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Toptan M, Yilmaz OF, Oguz H. Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes. Int Ophthalmol 2024; 44:269. [PMID: 38914871 PMCID: PMC11196301 DOI: 10.1007/s10792-024-03187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/15/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. METHODS A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior-posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). RESULTS There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). CONCLUSION In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.
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Affiliation(s)
- Müslüm Toptan
- Department of Ophthalmology, School of Medicine, Harran University, Sanlıurfa, Turkey.
| | - Omer Faruk Yilmaz
- Department of Ophthalmology, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Halit Oguz
- Department of Ophthalmology, Medeniyet University Göztepe Prof. Dr. Süleyman Yalçin City Hospital, Istanbul, Turkey
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Nakagawa S, Totsuka K, Okinaga K, Takamoto M, Ishii K. Background factors determining the time to intraocular lens dislocation. Int Ophthalmol 2024; 44:240. [PMID: 38904711 DOI: 10.1007/s10792-024-03166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To clarify the characteristics of intraocular lens (IOL) dislocation requiring IOL suture or intraocular scleral fixation. METHODS This retrospective consecutive case series included 21 eyes (21 patients) who required sutured or sutureless intrascleral IOL fixation following IOL extraction owing to IOL dislocation at the outpatient clinic in the Department of Ophthalmology, Saitama Red Cross Hospital, Japan, between January and December 2019. Medical records were retrospectively reviewed for background diseases, location of the dislocated IOL (intracapsular/extracapsular), insertion of a capsular tension ring (CTR), and the period from IOL insertion to dislocation. RESULTS We included 21 eyes of 21 patients who required IOL suture or intrascleral fixation for IOL dislocation at our clinic from January to December 2019 were included. The most common background disease was pseudoexfoliation syndrome (four cases), followed by atopic dermatitis, dysplasia/dehiscence of the zonule, post-retinal detachment surgery, high myopia, and uveitis (three cases each). At the time of dislocation, the IOLs were either intracapsular (16 cases, including 3 cases with CTR insertion) or extracapsular (5 cases). The time from IOL insertion to IOL dislocation was 13.7 ± 8.1 years (maximum: 31.3 years, minimum: 1.7 years). CONCLUSIONS In this study, all 21 cases represented late IOL dislocations occurring after 3 months postoperatively. Among these late IOL dislocation cases, IOL dislocation occurred in a short-medium period of time, especially in those with CTR insertion and weakness/dehiscence of the zonule, with an average of 3 to 5 years postoperatively. We propose referring to these cases as intermediate-term IOL dislocation.
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Affiliation(s)
- Suguru Nakagawa
- Department of Ophthalmology, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Japan.
| | - Kiyohito Totsuka
- Department of Ophthalmology, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Japan
| | - Kimiko Okinaga
- Department of Ophthalmology, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Japan
| | - Kiyoshi Ishii
- Department of Ophthalmology, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Japan
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Zhang C, Palka C, Zhu D, Lai D, Winokur J, Shwani T, DeAngelis MM, Reynolds AL. Clinical Outcomes in Scleral Fixation Secondary Intraocular Lens with Yamane versus Suture Techniques: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3071. [PMID: 38892783 PMCID: PMC11173341 DOI: 10.3390/jcm13113071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/17/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; p < 0.05 was considered statistically significant. Results: Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = -0.01, 95% CI: [-0.06, 0.04], p = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = -0.10, 95% CI: [-0.16, -0.04], p = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = -0.06, 95% CI: [-0.16, 0.04], p = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = -24.68, 95% CI: [-35.90, -13.46], p < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. Conclusions: The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods.
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Affiliation(s)
- Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (D.L.); (T.S.); (A.L.R.)
| | - Charles Palka
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 955 Main Street, Buffalo, NY 14203, USA;
| | - Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, NY 11021, USA; (D.Z.); (J.W.)
| | - Daniel Lai
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (D.L.); (T.S.); (A.L.R.)
| | - Jules Winokur
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, NY 11021, USA; (D.Z.); (J.W.)
| | - Treefa Shwani
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (D.L.); (T.S.); (A.L.R.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Margaret M. DeAngelis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (D.L.); (T.S.); (A.L.R.)
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Genetics, Genomics and Bioinformatics Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Andrew L. Reynolds
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (D.L.); (T.S.); (A.L.R.)
