are required.
Collapse
Affiliation(s)
- E Aydin
- Department of Ophthalmology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - L Kazanci
- Eye Clinic, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
3
|
Liu Z, Xie Q, Chen X, Xie B, Cai S. Effect of sutureless scleral fixed intraocular lens implantation on aphakic eyes: a system review and meta-analysis. BMC Ophthalmol 2023; 23:493. [PMID: 38053049 PMCID: PMC10698919 DOI: 10.1186/s12886-023-03223-6] [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: 03/09/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Sutureless scleral fixed intraocular lens implantation (SF-IOL) has become one of the mainstream schemes in clinical treatment of aphakic eyes because of its advantages, such as avoiding dislocation of intraocular lens or subluxation caused by suture degradation or fracture and significant improvement of postoperative visual acuity. However, a consensus on the relative effectiveness and safety of this operation and other methods is still lacking. This study aimed to compare the efficacy and safety of sutureless SF-IOL with other methods. Aphakia means that the lens leaves the normal position and loses its original function, including absence or complete dislocation and subluxation of the lens which could cause anisometropic amblyopia, strabismus, and loss of binocular function in children and adolescents. For adults, the loss of the lens could lead to high hyperopia and affect vision. Above all this disease can seriously affect the quality of life of patients. METHODS Literature about sutureless SF-IOL in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Technical Journal VIP database, and Wanfang database published from 2000 to 2022 was reviewed. The weighted average difference was calculated by RevMan5.3 software for analysis. Two researchers independently selected the study and used the Cochrane collaboration tool to assess the risk of errors. Cochrane bias risk tool was used to evaluate the quality of evidence. This study is registered on PROSPERO (CRD42022363282). RESULTS The postoperative IOL-related astigmatism of sutureless SF-IOL was lower than that of suture SF-IOL, and there was statistical difference when we compared the absolute postoperative spherical equivalent after sutureless SF-IOL and suture SF-IOL. Indicating that the degree of refractive error after sutureless SF-IOL was lower. Meanwhile, the operation time of sutureless SF-IOL was shorter than that of suture SF-IOL. The subgroup analysis showed that the absolute postoperative spherical equivalent and astigmatism values in Yamane technique were lower than those in suture SF-IOL. CONCLUSION Sutureless SF-IOL has the advantages of stable refraction, short operation time, and less postoperative complications. However, high-quality literature to compare these technologies is lacking. Some long-term follow-up longitudinal prospective studies are needed to confirm the findings.
Collapse
Affiliation(s)
- Zhao Liu
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
| | - Qian Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
| | - XingWang Chen
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
- Guizhou Eye Hospital, Zunyi, 563003, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China
| | - Bing Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
- Guizhou Eye Hospital, Zunyi, 563003, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China
| | - ShanJun Cai
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China.
- Guizhou Eye Hospital, Zunyi, 563003, China.
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China.
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China.
| |
Collapse
|
4
|
Sahin Vural G, Guven YZ, Karahan E, Zengin MO. Long term outcomes of Yamane technique in various indications. Eur J Ophthalmol 2023; 33:2210-2216. [PMID: 37038337 DOI: 10.1177/11206721231167198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
INTRODUCTION To describe the clinical and refractive outcomes of Yamane transconjunctival sutureless intrascleral intraocular lens (SIS IOL) fixation technique in aphakic and dislocated IOLs. METHODS The aphakic and IOL dispositioned patients who underwent Yamane surgery in Bozyaka Research and Training Hospital were evaluated retrospectively. The demographic data, preoperative & postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), indication for surgery, additional surgical interventions, complications, the final status of retina, and central macular thickness (CMT) through spectral-domain optic coherence tomography (SD-OCT) were recorded. RESULTS A total of 30 eyes of 30 patients were evaluated. The indication for surgery was aphakia in 24 patients, lens dislocation in 1 patient, and IOL dislocation in 5 patients. The mean age of participants was 64.17 ± 14.69 years, and the mean follow-up was 46.07 ± 7.96 months. The mean BCVA was improved from 0.25 ± 0.22 (-0.94 ± 0.83 log MAR) to 0.49 ± 0.24 in decimals (-0.37 ± 0.27 log MAR) (p:0.041). The mean subjective refraction improved from 10.06 ± 3.10 to -1.45 ± 0.73 D in the final visit (p < 0.05). The mean of cylindrical refraction was -1.22 ± 1.03 D in the postoperative period. At the time surgery, 36.6% of patients required at least one additional surgical procedure. During follow-up period, two (6.7%) out of 30 of patients had retinal detachment, two of the patients (6.7%) occured epiretinal membrane, one of the patients (3.3%) had cystoid macular edema. CONCLUSION Yamane SIS IOL fixation technique is an effective and reliable surgical option in complicated cases that require additional surgical interventions in long-term follow-up.
Collapse
Affiliation(s)
- Gozde Sahin Vural
- Department of Ophthalmology, Balıkesir University Medicine Faculty, Balıkesir, Turkey
| | - Yusuf Ziya Guven
- Department of Ophthalmology, Izmir Katip Celebi University, Izmir, Turkey
| | - Eyyup Karahan
- Department of Ophthalmology, Balıkesir University Medicine Faculty, Balıkesir, Turkey
| | | |
Collapse
|
5
|
Alshehri M, Bin Helayel H, Vargas JM, Almutlak M, Fairaq R. Preferred surgical techniques for secondary intraocular lens implantation in adults with aphakia. Int Ophthalmol 2023; 43:3539-3547. [PMID: 37356032 DOI: 10.1007/s10792-023-02761-8] [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: 02/21/2023] [Accepted: 05/21/2023] [Indexed: 06/27/2023]
Abstract
AIM To identify the current surgical management of aphakia and the outcomes and complications of each technique. METHODS This cross-sectional study included ophthalmic surgeons with at least one-year experience in surgery for aphakia. A study questionnaire was formulated to collect data in Saudi Arabia and other regional countries. The questionnaire included 22 questions on demographics, preferred surgical techniques, complications and the factors related to surgeon decision and the choice for managing aphakia. RESULTS The study included 145 participants (111; 76.6% were males) with mean age of 46.7 ± 11.5 years. The mean duration of cataract surgery experience was 17.6 ± 11.1 years. Most participants (86.2%) were trained in cataract surgery. Scleral fixation of intraocular lens (SFIOL) was the most commonly preferred technique, followed by iris fixation IOL, and anterior chamber IOL (75.2%, 9%, and 15.9%, respectively). The main determinants for selection of a surgical technique were simplicity (56.6%), surgical instrument availability (48.3%), and training on the technique (47.6%). The most frequent postoperative complications were pupil distortion, high intraocular pressure (IOP), pupillary capture of the IOL, and IOL decentration. CONCLUSIONS SFIOL is the preferred surgical technique for managing aphakia. The decision to choose one technique over another is complex and is based on several factors, including technical difficulty, previous training, anatomical variations, ocular comorbidities, and the potential complications. The most frequent complications after surgical correction of aphakia are pupil distortion, high IOP, pupillary capture of the IOL, and decentered IOLs.
Collapse
Affiliation(s)
- Mohammed Alshehri
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia
- Anterior Segment Division, King Faisal Medical City, Abha, Saudi Arabia
| | - Halah Bin Helayel
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia
| | - José Manuel Vargas
- Ophthalmology Division, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Mohammed Almutlak
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia
| | - Rafah Fairaq
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia.
| |
Collapse
|
6
|
Trans-Scleral Plugs Fixated FIL SSF IOL: A Review of the Literature and Comparison with Other Secondary IOL Implants. J Clin Med 2023; 12:jcm12051994. [PMID: 36902780 PMCID: PMC10004107 DOI: 10.3390/jcm12051994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications.