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Aiello F, Rampat R, Gallo Afflitto G, Din N, Mandal N, Maurino V. Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:67-72. [PMID: 36627103 DOI: 10.1016/j.jcjo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery. METHODS A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded. RESULTS ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes. CONCLUSIONS ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy.
| | - Radhika Rampat
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Niraj Mandal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Maurino
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Kang YK, Park DH, Ryu G, Kim HK, Kim DH, Do JR. Repositioned versus exchanged flanged intraocular lens fixation for intraocular lens dislocation. Sci Rep 2024; 14:6181. [PMID: 38485976 PMCID: PMC10940573 DOI: 10.1038/s41598-024-54694-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/15/2024] [Indexed: 03/18/2024] Open
Abstract
This study aimed to compare the outcomes of flanged intraocular lens (IOL) fixation with new IOL exchange after dislocated IOL removal and repositioned dislocated IOL in patients with IOL dislocation. Eighty-nine eyes that underwent flanged IOL fixation were retrospectively included, with 51 eyes in the exchanged IOL group and 38 eyes in the repositioned IOL group. In both groups, best-corrected visual acuity (BCVA) improved at 1, 3, 6, and 12 months postoperatively and did not differ between the two groups at any of these time points. However, at 1 week postoperatively, BCVA in the repositioned IOL group improved compared with baseline, whereas that in the exchanged IOL group did not. Moreover, there were lesser changes in the corneal endothelial cell density (ECD) and corneal astigmatism in the repositioned IOL group than in the exchanged IOL group. The IOL positions, including IOL tilt and IOL decentration, were not different between the groups. Flanged IOL fixation with new IOL exchange and with repositioned dislocated IOL for patients with IOL dislocation had similar visual outcomes and IOL position. However, the latter had a smaller corneal ECD decrease and astigmatic change. This technique was effective in treating IOL dislocation while minimizing corneal injury.
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Affiliation(s)
- Yong Koo Kang
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Republic of Korea
| | - Dong Ho Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Republic of Korea
| | | | - Hong Kyun Kim
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Republic of Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Republic of Korea
| | - Jae Rock Do
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Republic of Korea.
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Barbosa RC, Carvalho R. Z-suture scleral fixation intraocular lenses: A refractive and safety report. Eur J Ophthalmol 2024:11206721241230566. [PMID: 38304925 DOI: 10.1177/11206721241230566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
PURPOSE Scleral fixation of intraocular lenses constitutes a surgical option in cases where there is inadequate capsular support or zonular insufficiency. Knotless techniques, such as the z-suture technique, avoid suture-related complications, such as conjunctival erosion or exposure. The purpose of this study was to evaluate the visual outcomes and postoperative complications of patients who underwent scleral z-suture fixation of the Akreos AO® intraocular lenses. METHODS A retrospective, observational study was conducted, including 22 eyes of 20 patients who underwent Akreos AO® intraocular lenses using the z- suture scleral fixation technique. RESULTS The mean age of the patients was 55,64 ± 28,47 years old, and the mean follow-up time was 25,64 months. The most common indication for surgery was previous complicated cataract surgey. The mean postoperative spherical equivalent was +0,058D ± 0,79D, with values ranging from - 1,50D to +1,00D. Mean best-corrected visual acuity was 0,178 ± 0,15 logMAR. Intraocular pressure was 15,07 ± 2,56 mmHg on the day after surgery, and 16 ± 2,15 mmHg 1 month after. No suture-related complications were observed in any patient postoperatively. One patient had a slight inferonasal lens dislocation and another patient had a severe case of herpetic keratitis posoperatively. DISCUSSION The knotless z-suture technique appears to be a reliable and safe way to fix an intraocular lens in the sclera, regardless of the patient's age. Our results show good visual results and predictable refractive outcomes. Decades of follow-up may be necessary to assess the long-term risk of lens dislocation.
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Affiliation(s)
- Renato Correia Barbosa
- Ophthalmology Department, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, ULSM, Matosinhos, Portugal
| | - Rui Carvalho
- Ophthalmology Department, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, ULSM, Matosinhos, Portugal
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Desai A, Pappuru RR, Tyagi M. Ten-year results of scleral-fixated intraocular lens implantation: outcomes of ab externo scleral fixation with 10-0 polypropylene suture. J Cataract Refract Surg 2024; 50:128-133. [PMID: 38259132 DOI: 10.1097/j.jcrs.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/21/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE To describe long-term visual and anatomical outcomes of sutured scleral-fixated intraocular lens (SF IOL) implantation. SETTING Tertiary eyecare hospital in India. DESIGN Retrospective interventional noncomparative study. METHODS Postoperative change in corrected distance visual acuity (CDVA) and occurrence of complications were assessed from the patient medical records. Long-term SF IOL survival rates and factors affecting the occurrence of postoperative IOL-related complications were assessed. Patients with postoperative follow-up less than 10 years or incomplete medical records were excluded. RESULTS 64 eyes of 53 patients were included. Follow-up duration was 11.4 ± 1.2 years. Mean preoperative CDVA was 0.71 ± 0.43 logMAR (Snellen equivalent: 6/30), and mean CDVA at the final visit was 0.52 ± 0.49 logMAR (Snellen equivalent: 6/18) (P < .01). 48% cases had CDVA of 6/12 or better at the last follow-up. 58% cases had coexistent ocular pathology affecting the final visual outcome. IOL and suture-related complications were the commonest and included IOL decentration (17% cases), IOL drop (14%), and suture exposure (6%). The probability of IOL survival (postoperative period without IOL-related complications) was 90.6% at 8 years and 81.2% at 10 years (Kaplan-Meier analysis). Occurrence of postoperative IOL-related complications was unaffected by patient sex, age, indication for surgery (trauma or other), previous intraocular surgery, or technique of scleral fixation (2-point or 4-point) (multivariate regression analysis). CONCLUSIONS Although sutured SF IOL implantation is viable with favorable long-term visual outcomes, there is a risk of postoperative IOL-related complications. Occurrence of postoperative IOL-related complications is unaffected by patient and ocular factors.