Collapse
|
7
|
Garg A, Lau THA, Popovic MM, Kertes PJ, Muni RH. Sutured Scleral-Fixated Versus Anterior Chamber Intraocular Lens Implantation: A Meta-Analysis. Ophthalmic Surg Lasers Imaging Retina 2022; 53:12-21. [PMID: 34982000 DOI: 10.3928/23258160-20211213-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE No consensus exists on the comparative efficacy and safety of sutured scleral-fixated (SSF) and anterior chamber (AC) intraocular lens (IOL) implantation. We aim to compare outcomes of these two techniques. PATIENTS AND METHODS A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was conducted (2005 to 2020). Studies comparing SSFIOLs with ACIOLs were included. Outcomes included corrected distance visual acuity and complications. A meta-analysis was conducted with a random effects model. Weighted mean differences and risk ratios with 95% CIs were computed. RESULTS Seven hundred eighty-three eyes from nine studies were included. SSFIOLs had a significantly higher absolute postoperative spherical equivalent (weighted mean difference, 0.32; 95% CI, 0.03 to 0.60; P = .03; low certainty) and incidence of IOL decentration/subluxation (risk ratio, 2.69; 95% CI, 1.03 to 7.01; P = .04; moderate certainty) than ACIOLs. There was no difference in final corrected distance visual acuity (P = .26). CONCLUSIONS SSFIOLs have a higher absolute postoperative spherical equivalent and incidence of IOL decentration/subluxation than ACIOLs. Future prospective studies are needed to confirm these findings. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:12-21.].
Collapse
|
8
|
Sahoo S, Parida P, Mohanty A, Das S, Mohamed A, Sahu SK. Outcome of four-point fixated open loop polymethyl methacrylate anterior chamber intraocular lens. Int Ophthalmol 2021; 42:1051-1059. [PMID: 34792708 DOI: 10.1007/s10792-021-02089-1] [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: 06/04/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To study long-term visual and refractive outcomes and complications in eyes with anterior chamber intraocular lens (ACIOL) implantation. METHODS Data of patients who underwent primary and secondary ACIOL implantation at L V Prasad Eye Institute, Bhubaneswar between 2011 and 2020 was collected, including details of post-operative visits. For analysis, sample was divided into: group Ia (primary ACIOL in cases without risk factors, n = 104); group Ib (primary ACIOL in cases with pre-existing risk factors, n = 49); and group II (secondary ACIOL, n = 40). RESULTS A total of 193 eyes of 192 patients were included. Mean post-operative follow-up in groups I and II were 8.6 and 11.51 months, respectively. Mean pre-operative and last visit corrected distance visual acuity were 1.73 ± 0.11 and 0.42 ± 0.05 logMAR units in group Ia (p < 0.001), and 1.53 ± 0.14 and 0.49 ± 0.10 logMAR units in group Ib (p < 0.001). The mean spherical equivalent (MSE) for last refraction was -0.37 ± 0.18 diopters (D) and -0.15 ± 0.51 D in groups I and II, respectively. Of 76 eyes in which addition of 2.5 D (over the near emmetropic posterior chamber intraocular lens power) was taken for ACIOL, 40 (52.6%) had MSE within ± 0.5 D. Most common complications were transient corneal edema and anterior chamber reaction. Eyes on anti-glaucoma medications at last visit were eight (7.7%), 15 (30.6%), and two (5.0%) in groups Ia, Ib, and II, respectively. CONCLUSION We observed that ACIOLs have good visual and refractive outcomes. Raised IOP is a concern in eyes with pseudoexfoliation, but can be managed with close monitoring. Hence ACIOL can be a good option for managing aphakia after cataract surgery.
Collapse
Affiliation(s)
- Sonali Sahoo
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| | - Priyadarsini Parida
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| | - Amrita Mohanty
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India.
| |
Collapse
|
9
|
Ranno S, Rabbiolo GM, Lucentini S, Ruggiero E, Luccarelli SV, Lombardi L, Nucci P. Angle-supported intraocular lens versus scleral-sutured posterior chamber intraocular lens in post-cataract surgery aphakic patients: two-year follow-up cost-effectiveness analysis. Int Ophthalmol 2021; 42:871-879. [PMID: 34779973 DOI: 10.1007/s10792-021-02068-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare visual, anatomical and economical outcomes of patients with secondary anterior chamber intraocular lens (AC-IOL) implantation and secondary scleral fixated intraocular lens (SF-IOL) implantation. METHODS In this retrospective observational study, 38 aphakic patients after complicated phacoemulsification divided in two groups, AC-IOL group (17 patients receiving AC-IOL implantation) and SF-IOL group (21 patients receiving SF-IOL implantation). Corrected distance visual acuity (CDVA), patient reported visual outcome (VF-14) and endothelial cell density (ECD) were measured at baseline and two-year follow-up. Complication rate was registered. The global cost of each procedure and the incremental cost-effectiveness ratio (ICER) were calculated. RESULTS No statistically significant difference was found in CDVA (logMAR 0.24 ± 0.17 vs. 0.32 ± 0.26, p = 0.27), VF-14 (68 ± 18 vs. 61 ± 20, p = 0.24), ECD (1456.48 ± 525.15 vs. 1341.71 ± 374.33, p = 0.48) and overall complication rate (p = 0.79) postoperatively between the SF-IOL group and the AC-IOL group. The ECD loss rate was significantly higher in the AC-IOL group (15.5% vs. 3.5%, p = 0.004). The average global cost of the two procedures was higher in the SF-IOL group (p < 0.005) and ICER showed an additional payment of 693 € for each patient in SF-IOL group against a saving of 186 endothelial cells 2 years postoperatively. CONCLUSION AC IOL and SF-IOL implantation showed similar outcomes in terms of visual function and safety profile. Higher ECD loss was found in AC-IOL group. The global cost of implantation was significantly lower for AC-IOL, but the ICER seems to justify the SF-IOL implantation in patients with low ECD.
Collapse
Affiliation(s)
- Stefano Ranno
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy.
| | - Giovanni Mario Rabbiolo
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy
| | - Stefano Lucentini
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy
| | - Edoardo Ruggiero
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy
| | - Saverio Vincenzo Luccarelli
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy
| | - Linda Lombardi
- Plannin & Control Department, San Giuseppe Hospital, IRCCS MultiMedica, Milan, Italy
| | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Shahid SM, Flores-Sánchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, Charteris DG. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond) 2021; 35:2930-2961. [PMID: 34117388 PMCID: PMC8526814 DOI: 10.1038/s41433-021-01571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/08/2022] Open
Abstract
Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.
Collapse
Affiliation(s)
- S M Shahid
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK.
| | | | - E W Chan
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - R Anguita
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - S N Ahmed
- Ophthalmology Department, Northampton General Hospital, Cliftonville, Northampton, UK
| | - L Wickham
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - D G Charteris
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
11
|
Vaiano AS, Hoffer KJ, Greco A, Greco A, D'Amico G, Pasqualitto V, Carlevale C, Savini G. Long-term Outcomes and Complications of the New Carlevale Sutureless Scleral Fixation Posterior Chamber IOL. J Refract Surg 2021; 37:126-132. [PMID: 33577699 DOI: 10.3928/1081597x-20201207-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcomes and possible complications of a new foldable sutureless scleral fixation intraocular lens (SSF-IOL), the Carlevale IOL (Soleko). METHODS The SSF-IOL, which has two T-shaped self-blocking plugs on each haptic, was inserted into the posterior chamber. Both haptics was grabbed through two sclerotomies and the two short arms were blocked under the scleral flap, without any suture. A complete clinical evaluation was done preoperatively and at 3, 6, and 12 months postoperatively. RESULTS A total of 54 eyes of 50 consecutive patients were retrospectively analyzed. The mean corrected distance visual acuity was 0.93 ± 0.61 logMAR preoperatively and improved to 0.42 ± 0.34 logMAR at 3 months, 0.42 ± 0.37 logMAR at 6 months, and 0.38 ± 0.38 logMAR at 12 months postoperatively (all P < .0001). The mean corneal endothelial cell density decreased from 1,725.37 ± 528.06 to 1,612.81 ± 522.91 cells/mm2 at 12 months postoperatively (P < .0001). The mean IOL tilt value was 3.1 ± 1.1° at 12 months postoperatively. The authors observed 6 cases (11.1%) of intraoperative rupture of the IOL haptics, 4 cases (7.4%) of early hyphema, 4 cases (7.4%) of macular cystoid edema, 2 cases (3.7%) of haptic exposure under the conjunctiva, and 1 (1.8%) late retinal detachment. CONCLUSIONS This newly introduced surgical technique provided promising results regarding efficacy and safety. Complications occurred in a few cases and were successfully managed. The Carlevale IOL seems to be a surgical solution combining the advantages of an easy and minimally invasive implantation with a good functional recovery with minimal complications. [J Refract Surg. 2021;37(2):126-132.].