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Affiliation(s)
- Arjun Desai
- From the Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Chen FF, Jiang F, Zhang WW, Liu YJ, He ZF, Xie ZG. Six-point scleral fixation of a three-looped haptics one-piece posterior chamber intraocular lens by a single suture. Indian J Ophthalmol 2024; 72:S319-S322. [PMID: 38271430 DOI: 10.4103/ijo.ijo_1093_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 01/27/2024] Open
Abstract
To evaluate a novel technique for six-point scleral fixation of a three-looped haptics posterior chamber intraocular lens (PCIOL) by a single suture. Nine eyes of nine patients were studied from September 2021 to March 2023. All patients had undergone vitrectomy. Only a single 9-0 polypropylene suture was used for scleral fixation. The three looped haptics were fixed at 12, 4, and 8 o'clock with six-point scleral fixation. The entire procedure took about 30 min. Among the nine patients, eight (88.8%) eyes had a significant improvement in best-corrected visual acuity, whereas one (11.2%) eye showed no change. No intraoperative or postoperative complications were observed. By ultrasonic biomicroscopy examination, intraocular lenses were well positioned and stable with no tilt in the horizontal and vertical axis. The method of six-point scleral fixation of a three-looped haptics PCIOL by a single suture is safe and effective.
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Affiliation(s)
- Fei-Fei Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, Jiangsu Province, China
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Nayman T, Milad D, Sebag M. Long-term outcomes of iris-sutured subluxated intraocular lenses. Indian J Ophthalmol 2024; 72:S218-S223. [PMID: 38271417 DOI: 10.4103/ijo.ijo_3397_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/21/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing. SETTINGS AND DESIGN Retrospective chart review. METHODS Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure. RESULTS A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 ± 7.0 years. The mean follow-up duration was 46.8 ± 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 ± 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 ± 0.59 vs. 0.21 ± 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved. CONCLUSIONS The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.
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Affiliation(s)
- Taylor Nayman
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Daniel Milad
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Mikael Sebag
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Chang YM, Weng TH, Tai MC, Chen YH, Lee CH, Chang WC, Hsieh MW, Chien KH. A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia. Sci Rep 2024; 14:2044. [PMID: 38267491 PMCID: PMC10808084 DOI: 10.1038/s41598-023-49084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
This study compared the visual outcomes and complications between sutureless scleral-fixated intraocular lens and iris claw intraocular lens implantation in aphakia without adequate capsule and/or zonule support. Studies comparing the clinical outcomes of scleral-fixated intraocular lens and iris claw intraocular lens implantation published until April 2022 were retrieved from the PubMed, EMBASE, Cochrane Library, and Google Scholar databases. The outcomes included postoperative final visual acuity, surgical time, surgery-induced astigmatism, and complications. The weighted mean difference and odds ratio were calculated. Two randomized controlled trials and five cohort studies, including 244 and 290 eyes in the scleral-fixated intraocular lens group and iris claw group, respectively, were included. Scleral-fixated intraocular lens implantation results in a better postoperative final corrected distance visual acuity compared with iris claw intraocular lens implantation; however, it is more time-consuming. Scleral-fixated intraocular lens implantation seems to have lesser incidences of surgery-induced astigmatism. Furthermore, both procedures have a similar complication rate. Therefore, based on current best evidence, these two procedures should be considered according to patient's conditions.
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Affiliation(s)
- Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Cheng Chang
- Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China.
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Zhou Z, Yao G, Huang G, Zhong H, Chen Q, Yang K, Zhong S, Li M, Xu F. Application of the suture needle retrograde threading method in scleral fixation of intraocular lenses. BMC Ophthalmol 2023; 23:516. [PMID: 38114950 PMCID: PMC10729524 DOI: 10.1186/s12886-023-03258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Here we described a new threading technique for the universal fixation of any posterior chamber intraocular lens (IOL). METHODS Twenty-seven eyes of 27 patients whose surgery done by Surgeon A with the needle-guided method or the suture needle retrograde threading (SNRT) method for intrascleral IOL fixation were enrolled in the first group. Thirty-four eyes of 34 patients whose surgery done by Surgeon A, Surgeon B or Surgeon C with the SNRT method for intrascleral IOL fixation were grouped into three sub-groups by surgeon. Information regarding age, sex, best-available visual acuity (BCVA), intraocular pressure (IOP), past ophthalmological history, threading time (from puncturing to externalizing suture) and complications during and after the surgery were gathered. RESULTS The analysis showed that the threading time was less in the SNRT group than needle-guided group by Surgeon A. There was one eye with suture needle slipping from the guide needle when guiding out of the eye. The threading procedure was completed one time without suture ruptures or loop slippage in the SNRT group operated by Surgeon A. And using the SNRT method, Surgeon A, Surgeon B, and Surgeon C did not show any significant difference in threading time. No complications (e.g., vitreous hemorrhage, hyphemia, retinal detachment, suprachoroidal hemorrhage, or hypotony) were observed during surgery or postoperatively in all cases. No leakage occurred at the site of the puncture after the operation. CONCLUSIONS The described technique appears to be a safe, simple, easy-to-learn, and universal surgical method, which is suitable for various types of IOLs.