Collapse
|
12
|
Forlini M, Bedi R. Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses. J Cataract Refract Surg 2021; 47:792-801. [PMID: 33278236 DOI: 10.1097/j.jcrs.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Cataract surgery via phacoemulsification with intraocular lens (IOL) placement in the capsular bag is the gold standard in the presence of adequate capsular support. However, when capsule and/or zonular fibers are weak or absent, alternate fixation strategies are required. Common alternative options include retropupillary iris-claw IOLs (RP-IC IOLs) and scleral-fixated IOLs (SF IOLs). In the present review of 87 articles with 2174 eyes implanted with RP-IC IOLs and 2980 eyes with SF IOLs, we discuss the published literature with respect to safety and efficacy. Although the studies reporting outcomes of these IOLs have been performed in patients with different concomitant conditions, visual and refractive outcomes were found to be comparable between RP-IC IOLs and SF IOLs. RP-IC IOL implantation seemed to provide equivalent or a potentially lower rate of complications than SF IOL implantation. Data from the literature also suggest that the surgical technique of RP-IC IOL implantation is relatively simpler with correspondingly shorter surgical times.
Collapse
Affiliation(s)
- Matteo Forlini
- From the Domus Nova Hospital, Ravenna, Italy (Forlini); Iris Advanced Eye Center, Chandigarh, India (Bedi)
| | | |
Collapse
|
13
|
A Review and Update on Surgical Management of Intraocular Lens Dislocation. Int Ophthalmol Clin 2021; 61:15-28. [PMID: 33337791 DOI: 10.1097/iio.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Mahapatra SK, Mannem N. Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens. Indian J Ophthalmol 2021; 69:1404-1408. [PMID: 34011709 PMCID: PMC8302310 DOI: 10.4103/ijo.ijo_2192_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens. Methods: In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted. Results: Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases. Conclusion: Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.
Collapse
Affiliation(s)
- Santosh K Mahapatra
- Chief Medical Officer and Vitreoretinal Surgeon, Department of Vitreoretina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack, Odisha, India
| | - Navya Mannem
- Opthalmology Resident, Department of Vitreoretina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack, Odisha, India
| |
Collapse
|
15
|
Pineda-Fernández A, Chen Y, Rodriguez L. Transfixion of Foldable Intraocular Lens With Polytetrafluoroethylene Suture for Scleral Fixation. J Refract Surg 2021; 37:180-185. [PMID: 34038296 DOI: 10.3928/1081597x-20201222-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a new scleral fixation technique potentially usable for every acrylic foldable intraocular lens (IOL) available in the market, regardless of whether it is a three-piece, single-piece, or haptic shape. METHODS Before surgery, the authors performed the transfixion of the IOL optic in four points with the polytetrafluoroethylene suture under a surgical microscope. Four sclerotomy sites were marked 2 mm from the limbus, and two scleral grooves were created in between. The IOL was introduced into the posterior chamber. The four ends of the needleless polytetrafluoroethylene sutures were externalized through the sclerotomies, tightened for optimum IOL centration, and tied. The exposed sutures were placed within the scleral grooves, and the knots were buried within the sclerotomies. This technique was performed uneventfully in 7 cases. RESULTS The foldable IOL was stable in all eyes 6 months after surgery, with no signs of IOL subluxation, dislocation, tilt, or suture-related complications, such as erosion or infection. CONCLUSIONS The transfixion of the foldable posterior chamber IOL for stable four-point scleral fixation using a polytetrafluoroethylene suture provides excellent stability and prevents IOL tilt and decentration. This technique can immensely benefit patients requiring secondary foldable posterior chamber IOL implantation in the absence of capsular support. [J Refract Surg. 2021;37(3):180-185.).
Collapse
|
16
|
Wong HM, Kam KW, Rapuano CJ, Young AL. A Systematic Review on Three Major Types of Scleral-Fixated Intraocular Lens Implantation. Asia Pac J Ophthalmol (Phila) 2021; 10:388-396. [PMID: 33481393 DOI: 10.1097/apo.0000000000000369] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. DESIGN Systematic review. METHODS We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. RESULTS Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. CONCLUSIONS Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.
Collapse
Affiliation(s)
- Ho Ming Wong
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, US
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| |
Collapse
|
17
|
Choi EY, Lee CH, Kang HG, Han JY, Byeon SH, Kim SS, Koh HJ, Kim M. Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation. Sci Rep 2021; 11:726. [PMID: 33436860 PMCID: PMC7804091 DOI: 10.1038/s41598-020-80292-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P < 0.001), compared to the preoperative value. IOP (− 2.3 mmHg, P = 0.008) and ECC (− 333.4 cells/mm2, P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.
Collapse
Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Chul Hee Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea.
| |
Collapse
|
18
|
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]
|
19
|
Outcomes and complications in scleral-fixated intraocular lens implantations. Int Ophthalmol 2020; 40:2969-2977. [PMID: 32613460 DOI: 10.1007/s10792-020-01480-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study compares outcomes and complications of scleral-fixated intraocular lens implantation between 2 levels of surgeons. METHODS A retrospective case series of patients undergoing scleral-fixated intraocular lens implantation at Prince of Wales Hospital, Hong Kong, between May 2012 and April 2017 were reviewed. Data collected included age, gender, affected eye, preoperative and postoperative visual acuities, refractive target and outcome, surgeon profile, operative details including method of scleral fixation, intraoperative and postoperative complications and length of follow-up. RESULTS Ninety eyes of 90 patients were included for analyses. The mean LogMAR visual acuities were 1.17 ± 0.70 at postoperative week 1, 0.81 ± 0.56 at 1 month, 0.66 ± 0.55 at 3 months, 0.56 ± 0.59 at 6 months, and 0.51 ± 0.60 at 1 year, respectively. After adjusting for age at operation, operative time, axial length, subspecialty of the surgeon and preoperative LogMAR, surgeon seniority was not significantly associated with final visual outcomes. There was no statistically significant difference between the mean improvement in visual acuities between eyes operated by consultants and fellows under direct supervision of a senior surgeon. CONCLUSION Scleral-fixated intraocular lens implantation is safe and effective in improving visual acuity in aphakic adults without capsular support. Under good supervision, fellows were able to produce comparable results compared with experienced specialists.
Collapse
|
20
|
PARS PLANA VITRECTOMY WITH ANTERIOR CHAMBER VERSUS GORE-TEX SUTURED POSTERIOR CHAMBER INTRAOCULAR LENS PLACEMENT: Long-Term Outcomes. Retina 2020; 39:860-866. [PMID: 29346243 DOI: 10.1097/iae.0000000000002042] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare clinical outcomes of combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) placement versus scleral fixation of a posterior chamber intraocular lens (PCIOL) using Gore-Tex suture. METHODS Retrospective, interventional case series of eyes undergoing combined PPV and IOL placement for retained lens material, aphakia, or dislocated IOL. Eyes with history of amblyopia, corneal opacity, retinal, or optic nerve disease were excluded. Outcome measures were change in visual acuity and occurrence of postoperative complications with minimum follow-up of 1 year. RESULTS Sixty-three eyes of 60 patients were identified. Thirty-three eyes underwent combined PPV and ACIOL placement and 30 eyes underwent combined PPV and scleral fixation of a PCIOL using Gore-Tex suture. Mean follow-up was 502 ± 165 days (median 450, range 365-1,095 days). In the ACIOL group, mean visual acuity improved from 20/914 preoperatively to 20/50 postoperatively (P < 0.001). In the scleral-fixated PCIOL group, mean visual acuity improved from 20/677 preoperatively to 20/46 postoperatively (P < 0.001). No difference in visual acuity was noted between groups at 1-year (P = 0.91) or final follow-up (P = 0.62). Regarding postoperative complications, eyes undergoing ACIOL placement had a significantly higher rate of transient corneal edema (30.3 vs. 6.7%, P = 0.02) compared with eyes undergoing scleral fixation of a PCIOL. CONCLUSION Combined PPV with ACIOL placement or scleral fixation of a PCIOL with Gore-Tex suture were well tolerated. The techniques resulted in similar visual outcomes at minimum follow-up of 1 year.