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Affiliation(s)
- Zhou Zhou
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Gang Yao
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Guangyi Huang
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Haibin Zhong
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Qi Chen
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Ke Yang
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Shan Zhong
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Min Li
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China
| | - Fan Xu
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, Guangxi, People's Republic of China.
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Boz AAE, Atum M, Özmen S, Yuvacı İ, Çelik E. Comparison of three different intraocular lens implantation techniques in the absence of capsular support: sutured scleral, haptic flanged intrascleral, and four flanged intrascleral fixations. Int Ophthalmol 2023; 43:5045-5053. [PMID: 37851141 DOI: 10.1007/s10792-023-02907-8] [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: 02/12/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION After lens extraction, if the capsular bag insufficiency occurs, there are different IOL implantation techniques. IOL implantation in the posterior chamber is safer in eyes with low endothelial cell count, peripheral anterior synechiae, shallow anterior chamber, and glaucoma. Alternative approaches for scleral fixation techniques, both with and without sutures, continue to undergo development. In this study, we aimed to compare the postoperative outcomes of the sutured scleral fixation (SSF), haptic flanged intrascleral fixation (HFISF) and four flanged intrascleral fixation (FFISF) IOL implantation techniques in eyes with the absence of capsular support. MATERIALS AND METHODS A hundred and thirty-seven aphakic eyes with the absence of capsular support were included in the study. The patients were divided into three groups: group 1-SSF, group 2-HFISF (Yamane technique), and group 3-FFISF. Surgical time in minutes, preoperative and postoperative parameters such as best corrected visual acuity (BCVA), corneal astigmatism, lenticular astigmatism, intraocular pressure (IOP), specular microscopy, central macular thickness (CMT) were recorded. Pseudophacodonesis was assessed at 6 months postoperatively using a slit lamp, and early and late complications were recorded. RESULTS Of the 137 eyes, 69 eyes were included in the SSF group, 41 eyes in the HFISF group, and 27 eyes in the FFISF group. No statistically significant differences were observed among the three groups in terms of age, gender, preoperative mean BCVA, corneal astigmatism, IOP, endothelial cell density, and CMT. It was observed that the mean BCVA significantly improved compared to the preoperative visual acuity in all three groups. Postoperative lenticular astigmatism, pseudophacodonesis score, percentage of the endothelial cell loss were found to be higher in FFISF groups. The surgical time was found to be shorter in the HFISF group. IOL decentration was observed in 1.44% of the SSF group and 7.40% of the FFISF group. Cystoid macular edema was observed in 5.79% of the SSF group, 4.87% of the HFISF group, and 7.40% of the FFISF group. Retinal detachment was observed in 1.44% of the SSF group and 7.31% of the HFISF group. CONCLUSIONS The optimal technique for treating aphakia without capsular support remains uncertain. Surgeons are tasked with a complex decision, aiming for both excellent vision and minimal risk. This decision is based on their expertise, the distinctive ocular condition of the patient, and the availability of essential operating room equipment. In this study, the following findings were observed: in the HFISF technique, the average surgical time was found to be shorter, the SSF technique demonstrated greater stability in terms of astigmatism and pseudophacodonesis and the FFISF technique was recognized for its relatively straightforward application method. It is important to note that the three IOL implantation techniques yielded comparable outcomes in terms of postoperative BCVA, as well as early and late complications.
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Affiliation(s)
- Ali Altan Ertan Boz
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey.
| | - Mahmut Atum
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Sedat Özmen
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - İsa Yuvacı
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Erkan Çelik
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
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13
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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: 0] [Impact Index Per Article: 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.
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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
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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.
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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.
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Januschowski K, Boden KT, Macek AM, Szurman P, Bisorca-Gassendorf L, Hoogmartens C, Rickmann A. MODIFIED SUTURELESS INTRASCLERAL FIXATION TECHNIQUE FOR SECONDARY INTRAOCULAR LENS IMPLANTATION: A Pilot Study. Retina 2023; 43:1802-1806. [PMID: 34050099 DOI: 10.1097/iae.0000000000003220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To demonstrate possible complications of a new intraocular lens for sutureless secondary scleral implantation and modifications of the surgical technique to optimize outcomes. METHODS A retrospective study of 16 eyes (16 patients) who underwent a secondary intraocular lens implantation using the Carlevale intraocular lens (Soleko, Italy) with two anchor haptics for intrascleral implantation (mean follow-up 2.2 months). RESULTS The visual acuity did not improve statistically significantly postoperatively ( P = 0.601). Seven (44%) patients suffered from postoperative hypotonia (intraocular pressure <5 mmHg) during the first three postoperative days. CONCLUSION Owing to the early postoperative hypotony, we decided to modify the surgical technique. We present several suggestions to optimize the technique and outcome such as positioning the sclerotomies at the 2 and 8 o'clock positions, using 27 G trocars alone and suturing the frown incisions using self-resorbing sutures.