Collapse
|
21
|
Mastromonaco C, Balazsi M, Saheb N, Salimi A, Burnier MN. Histopathological changes in the anterior segment with anterior and posterior chamber intraocular lens. Can J Ophthalmol 2020; 55:437-444. [PMID: 32585141 DOI: 10.1016/j.jcjo.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Patients have shown a lowering of intraocular pressure (IOP) after cataract surgery. Histopathology studies have reported trabecular meshwork (TM) changes in pseudophakic eyes with posterior chamber intraocular lens (PCIOL) and have eluded to the mechanisms for IOP decrease. Unlike PCIOLs, TM histopathology changes after implantation of an anterior chamber intraocular lens (ACIOL) have not been studied, to our knowledge. Therefore, this study aims to examine the histopathological changes in both the TM and corneal endothelium among donor eyes with ACIOL, PCIOL, and phakic eyes. METHODS Forty fixed postmortem donor eyes were obtained, sectioned, and embedded. Slides were stained with Masson's trichrome and CD31 vascular endothelial antibody, and further digitalized. Customized Medical Parachute TMAN software quantified the cellular components, the trabecular extracellular matrix (ECM), ECM fibrosis, and trabecular area. Schlemm's canal and corneal endothelium were quantified across the ACIOL, PCIOL, and phakic groups. RESULTS Cellular area component of the TM was lower in the ACIOLs and PCIOLs than in phakic eyes, but statistically significant only between PCIOL and phakic eyes (p = 0.0023). ECM area component, TM fibrosis score and TM lamellae area, ciliary process fibrosis, and CD31 expression in Schlemm's canal showed no differences (p = 0.40, 0.99, 0.10, 0.83, 0.45). Significantly lower corneal endothelial cells were seen in ACIOLs compared with both PCIOLs and phakic eyes (p = 0.0002). CONCLUSIONS ACIOLs and PCIOLs in our sample group showed that there is loss of cellular components in the TM compared with the phakic eyes, with PCIOLs displaying the least amount of TM cells statistically, in this cohort. The ACIOLs led to a greater loss of corneal endothelial cells than both PCIOLs and phakic eyes after cataract surgery. The endothelial cells in Schlemm's canal did not seem to be affected by the IOL placements. Therefore, this study illustrates that there are histopathological differences seen with the placements of ACIOLs in both TM and cornea.
Collapse
Affiliation(s)
- Christina Mastromonaco
- Ocular Pathology Laboratory, Department of Pathology and Ophthalmology, The MUHC-McGill University, Montreal, Que.
| | - Matthew Balazsi
- Department of Ophthalmology, Faculty of Medicine, Montreal, Qc, Canada
| | - Nabil Saheb
- Ocular Pathology Laboratory, Department of Pathology and Ophthalmology, The MUHC-McGill University, Montreal, Que
| | - Ali Salimi
- Ocular Pathology Laboratory, Department of Pathology and Ophthalmology, The MUHC-McGill University, Montreal, Que; Department of Ophthalmology, Faculty of Medicine, Montreal, Qc, Canada
| | - Miguel N Burnier
- Ocular Pathology Laboratory, Department of Pathology and Ophthalmology, The MUHC-McGill University, Montreal, Que
| |
Collapse
|
22
|
Artisan iris-claw intraocular lens implantation in vitrectomised eyes. Eye (Lond) 2020; 35:1393-1397. [PMID: 32555519 DOI: 10.1038/s41433-020-1022-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To present the visual acuity (VA) results and complication rates following Artisan intraocular lens (IOL) insertion in vitrectomised eyes. METHODS Outcome data were collected for all vitrectomised patients who had undergone Artisan IOL insertion between January 2014 and May 2019 at Moorfields Eye Hospital. All those with follow-up greater than 2 months were included in the analysis. RESULTS Sixty-nine eyes from 61 patients were included. Average follow up was 2 years. Fifty-five (80%) eyes had at least one ocular comorbidity prior to Artisan IOL insertion. At final follow up 46 (67%) eyes had best-corrected VA better than 6/12. Sixty-three eyes (91%) either gained or maintained VA. Mean post-operative spherical equivalent was -0.2D. Two (3%) lenses became de-enclavated requiring further surgery. Two (3%) eyes developed acute post-operative cystoid macular oedema. Two (3%) required additional topical IOP-lowering therapy to their pre-operative glaucoma regimen. One eye had mild corneal oedema, which persisted for 1 year following surgery and subsequently resolved. CONCLUSIONS Artisan IOL insertion is a safe and effective option for the surgical correction of aphakia in vitrectomised eyes lacking capsular support. Refractive results comparable to posterior chamber IOL placement can be achieved with these lenses.
Collapse
|
23
|
Intraocular Lens Implantation in the Absence of Zonular Support: An Outcomes and Safety Update: A Report by the American Academy of Ophthalmology. Ophthalmology 2020; 127:1234-1258. [PMID: 32507620 DOI: 10.1016/j.ophtha.2020.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review the published literature on the visual acuity results and complications of different surgical techniques for intraocular lens (IOL) implantation in the absence of zonular support. METHODS Peer-reviewed literature searches were conducted last in PubMed and the Cochrane Library in July 2019. The searches yielded 734 citations of articles published in English. The panel reviewed the abstracts of these mostly retrospective case series studies, and 45 were determined to be relevant to the assessment objectives. Three articles were rated as level II evidence, and 42 articles were rated as level III evidence. RESULTS Eight different types of IOL fixation techniques with at least 6-month follow-up were evaluated: anterior chamber IOL (ACIOL), iris-claw IOL, retropupillary iris-claw IOL, 10-0 polypropylene iris-sutured posterior chamber IOL (PCIOL), 10-0 polypropylene scleral-sutured PCIOL, 8-0 polypropylene scleral-sutured PCIOL, CV-8 polytetrafluoroethylene, and intrascleral haptic fixation (ISHF). Eight articles reported data comparing 2 techniques. The 45 studies had insufficient statistical power to compare the techniques conclusively. A qualitative analysis of similar types showed that trends in visual acuity outcomes were not inferior to those of ACIOL implantation, but the severity of preoperative pathologic features was not controlled for. Compared with ACIOL, complications of cystoid macular edema were higher in 10-0 polypropylene iris-sutured PCIOL and 8-0 polypropylene scleral-sutured PCIOL. Non-anterior chamber IOL techniques were less likely to report chronic uveitis. Chronic glaucoma was highest in the 8-0 polypropylene scleral-sutured PCIOL group. Although retinal detachment was infrequent overall, it was twice as common in both iris- and scleral-sutured PCIOLs (except CV-8 polytetrafluoroethylene suture) compared with nonsutured methods: ACIOL, iris-clipped IOL, and ISHF PCIOL. CONCLUSIONS The evidence reviewed shows no superiority of any single IOL implantation technique in the absence of zonular support. The various techniques seem to have equivalent visual acuity outcomes and safety profiles. Each technique has its own profile of inherent risk of postoperative complications. Surgeons must educate patients on the importance of close, long-term follow-up as a result of the uncertain nature of these techniques. Large prospective studies are needed to confirm the long-term complication profiles of these various IOL implantation techniques.