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Affiliation(s)
- Kai Januschowski
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Centre for Ophthalmology, University Eye Hospital Tuebingen, Tuebingen, Germany; and
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
| | - Karl T Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Andrej M Macek
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Peter Szurman
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
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Iannetta D, Febbraro S, Valsecchi N, Moramarco A, Fontana L. FIL SSF intraocular lens opacification after pars plana vitrectomy with gas tamponade for traumatic lens luxation and retinal detachment: a case report and literature review. BMC Ophthalmol 2023; 23:383. [PMID: 37743488 PMCID: PMC10519003 DOI: 10.1186/s12886-023-03126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To report a case of sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF IOL, Soleko, Italy) opacification following pars plana vitrectomy surgery using sulfur hexafluoride (SF6) for traumatic lens luxation associated with retinal detachment. CASE PRESENTATION A 77-year-old woman was referred to our emergency department after blunt trauma in her right eye. At the ophthalmic evaluation, visual acuity was hand movement, biomicroscopy showed pseudoexfoliation syndrome and a traumatic lens luxation in the vitreous chamber. The patient underwent pars plana vitrectomy, subluxated cataract explantation, and FIL SSF IOL implant. During surgery, an inferior retinal detachment was encountered, requiring 20% SF6 gas tamponade. No adverse events were encountered. One month postoperatively, visual acuity (BCVA) improved to 0,3 logMAR. At the 3-month follow-up, the patient presented with BCVA of 0,5 logMAR, and biomicroscopy showed a minimal IOL opacification. Six months postoperatively, BCVA decreased to 1.0 logMAR, and diffuse, IOL opacification was noted at slit lamp examination. The patient refused any other surgical intervention for IOL exchange. CONCLUSIONS Although hydrophilic IOL opacification gas related is known, to the best of our knowledge, this is the first case reported in the literature of FIL SSF IOL opacification after pars plana vitrectomy with gas tamponade for retinal detachment.
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Affiliation(s)
- Danilo Iannetta
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy.
| | - S Febbraro
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - N Valsecchi
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - A Moramarco
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - L Fontana
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
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Januschowski K, Rickmann A, Boden KT, Ehrlich-Treuenstätt GV, Wakili P, Bisorca-Gassendorf L. Clinical Experience of Two Sutureless Intrascleral Fixation Techniques for Secondary Intraocular Lens Implantation. Ophthalmologica 2023; 247:1-7. [PMID: 37647875 DOI: 10.1159/000532065] [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: 02/16/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the outcome of the modified Carlevale intraocular lens (IOL) fixation technique, using two different vitrectomy ports (23- vs. 27-gauge) as anchor fixation. METHODS Retrospective, consecutive study of 282 eyes (282 patients) who underwent a secondary IOL implantation using the Carlevale IOL (Soleko IOL Division, Italy) with two anchor haptics for intrascleral implantation with either 23- or 27-gauge (G) port. RESULTS Transient post-operative ocular hypotonia (intraocular pressure ≤5 mm Hg) was observed less in the 27-G group (13 vs. 4 patients, p = 0.057) three requiring additional tunnel sutures (2 cases for 23-G; 1 case 27-G). Post-operative vitreous haemorrhage was recorded more often in the 23-G group (8 vs. 1 patient, p = 0.034), but all cases in both groups resolved without intervention. Visual acuity did improve post-operatively in the two groups. No post-operative complications such as retinal detachment, endophthalmitis, and IOL-dislocation tilt were observed in the follow-up. CONCLUSION The 27-G modified technique for sutureless intrascleral implantation is simple and effective and causes less post-operative hypotony.
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Affiliation(s)
- Kai Januschowski
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Eye Clinic, Petrisberg, Trier, Germany
| | | | - Karl T Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | | | - Philip Wakili
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Lukas Bisorca-Gassendorf
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Eye Clinic, Petrisberg, Trier, Germany
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Zou M, Lian Z, Young CA, Liu S, Zhang X, Zheng D, Jin G. Improving Effective Lens Position Prediction for Transscleral Fixation of Intraocular Lens Among Congenital Ectopia Lentis Patients. Am J Ophthalmol 2023; 252:121-129. [PMID: 36972739 DOI: 10.1016/j.ajo.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/25/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To introduce a method of predicting effective lens position (ELP) among congenital ectopia lentis (CEL) patients undergoing transscleral fixation of intraocular lens (IOL), and evaluate its effect on improving refractive outcome by utilizing the Sanders-Retzlaff-Kraff / theoretical (SRK/T) formula. DESIGN Retrospective cross-sectional study. METHODS A training set (93 eyes) and validation set (25 eyes) was included. Z value as the distance between the iris plane and a hypothetic postoperative IOL position was introduced in this study. The Z-modified ELP consisted of corneal height (Ch) and Z (ELP = Ch + Z), and Ch was calculated by keratometry (Km) and white-to-white (WTW). The value of Z was identified by linear regression formula with the involvement of axial length (AL), Km, WTW, age, and gender. The comparison of mean (MAE) and mediate absolute error (MedAE) among Z-modified SRK/T formula, SRK/T, Holladay I, and Hoffer Q formula was performed to evaluate the performance of Z-modified SRK/T formula. RESULTS Z value was associated with AL, K, WTW, and age (Z = offset + 15.1093 × lg (AL) + 0.0953899 × Km - 0.3910268 × WTW + 0.0164197 × Age - 19.34804). The Z-modified ELP has good accuracy with no difference to back-calculated ELP. The accuracy of Z-modified SRK/T formula was better than other formulas (P < .001) as the MAE was 0.24 ± 0.19 diopter (D) and MedAE was 0.22 D (95% CI: 0.01-0.57 D). Sixty-four percent of eyes had a refractive error smaller than ±0.25 D, and none of the subjects had a prediction error greater than ±0.75 D. CONCLUSIONS ELP of CEL can be accurately predicted by AL, Km, WTW, and age. Z-modified SRK/T formula improved on the current formula by improving predicting accuracy of ELP and may serve as a promising formula for CEL patients with transscleral fixation of IOL.
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Affiliation(s)
- Minjie Zou
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | - Zhangkai Lian
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | | | - Siyuan Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | - Xinyu Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | - Danying Zheng
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China.
| | - Guangming Jin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China.
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Lewin GA, Dixon CJ. Scleral fixation of a novel modified, injected canine intraocular lens by haptic capture, in 17 dogs. Vet Ophthalmol 2023. [PMID: 37410806 DOI: 10.1111/vop.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/14/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The aims of lens removal surgery are to re-establish or preserve both a clear visual axis and emmetropic vision. Trans-scleral intraocular lens (IOL) fixation has been described in cases where lens capsule instability precludes the insertion of a prosthetic intraocular lens into the lens capsule. Previous techniques have necessitated enlargement of the corneal incision to accommodate either a rigid polymethylmethacrylate IOL or an acrylic foldable IOL inserted using forceps. This paper reports the modification of an endocapsular IOL to be used as an injectable suture-fixated IOL introduced through a 2.8 mm corneal incision. MATERIALS AND METHODS All cases underwent lens extraction by phacoemulsification followed by removal of the unstable lens capsule. A PFI X4 IOL (Medicontur) was modified to create four open-loop haptics. The IOL was injected into the anterior chamber, each haptic was captured in a loop of suture introduced ab externo, and the lens was sutured with four-point fixation. RESULTS The results from 20 eyes in 17 dogs are reported. Over an average follow-up time of 14.5 months, vision was retained in 16/20 eyes. Vision was lost in four eyes due to corneal ulceration and ocular hypertension (1/20), retinal detachment (2/20), and Progressive Retinal Atrophy (1/20). CONCLUSIONS The modified PFI X4 proved suitable for injection and scleral fixation through a 2.8 mm corneal incision, with a success rate comparable to previously published techniques.
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20
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Schranz M, Reumüller A, Kostolna K, Novotny C, Schartmüller D, Abela-Formanek C. Refractive outcome and lens power calculation after intrascleral intraocular lens fixation: a comparison of three-piece and one-piece intrascleral fixation technique. EYE AND VISION (LONDON, ENGLAND) 2023; 10:29. [PMID: 37291668 DOI: 10.1186/s40662-023-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/30/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques. METHODS This is a prospective, randomized, longitudinal, single-site, single-surgeon study. Patients who underwent intrascleral IOL implantation using the Yamane or the Carlevale technique were followed up for a period of six months postoperatively. Refraction was measured using the best-corrected visual acuity at 4 m (EDTRS chart). Lens decentration, tilt and effective lens position (ELP) were assessed using an anterior segment optical coherence tomography (AS-OCT). The prediction error (PE) and the absolute error (AE) were evaluated for the SRK/T, Hollayday1 and Hoffer Q formula. Subsequently, correlations between the PE and axial length, keratometry, white to white and ELP were assessed. RESULTS In total, 53 eyes of 53 patients were included in the study. Twenty-four eyes of 24 patients were in the Yamane group (YG) and 29 eyes of 29 patients were in the Carlevale group (CG). In the YG, the Holladay 1 and Hoffer Q formulae resulted in a hyperopic PE (0.02 ± 0.56 D, and 0.13 ± 0.64 D, respectively) while in the SRK/T formula the PE was slightly myopic (- 0.16 ± 0.56 D). In the CG, SRK/T and Holladay 1 formulae led to a myopic PE (- 0.1 ± 0.80 D and - 0.04 ± 0.74 D, respectively), Hoffer Q to a hyperopic PE (0.04 ± 0.75 D). There was no difference between the PE of the same formulae across both groups (P > 0.05). In both groups the AE differed significantly from zero in each evaluated formula. The AE error was within ± 0.50 D in 45%-71% and was within ± 1.00 D in 72%-92% of eyes depending on the formula and surgical method used. No significant differences were found between formulae within and across groups (P > 0.05). Intraocular lens tilt was lower in the CG (6.45 ± 2.03°) compared to the YG (7.67 ± 3.70°) (P < 0.001). Lens decentration was higher in the YG (0.57 ± 0.37 mm) than in the CG (0.38 ± 0.21 mm), though the difference was not statistically significant (P = 0.9996). CONCLUSIONS Refractive predictability was similar in both groups. IOL tilt was better in the CG, however this did not influence the refractive predictability. Though not significant, Holladay 1 formula seemed to be more probable than the SRK/T and Hoffer Q formulae. However, significant outliers were observed in all three different formulae and therefore remain a challenging task in secondary fixated IOLs.