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Veronese C, Maiolo C, Armstrong GW, Primavera L, Torrazza C, Della Mora L, Ciardella AP. New surgical approach for sutureless scleral fixation. Eur J Ophthalmol 2020; 30:612-615. [DOI: 10.1177/1120672120902020] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The aim of this article is to describe a novel surgical technique for sutureless scleral fixation of an intraocular lens using the newly developed FIL SSF Carlevale IOL (Soleko, Italy). Methods: Four eyes of four patients with poor capsular support were recruited to our study, three resulting from intraocular lens subluxation and one case resulting from traumatic cataract. A novel sutureless sclera-fixated intraocular lens was implanted into the posterior chamber of each eye with sclerocorneal plugs fixating the lens to the wall of the eye. Results: Mean age of patients was 52 ± 16 years, ranging from 35 to 70 years. Mean follow-up was 6.50 ± 1.29 months (range: 5–7 months). Mean preoperative best-corrected visual acuity was 0.50 ± 0.33 logMAR (range: 1–0.3 logMAR). Postoperative best-corrected visual acuity improved to 0.08 ± 0.08 logMAR (range: 0.2–0 logMAR). There was no significant change in the mean intraocular pressure and there were no postoperative complications, such as iatrogenic distortion or breakage of the intraocular lens haptic, intraocular lens decentration, endophthalmitis, or retinal detachment. Discussion: To the best of our knowledge, this is the first report of outcomes using the novel sutureless sclera-fixated FIL SSF Carlevale IOL. This new surgical technique offers a simplified and effective approach for sutureless scleral intraocular lens fixation with good refractive outcomes.
Collapse
Affiliation(s)
- Chiara Veronese
- Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Grayson W Armstrong
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Carlo Torrazza
- Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Antonio P Ciardella
- Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
26
|
Castanos MV, Najac T, Dauhajre J, Buxton DF. Late intraocular Lens dislocation following scleral depression: a case report. BMC Ophthalmol 2020; 20:39. [PMID: 32000720 PMCID: PMC6990508 DOI: 10.1186/s12886-020-1327-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background The case describes a rare entity. Most cases of IOL dislocation are associated with surgical trauma or preexisting zonulopathy. This patient presents IOL dislocation following routine exam, suggesting the need of careful evaluation of zonular integrity on pseudopahkic patients. Methods Patient is a 65 year old who presented with sudden loss of vision and pain following retinal examination using scleral depression. Patient was diagnosed with late intraocular lens dislocation, which was subsequently for proper repositioning of IOL. Conclusion Pseduophakic eyes should be approached with caution when scleral indentation is attempted due to the possibility of zonular dehiscence and subsequent intraocular lens dislocation.
Collapse
Affiliation(s)
- Maria V Castanos
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA.
| | - Tyler Najac
- Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Jacqueline Dauhajre
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| | - Douglas F Buxton
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW To review current, effective and more popular techniques for scleral fixation of intraocular lens (IOLs) and IOL-capsular bag complex. RECENT FINDINGS Scleral fixation of IOLs became popular, originally with sutured scleral fixated IOLs and later the Scharioth technique of intrascleral haptic fixation. This was further developed as the Glued IOL technique which enjoys widespread adoption all over the world. Recently the Yamane technique has also become popular and is being widely adopted as well. SUMMARY Scleral fixated IOLs have evolved in the last 2 decades with technical modifications, extended indications and improvised instrumentation. Though sutured and sutureless techniques have been growing equally, the sutureless scleral fixation techniques have attracted special interest. Reduced suture-related complications, technical ease and high-quality functional outcomes may be possible reasons. Sutureless capsular bag fixation also has distinct advantages.
Collapse
|
28
|
Brunin G, Sajjad A, Kim EJ, Montes de Oca I, Weikert MP, Wang L, Koch DD, Al-Mohtaseb Z. Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg 2019; 43:369-376. [PMID: 28410720 DOI: 10.1016/j.jcrs.2016.12.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/09/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. SETTING Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN Retrospective case series. METHODS All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. RESULTS The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. CONCLUSIONS When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.
Collapse
Affiliation(s)
- Greg Brunin
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ahmar Sajjad
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Kim
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ildamaris Montes de Oca
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Mitchell P Weikert
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Douglas D Koch
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Zaina Al-Mohtaseb
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
29
|
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.
Collapse
Affiliation(s)
| | | | | | - Serra Arf
- İstanbul Retina Institute, İstanbul, Turkey
| | | |
Collapse
|
30
|
Bedda AM, ElGoweini HF, Abdelhadi AM, Elhady AM. Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation. Int J Ophthalmol 2019; 12:1283-1289. [PMID: 31456918 DOI: 10.18240/ijo.2019.08.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens (PCIOL) implantation in aphakic eyes with insufficient or no capsular support. METHODS A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure (IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy (UBM) was done for 10 cases to evaluate optic tilt. RESULTS The study evaluated 42 eyes of 42 patients. The follow-up period was 6mo. Improvement of best corrected visual acuity (BCVA) one line occurred in 10 cases (23.8%) and loss of one line in 3 cases (7.1%). Intraoperative complications included: haptic kink in 4 cases (9.5%), haptic breakage in 1 case (2.4%), haptic dislocation in 1 case (2.4%), haptic slippage in 3 cases (7.1%), IOL dislocation in 1 case (2.4%) and sclerotomy related bleeding in 1 case (2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases (7.1%), choroidal detachment in 1 case (2.4%), cystoid macular edema (CME) in 1 case (2.4%), optic capture in 1 case (2.4%), subconjunctival haptic in 2 cases (4.8%), ocular hypotony in 4 cases (9.5%) and ocular hypertension in 1 case (2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases (30%). CONCLUSION Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus-provided axial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6mo.
Collapse
Affiliation(s)
- Ahmed M Bedda
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Hesham F ElGoweini
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Ahmed M Abdelhadi
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Amr M Elhady
- Department of Ophthalmology, the General Ophthalmology Hospital, Alexandria 21515, Egypt
| |
Collapse
|
31
|
Demir G, Sucu ME, Yildirim Y, Kepez Yildiz B, Agca A, Alagoz N. The effects of complicated cataract surgery on iris structure and anterior chamber angle. J Fr Ophtalmol 2019; 42:829-833. [PMID: 31200981 DOI: 10.1016/j.jfo.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate iris structure in aphakic eyes scheduled for placement of a secondary intraocular lens. METHODS Twenty-eight aphakic eyes of 28 patients who were scheduled for secondary intraocular lens implantation between January 2012 and January 2017 at Beyoglu Eye Training and Research Hospital after a complicated cataract surgery were recruited in this study. The phakic fellow eyes of the patients were defined as a control group. Iris thickness was assessed using anterior segment optical coherence tomography at 750μm (IT750) and 2000μm (IT2000) from the scleral spur. Moreover, maximum iris thickness (ITM) and anterior chamber angle parameters such as trabecular iris surface area at 500 and 750μm (TISA500, TISA750), angle opening distances at 500 and 750μm (AOD500, AOD750) and anterior chamber depth (ACD) were also evaluated. RESULTS Mean IT750, IT2000 and ITM readings and were significantly lower in the aphakic eyes compared to the healthy eyes (P=0.04, P=0.01, P=0.01 respectively). Anterior chamber parameters (TISA500, TISA750, AOD500 and AOD750) and ACD were significantly increased in aphakic eyes following complicated cataract surgery compared to healthy fellow eyes (all P<0.001). CONCLUSIONS Complicated cataract surgery leading to aphakia results in decreased iris thickness and increased anterior chamber depth. These findings might be helpful in the selection of the type of surgery for placement of a secondary IOL.
Collapse
Affiliation(s)
- G Demir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey.
| | - M E Sucu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Y Yildirim
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - B Kepez Yildiz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - A Agca
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - N Alagoz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| |
Collapse
|
32
|
Li B, Zhang Y, Gao X. Simple Technique for Transscleral Fixation of a Foldable Posterior Chamber Intraocular Lens Using a Single Suture. J INVEST SURG 2019; 33:446-452. [PMID: 30884995 DOI: 10.1080/08941939.2018.1535011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To explore the simplified technique for transscleral fixation of a foldable posterior chamber intraocular lens (IOLs) in patients with aphakia or inadequate posterior capsule support. Methods: A review was conducted of 18 eyes of eighteen patients with the absence of-or inadequate-capsule support, after the simplified technique of using a foldable posterior chamber intraocular lens (PC IOLs) with stable four-point transscleral fixation, as performed by a skilled surgeon. This technique uses only a single suture and a knot to fix a PC IOL firmly without creating a scleral flap. The mean follow-up time was 18 ± 5.8 months (ranging from 12 to 24 months). Results: All patients exhibited improved visual acuity. No IOL tilt or dislocation or iris capture was observed, and all patients exhibited stable and centered IOL after surgery. No complex complications, such as suture shedding and exposure, corneal endothelial decompensation, persistent uveitis, or retinal detachment and endophthalmitis were observed. Conclusion: The simplified technique proposed here is a reliable, economical, and reproducible method of treating patients with aphakia or inadequate posterior capsule support. It provides excellent IOL stability, reduces surgical duration and complexity, and prevents certain complications.