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Affiliation(s)
- Markus Schranz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Adrian Reumüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Klaudia Kostolna
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Caroline Novotny
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Claudette Abela-Formanek
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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21
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Mekonnen T, Zevallos-Delgado C, Zhang H, Singh M, Aglyamov SR, Larin KV. The lens capsule significantly affects the viscoelastic properties of the lens as quantified by optical coherence elastography. Front Bioeng Biotechnol 2023; 11:1134086. [PMID: 36970614 PMCID: PMC10034121 DOI: 10.3389/fbioe.2023.1134086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
The crystalline lens is a transparent, biconvex structure that has its curvature and refractive power modulated to focus light onto the retina. This intrinsic morphological adjustment of the lens to fulfill changing visual demands is achieved by the coordinated interaction between the lens and its suspension system, which includes the lens capsule. Thus, characterizing the influence of the lens capsule on the whole lens’s biomechanical properties is important for understanding the physiological process of accommodation and early diagnosis and treatment of lenticular diseases. In this study, we assessed the viscoelastic properties of the lens using phase-sensitive optical coherence elastography (PhS-OCE) coupled with acoustic radiation force (ARF) excitation. The elastic wave propagation induced by ARF excitation, which was focused on the surface of the lens, was tracked with phase-sensitive optical coherence tomography. Experiments were conducted on eight freshly excised porcine lenses before and after the capsular bag was dissected away. Results showed that the group velocity of the surface elastic wave, V, in the lens with the capsule intact (V=2.55±0.23 m/s) was significantly higher (p < 0.001) than after the capsule was removed (V=1.19±0.25 m/s). Similarly, the viscoelastic assessment using a model that utilizes the dispersion of a surface wave showed that both Young’s modulus, E, and shear viscosity coefficient, η, of the encapsulated lens (E=8.14±1.10 kPa,η=0.89±0.093 Pa∙s) were significantly higher than that of the decapsulated lens (E=3.10±0.43 kPa,η=0.28±0.021 Pa∙s). These findings, together with the geometrical change upon removal of the capsule, indicate that the capsule plays a critical role in determining the viscoelastic properties of the crystalline lens.
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Affiliation(s)
- Taye Mekonnen
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | | | - Hongqiu Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Manmohan Singh
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Salavat R. Aglyamov
- Department of Mechanical Engineering, University of Houston, Houston, TX, United States
| | - Kirill V. Larin
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
- *Correspondence: Kirill V. Larin,
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22
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Surgical correction of corneal opacity and aniridia with penetrating keratoplasty and a new iris prosthesis implant. Graefes Arch Clin Exp Ophthalmol 2022; 261:1331-1338. [PMID: 36480049 DOI: 10.1007/s00417-022-05920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study is to describe the clinical outcome of penetrating keratoplasty combined with implantation of a novel intraocular lens with an artificial iris, aided by continuous vitreous chamber infusion, in patients with severe aniridia and corneal alterations. METHODS This was a prospective single-center case series study involving five patients with corneal alterations and aniridia. All subjects underwent simultaneous penetrating keratoplasty and implantation of a new intraocular lens with an artificial iris with the assistance of infusion into the vitreous chamber to regulate intraocular pressure during the surgical procedure. Visual acuity, corneal endothelial cell density, and intraocular pressure assessments were performed in the postoperative period. The final cosmetic outcome of the iris prosthesis placement was also evaluated. RESULTS In all cases, increased visual acuity and a good aesthetic result were observed in all affected eyes except one in which, despite the excellent aesthetic outcome, the eye was very hypotonic as it had high myopia and had undergone several previous surgeries. CONCLUSION The single surgical procedure combining implantation of an intraocular lens-iris prosthesis with penetrating keratoplasty is an effective technique for the simultaneous treatment of aphakia and aniridia. However, larger series with longer-term follow-up are needed to definitively establish the benefits of this technique.