Collapse
Affiliation(s)
- Baojiang Li
- Department of Opthalmic Center, the 474th Hospital of Chinese PLA, XinJiang, China
| | - Yangjing Zhang
- Department of Opthalmic Center, the 474th Hospital of Chinese PLA, XinJiang, China
| | - Xiaowei Gao
- Department of Opthalmic Center, the 474th Hospital of Chinese PLA, XinJiang, China
| |
Collapse
|
33
|
Khatri A, Singh S, Rijal R, Khatri BK, Kharel M. 27-gauge needle-assisted externalization and haptic securing technique for sutureless scleral fixation of the intraocular lens - moving toward simplicity. Clin Ophthalmol 2018; 12:1441-1447. [PMID: 30147296 PMCID: PMC6097516 DOI: 10.2147/opth.s166354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To report a modified technique of sutureless intrascleral fixation of a posterior chamber intraocular lens with use of instruments of anterior segment surgery and its outcomes. Design Prospective, noncomparative, interventional case series. Participants Ninety-two eyes of 92 patients with aphakia and subluxated lens who underwent surgery were evaluated. Materials and methods 27-gauge needles were introduced transclerally and guided by the viscocanula to externalize via the main wound. The haptics were loaded into the lumen and externalized from entry points. The haptics were then fixed in a scleral tunnel made by a 27-gauge needle. The best-corrected visual acuity (BCVA) and complications were determined. Results Ninety two eyes which were operated and completed follow-up of 6 weeks were included in the study. The most common indications for scleral-fixated intraocular lens (SFIOL) were subluxated lens – 55 eyes (59%), and surgical aphakia – 31 eyes (34%). Sixty-nine eyes (75.7%) had a postoperative vision of uncorrected visual acuity of 6/18 on day 1. There was an improvement in mean logMAR BCVA (0.086±0.18) at 6 weeks as compared to preoperative visual acuity (p<0.05). BCVA of 6/12 or better was attained in 94% of the cases at 6 weeks. Special mentions need to be made for 6 (7%) of our cases. Three of the patients were cases of fully treated postoperative endophthalmitis who lacked capsular support. Two of the other cases had undergone pars plana vitrectomy for retinal detachment. Both had silicon oil removal done 1 month before the SFIOL procedure. One of the patients had Marfan’s syndrome. Conclusion Our procedure is safe, easy, less traumatic, and less resource-demanding with good visual outcomes and can be performed even in low-resource settings of developing countries. It may also be considered in patients who have had posterior segment surgeries previously.
Collapse
Affiliation(s)
| | | | | | | | - Muna Kharel
- Nepalese Army Insitute of Medical Sciences, Kathmandu, Nepal
| |
Collapse
|
34
|
Negretti GS, Lai M, Petrou P, Walker R, Charteris D. Anterior chamber lens implantation in vitrectomised eyes. Eye (Lond) 2018; 32:597-601. [PMID: 29219957 PMCID: PMC5848289 DOI: 10.1038/eye.2017.261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/30/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo investigate long-term visual acuity (VA) outcomes and complication rates in vitrectomised eyes undergoing anterior chamber intraocular lens (ACIOL) insertion.Patients and methodsA single-centre, retrospective case series including all patients who had undergone ACIOL placement at the time of vitrectomy surgery or having had previous vitrectomy, between January 2007 and January 2013. Patients were identified using an electronic database and paper casefile notes were analysed for all patients. Patients were excluded if they had <3 months follow-up.ResultsTwo hundred and seventy-one patients were included in the analysis. Mean follow-up was 27 months. One hundred and forty-eight patients were vitrectomised before ACIOL placement. One hundred and twenty-three patients underwent vitrectomy at the time of ACIOL placement. Mean best-corrected visual acuity (BCVA) before ACIOL placement was 1.27 LogMar (SD 0.95). Mean BCVA at final follow-up was 0.51 LogMar (SD 0.66) (paired-sample T-test P<0.001). Forty (15%) patients developed postoperative cystoid macular oedema (CMO). Eighty-seven (32%) patients had an intraocular pressure (IOP) rise acutely post ACIOL insertion. Fifteen (6%) patients developed corneal decompensation. Five subsequently required corneal grafting. Sixteen patients had ACIOL displacement or instability requiring further surgery.ConclusionsACIOL insertion after vitrectomy is effective. Ninety-two per cent of patients maintained or gained VA, comparable to previous studies of ACIOL insertion post complicated cataract surgery. Raised IOP was the most frequent complication: 61 patients were on topical therapy at most recent follow-up. CMO tended to be acute. Corneal decompensation was infrequent.
Collapse
Affiliation(s)
- G S Negretti
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - M Lai
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - P Petrou
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - R Walker
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - D Charteris
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| |
Collapse
|
35
|
Chantarasorn Y, Techalertsuwan S, Siripanthong P, Tamerug A. Reinforced scleral fixation of foldable intraocular lens by double sutures: comparison with intrascleral intraocular lens fixation. Jpn J Ophthalmol 2018; 62:365-372. [PMID: 29464488 DOI: 10.1007/s10384-018-0579-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 01/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study is to describe a new technique for small-incision scleral fixation of intraocular lens (IOL) using double 10-0 polypropylene sutures, and to report the outcomes of IOL position compared with intrascleral IOL fixation at 12-month follow-up. STUDY DESIGN A retrospective comparative study. METHOD This new technique, called double sutured scleral fixated-IOL (DSF-IOL), was created to help with long-term knots strengthening by applying double sutures to each IOL haptic using an augmented Clove-hitch knot instead of the conventional knots tied by single suture. The tilt and decenter of IOL were measured by Scheimpflug camera and other refractive outcomes were compared between two groups at 12-month follow-up. RESULTS This study consisted of 26 eyes (54.2%) from the DSF-IOL group, and 22 eyes (45.8%) from the intrascleral fixated IOL (ISF-IOL) group. No significant differences of mean absolute degree of IOL tilt (2.90 ± 0.77 vs 2.82 ± 0.72; p = 0.633) and IOL decenter (151.90 ± 59.80 vs 175.0 ± 73.14 microns; p = 0.265) were found between the two groups. Post-operative LogMAR visual acuity was not statistically different between the two groups (0.32 ± 0.17 vs 0.41 ± 0.19, p = 0.089). Early post-operative hypotony was only present in the ISF-IOL group (13.6%). CONCLUSION This study shows that DSF-IOL is as effective as ISF-IOL. This technique can be a simpler approach to optimize small-incision scleral fixation of IOL without the complications associated with intrascleral IOL fixation.
Collapse
Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Dusit, Bangkok, 10300, Thailand.
| | - Settapong Techalertsuwan
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| | - Pongsavit Siripanthong
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| | - Anurak Tamerug
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| |
Collapse
|
36
|
Sen P, S. VK, Bhende P, Rishi P, Rishi E, Rao C, Ratra D, Susvar P, Kummamuri S, Shaikh S, Gopal L. Surgical outcomes and complications of sutured scleral fixated intraocular lenses in pediatric eyes. Can J Ophthalmol 2018; 53:49-55. [DOI: 10.1016/j.jcjo.2017.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 11/24/2022]
|
37
|
Lens Placement in the Absence of Capsular Support: Scleral-fixated Versus Iris-fixated IOL Versus ACIOL. Int Ophthalmol Clin 2017; 56:93-106. [PMID: 27257725 DOI: 10.1097/iio.0000000000000116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Sarioglu FAO, Tasci YY, Kurtul BE, Boluk SO. Implantation of a double iris-claw intraocular lens in an aphakic nanophthalmic eye. Indian J Ophthalmol 2017; 65:1490-1492. [PMID: 29208842 PMCID: PMC5742990 DOI: 10.4103/ijo.ijo_441_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old female with an aphakic nanophthalmic eye underwent a secondary intraocular lens implantation (IOL) with double Artisan aphakia iris claw IOLs (ICIOLs) and was evaluated in this research. The patient's preoperative best-corrected visual acuity (BCVA) of the right eye was 0.4 (0.4 logMAR) (with + 21.00 D), postoperative 1st and 3rd month, 1st year, and 3 years BCVAs were 0.4 (0.4 logMAR). The intraocular pressure was 15 mmHg preoperatively, and 14, 12, 12, and 15 mmHg postoperatively at 1st and 3rd month, 1st year, and 3 years, respectively. The preoperative endothelial cell density (ECD) was 2372 cells/mm2, and postoperative ECDs were 2352, 2391, 2246, and 2240 cells/mm2 at 1st and 3rd months, at 1st year, and 3 years respectively. In aphakic nanophthalmic eyes with inadequate capsular support, which require high IOL dioptry, the implantation of double ICIOLs (one in front of the iris and the other behind the iris) seems to be safe and provides good visual rehabilitation.
Collapse
Affiliation(s)
| | - Yelda Yildiz Tasci
- Department of Ophthalmology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Bengi Ece Kurtul
- Department of Ophthalmology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | | |
Collapse
|
39
|
Gushchin AV, Kadatskaya NV. [Outcomes of intraocular lens implantation in the absence of capsular support: a review of current literature]. Vestn Oftalmol 2017; 133:103-111. [PMID: 29165421 DOI: 10.17116/oftalma20171335103-111] [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] [Indexed: 11/17/2022]
Abstract
Тhe prevalence of complications associated with the deficiency or absence of capsular support in cataract patients is 5-15%. Moreover, approximately 20% of patients have an inconspicuous zonular weakness, which is often left undetected preoperatively. AIM to classify and comparatively analyze the latest published data on the outcomes of various kinds of complicated cataract surgery. MATERIAL AND METHODS Analysis of available literature on the subject of research published in 2003-2016. RESULTS The method of sutured scleral fixation of the intraocular lens (IOL) is the most fully covered in the current literature. It has been used long enough and is, therefore, well tested. Its typical complications include sutures degradation, hemorrhage, and inflammation. Sutureless fixation of the IOL, which has become more common in recent years, is free of complications associated with degradation of the sutures. However, studies on the long-term results of this technique are few and most of them were conducted in a small clinical material. CONCLUSION Basing on the present analysis, one may conclude that at the current level of surgery, sutureless scleral and iridal fixation of the IOL is more preferable in terms of possible postoperative complications.
Collapse
Affiliation(s)
- A V Gushchin
- Volgograd State Medical University, 1 Pavshikh Bortsov Sq., Volgograd, Russian Federation, 400131
| | - N V Kadatskaya
- Volgograd branch of S. Fyodorov Eye Microsurgery Federal State Institution, 80 Zemlyachki St., Volgograd, Russian Federation, 400138
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Huerva V, Ascaso FJ, Caral I, Grzybowski A. Calculation of iris-claw IOL power for correction of late in-the-bag IOL complex dislocation. BMC Ophthalmol 2017; 17:122. [PMID: 28693457 PMCID: PMC5504750 DOI: 10.1186/s12886-017-0516-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023] Open
Abstract
Background To assess the constants and formula for aphakia correction with iris-claw IOLs to achieve the best refractive status in cases of late in-the-bag IOL complex dislocation. Methods A literature search was performed. The following data were obtained: Iris-claw IOL model, Iridal or retroiridal enclavation, A-constant, ultrasound or optical biometry, formula employed and refractive outcomes. Acceptable emmetropia was considered if the resulting spherical equivalent (SE) was within ±1.00 D. Results The majority of the studies used SRK/T formula (66.6%). The 88.9% of the reports obtained a SE within ±1.00 D. Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, the emmetropia (±1.00 D) of SE, was able to get near 100% of reported cases over the pupil implantation. However, the emmetropia decreased to 80% when the enclavation is retropupilar using the same formula. The A-constant can vary from 116.7 to 117.5 for retropupilar enclavation. Conclusions Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, ±1.00 D of SE, is able to get near 100% of cases. Nevertheless, ±1.00 D of SE decreased to 80% of the cases when the enclavation is retropupilar.
Collapse
Affiliation(s)
- Valentín Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198, Lleida, Spain. .,IRB Lleida, Lleida, Spain.
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Isabel Caral
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198, Lleida, Spain.,IRB Lleida, Lleida, Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, Poznań, Poland.,University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
42
|
Radke N, Liu S, Chen L. Pars Plana Vitrectomy Combined With Either Secondary Scleral-Fixated or Anterior Chamber Intraocular Lens Implantation. Am J Ophthalmol 2017; 176:261-262. [PMID: 28236441 DOI: 10.1016/j.ajo.2017.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
|
43
|
Twenty-Seven-Gauge Vitrectomy-Assisted Four-Point Scleral Fixation of Intraocular Lens in the Absence of Capsular Support. Retina 2017; 36:1605-8. [PMID: 27388734 DOI: 10.1097/iae.0000000000001148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Stem MS, Todorich B, Woodward MA, Hsu J, Wolfe JD. Scleral-Fixated Intraocular Lenses: Past and Present. ACTA ACUST UNITED AC 2017; 1:144-152. [PMID: 29104957 DOI: 10.1177/2474126417690650] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan's syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement in the anterior chamber (ACIOLs), fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the pre-operative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.
Collapse
Affiliation(s)
- Maxwell S Stem
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Bozho Todorich
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jeremy D Wolfe
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| |
Collapse
|
45
|
Kavuncu S, Omay AE, Tırhış MH, Yılmazbaş P. Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital. Turk J Ophthalmol 2017; 46:156-160. [PMID: 28058149 PMCID: PMC5200819 DOI: 10.4274/tjo.69379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/24/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL) in a tertiary referral eye hospital. Materials and Methods: Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease. Results: The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX) was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively. Conclusion: IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery.
Collapse
Affiliation(s)
- Sevim Kavuncu
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | | | - Pelin Yılmazbaş
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
46
|
Helvaci S, Demirduzen S, Oksuz H. Iris-claw intraocular lens implantation: Anterior chamber versus retropupillary implantation. Indian J Ophthalmol 2016; 64:45-9. [PMID: 26953023 PMCID: PMC4821121 DOI: 10.4103/0301-4738.178139] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To compare the outcomes of anterior chamber and retropupillary implantation of iris-claw Artisan intraocular lenses (IOL). Design: Prospective, randomized, single-blinded study. Patients and Methods: Forty eyes of forty aphakic patients were enrolled. Patients were randomized into two groups. Each group includes twenty patients. Group 1 received anterior chamber Artisan IOL implantation. Group 2 received retropupillary Artisan IOL implantation. Preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and all complications were noted and compared at 6 months follow-up. Results: Each two groups obtained a significant improvement in CDVA (P < 0.05). Four patients in Group 1 and five patients in Group 2 had significant but nonpermanent increase at IOP values. There were one and two pupillary irregularity in Group 1 and Group 2, respectively. In one patient, a shallow and inferior located retinal detachment were encountered in anterior chamber group. Conclusions: The results were not significantly different between the two fixation techniques for iris-claw lens. The surgery procedure is dependent to surgeon experience and eye's conditions.
Collapse
Affiliation(s)
- Sezer Helvaci
- Department of Ophthalmology, Adana Numune Training and Research Hospital, Adana, Turkey
| | | | | |
Collapse
|
47
|
Zhang H, Zhao J, Zhang LJ, Liu J, Liu Y, Song W, Tian QF, Wang Q, Hamilton DR. Comparison of iris-fixated foldable lens and scleral-fixated foldable lens implantation in eyes with insufficient capsular support. Int J Ophthalmol 2016; 9:1608-1613. [PMID: 27990363 DOI: 10.18240/ijo.2016.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the outcomes of vision using two different intraocular lens (IOL) replacement techniques, iris-fixated foldable intraocular lens (IF-IOL) and scleral-fixated foldable intraocular lens (SF-IOL) in patients with insufficient capsular support. METHODS Total 63 eyes (62 patients) with insufficient posterior capsule support underwent replacement of IF-IOL or SF-IOL between January 2008 and August 2011. Outcome measures included changes in visual acuity, slit lamp examination, refractive indices and corneal curvatures. RESULTS The mean improvement of uncorrected visual acuity (UCVA) was greater in IF-IOL group compared to the SF-IOL group (0.43 D±0.19 D vs 0.35 D±0.18 D, P<0.05). Moreover, 12 (38.71%) eyes in IF-IOL group and 4 (12.50%) in SF-IOL group had a higher postoperative UCVA than preoperative best corrected visual acuity (BCVA) while 9 (29.03%) eyes in IF-IOL group and 18 (56.25%) in SF-IOL group had a lower postoperative UCVA than preoperative BCVA. The myopic mean manifest sphere and mean cylinder magnitude were lower in the IF-IOL group than that in the SF-IOL group (-0.47 D±0.58 D vs 0.50 D±0.43 D, P<0.01; 0.84 D±0.53 D vs 1.23 D±0.70 D, P<0.05). No difference of corneal astigmatism and surgically induced astigmatism was found between the two groups. In addition, fewer complications were observed in IF-IOL eyes. CONCLUSION IF-IOL implantation can give a significant improvement in vision with fewer complications than SF-IOL in patients with insufficient capsular support.
Collapse
Affiliation(s)
- Han Zhang
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Jun Zhao
- Department of Ophthalmology, General Hospital of Liaohe Oil Field, Panjin 124010, Liaoning Province, China
| | - Li-Jun Zhang
- Refractive Center, Third Hospital Affiliated of Dalian Medical University, Dalian 116033, Liaoning Province, China
| | - Jing Liu
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Yuan Liu
- Department of Ophthalmology, Zibo Kangming Ophthalmology Hospital, Zibo 255025, Shandong Province, China
| | - Wei Song
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qing-Fen Tian
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, General Hospital of Liaohe Oil Field, Panjin 124010, Liaoning Province, China
| | | |
Collapse
|
48
|
Sindal MD, Nakhwa CP, Sengupta S. Comparison of sutured versus sutureless scleral-fixated intraocular lenses. J Cataract Refract Surg 2016; 42:27-34. [PMID: 26948775 DOI: 10.1016/j.jcrs.2015.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the intermediate-term anatomic and visual results of scleral-fixated intraocular lens (IOL) implantation using 4-point suture fixation or transscleral sutureless fixation. SETTING Tertiary referral eye care center in South India. DESIGN Retrospective case series. METHODS Medical records of consecutive patients who had scleral-fixated IOL surgery from January 1, 2010, to March 31, 2014, with more than 1 year of follow-up were retrospectively analyzed. Indication for scleral-fixated IOL implantation was aphakia after cataract extraction or trauma. The surgical technique was based on individual surgeon preference. The uncorrected distance visual acuity (UDVA), previous surgery, type of trauma, surgical technique, and complications were analyzed. RESULTS One hundred nine cases were analyzed. The mean follow-up was 18.9 months ± 8.7 (SD). The majority of eyes experienced an improvement in UDVA after surgery; 93 eyes (86%) had a Snellen equivalent corrected distance visual acuity of 6/12 or better. The baseline characteristics and final visual outcomes in the sutured scleral-fixated IOL group (n = 52) and sutureless scleral-fixated IOL group (n = 59) were comparable. Patients with previous trauma (n = 52) were predominantly men and were significantly younger than those in the cataract group. The visual and refractive outcomes were comparable between eyes with previous trauma and eyes with previous cataract surgery. Transient cystoid macular edema was the most common complication (12%); retinal detachment occurred in 5 cases (4.5%). CONCLUSIONS Scleral-fixated IOLs provided excellent visual rehabilitation of aphakic eyes without capsular support. The sutured technique and sutureless technique appear to be equally good in eyes with aphakia after cataract surgery or trauma. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Manavi D Sindal
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India.
| | - Chinmay P Nakhwa
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Sabyasachi Sengupta
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| |
Collapse
|
49
|
Terveen DC, Fram NR, Ayres B, Berdahl JP. Small-incision 4-point scleral suture fixation of a foldable hydrophilic acrylic intraocular lens in the absence of capsule support. J Cataract Refract Surg 2016; 42:211-6. [PMID: 27026444 DOI: 10.1016/j.jcrs.2015.10.068] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/10/2015] [Accepted: 10/25/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the visual outcomes and complications of a new small-incision technique for 4-point fixation of a hydrophilic acrylic posterior chamber intraocular lens (IOL) in the absence of capsule support. SETTING Three North American tertiary referral centers and a private practice. DESIGN Retrospective case series. METHODS Secondary IOL placement was performed from 2011 to 2014. Indications for surgery, clinical results, and complications were analyzed. Primary outcomes included postoperative corrected distance visual acuity (CDVA) and surgical complications. RESULTS Charts of 35 patients (37 eyes) were reviewed. The mean age at surgery was 56 years, and the mean follow-up was 6 months (range 3 to 24 months). Clinical indications included a dislocated IOL (30%), ocular trauma (19%), crystalline lens subluxation (19%), uveitis-glaucoma-hyphema syndrome (5%), post-complicated cataract (8%), congenital cataract (8%), and decompensated cornea (3%). The mean CDVA improved from 20/80 preoperatively to 20/40 postoperatively (P < .01). Thirty-six eyes (97%) had an improved or unchanged CDVA, and 1 eye (3%) had a reduced CDVA because of worsening glaucoma. Postoperative complications included ocular hypertension (24%), iritis (5%), wound leakage (3%), transient corneal edema (3%), glaucoma requiring a tube shunt (3%), and IOL dislocation (3%). CONCLUSION Small-incision 4-point scleral fixation of the Akreos AO60 hydrophilic acrylic IOL in the absence of capsule support appears to be a safe and effective technique for secondary IOL placement. FINANCIAL DISCLOSURES Drs. Berdahl and Ayres are consultants to Bausch & Lomb, Inc. Drs. Ayres and Fram have received speaker fees from Bausch & Lomb. Dr. Terveen does not have a financial or proprietary interest in any material or methods mentioned.
Collapse
Affiliation(s)
- Daniel C Terveen
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Nicole R Fram
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brandon Ayres
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John P Berdahl
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
50
|
Brunin G, Khandelwal S, Coffee RE, Orengo-Nania S, Biggerstaff KS. Outcomes of anterior chamber intraocular lenses placed by surgeons in training. J Cataract Refract Surg 2016; 41:2102-6. [PMID: 26703285 DOI: 10.1016/j.jcrs.2015.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/11/2015] [Accepted: 03/18/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate risk factors and outcomes of unplanned, primary anterior chamber intraocular lenses (AC IOLs) placed by surgeons in training. SETTING Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. DESIGN Retrospective case series. METHODS Cataract surgeries performed primarily by a resident surgeon that resulted in an unplanned AC IOL were included. Cases that had concomitant retinal surgery were excluded. Preoperative data gathered included corrected distance visual acuity (CDVA), intraocular pressure (IOP), and ocular comorbid conditions. Operative times and complications requiring an AC IOL were assessed. Postoperative CDVA, IOP, corneal edema, persistent intraocular inflammation, macular edema, and need for additional surgery were analyzed for the first postoperative year. RESULTS Twenty-two eyes were included. The mean preoperative CDVA was 1.24 logMAR ± 0.92 SD and the mean preoperative IOP was 17.55 ± 3.88 mm Hg. The mean operative time was 103 ± 30 minutes. The most common operative complications necessitating an AC IOL were 7 (32%) capsule tears with vitreous prolapse requiring anterior vitrectomy and 7 (32%) capsule tears, zonular dehiscence, and vitreous prolapse requiring anterior vitrectomy. By the first postoperative year, the mean visual acuity was 0.40 ± 0.58 logMAR and the IOP was 15.05 ± 6.01 mm Hg. The most common complications 1 year postoperatively included persistent macular edema (23%) and need for additional surgery (18%). CONCLUSION This group of patients who received unplanned primary AC IOLs by surgeons in training had improved visual acuity and well-controlled IOP 1 year postoperatively. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Greg Brunin
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Sumitra Khandelwal
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert E Coffee
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Silvia Orengo-Nania
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Kristin S Biggerstaff
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|