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Gajula S, Manayath GJ, Verghese S, Saravanan VR, Narendran K, Narendran V. Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation. Eye (Lond) 2022; 36:2334-2340. [PMID: 34980895 PMCID: PMC9674570 DOI: 10.1038/s41433-021-01880-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/02/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance. RESULTS A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.
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Affiliation(s)
- Shruthi Gajula
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - George J Manayath
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Shishir Verghese
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India.
| | - V R Saravanan
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Kalpana Narendran
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Venkatapathy Narendran
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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Cheng KKW, Tint NL, Sharp J, Alexander P. Surgical management of aphakia. J Cataract Refract Surg 2022; 48:1453-1461. [PMID: 36449676 DOI: 10.1097/j.jcrs.0000000000000954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022]
Abstract
Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.
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Affiliation(s)
- Kelvin K W Cheng
- From the Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom (Cheng, Tint); Cambridge University Hospitals, Cambridge, United Kingdom (Sharp, Alexander)
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25
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Zou C, Zhang T, Wang X, Zhuang H, Jiang R. Treatment of long-term endophthalmitis developing after intraocular lens implantation in children: a retrospective study. BMC Ophthalmol 2022; 22:301. [PMID: 35820855 PMCID: PMC9277780 DOI: 10.1186/s12886-022-02519-3] [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] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background To discussed the risk factor and the management of vitrectomy for long-term endophthalmitis developing after intraocular lens (IOL) implantation in children. Methods We retrospectively investigated the clinical characteristics and surgical outcomes of long-term endophthalmitis developing after IOL implantation in children. Results Four eyes of four children were included in the study. The mean time to endophthalmitis development after IOL implantation was 3.0 ± 0.8 years. The corneal or scleral sutures may have been caused the infection. All 4 patients underwent vitrectomy and received intravitreal antibiotics with or without IOL removal. At the last follow-up, the outcomes were satisfactory; the fundus was clear, the retina remained attached, the visual acuity improved, and there were no severe complications. Conclusions The use of scleral sutures and the exposure of conceal sutures may induce the onset of long-term endophthalmitis after IOL implantation. Complete vitrectomy and appropriate use of antibiotics are effective in the treatment of long-term endophthalmitis developing after IOL implantation in children.
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Affiliation(s)
- Chen Zou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Xin Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China.
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Complications of Secondary Scleral-fixated Intraocular Lens Placement. Int Ophthalmol Clin 2022; 62:93-102. [PMID: 35752888 DOI: 10.1097/iio.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Comparison of Visual Quality and Contrast Sensitivity between Patients with Scleral-Fixated and In-Bag Intraocular Lenses. J Clin Med 2022; 11:jcm11102917. [PMID: 35629043 PMCID: PMC9147216 DOI: 10.3390/jcm11102917] [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] [Received: 03/17/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose: To analyze visual quality and contrast sensitivity in patients after intraocular lens (IOL) implantation with sutured scleral fixation. Setting: Chang Gung Memorial Hospital, Taoyuan, Taiwan. Design: Retrospective observational study. Methods: Data on the refractive outcome, visual acuity, and subjective visual symptoms in patients with scleral-fixated or in-bag IOL implantation were collected from September 2019 to March 2020. We also investigated patients’ postoperative higher-order aberrations (HOAs) and dysphotopsia using a wavefront aberrometer and glaretester, respectively. The following values were compared: corrected distance visual acuity, spherical equivalent, root mean square values for aberrations, and contrast sensitivity. Results: A total of 23 eyes implanted with scleral-fixated IOL and 74 eyes with in-bag IOL were studied. The mean postoperative spherical equivalent and logarithm of the minimum angle of resolution after scleral fixation were −1.09 ± 3.32 D and 0.20 ± 0.17, respectively. The ocular HOAs were higher in the scleral-fixation group than in the in-bag group (p = 0.001). Contrast sensitivity was negatively associated with age, and it was similar between the two groups after controlling for the age effect. Conclusions: Ocular HOAs and refractive errors were higher in the scleral-fixation group than in the in-bag group. However, no significant difference was noted in contrast sensitivity between advanced scleral fixation and in-bag IOL implantation.
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28
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Potemkin V. Limbal mini-pockets for transscleral IOL fixation. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100044. [PMID: 37846224 PMCID: PMC10577843 DOI: 10.1016/j.aopr.2022.100044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2023]
Affiliation(s)
- Vitaly Potemkin
- Department of Ophthalmology, First Pavlov State Medical University of St. Petersburg, 197089, St. Petersburg, Lev Tolstoy Str., 6-8, Building 16, Russia
- City Ophthalmologic Center of City Hospital, № 2, St. Petersburg, Uchebniy Pereulok, 5, 194354, Russia
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Sugiura T, Sakimoto T, Tanaka Y, Inoue Y, Oshika T. Long-term outcomes of transsclerally sutured intraocular lens correctly fixed in the ciliary sulcus. BMJ Open Ophthalmol 2022; 7:bmjophth-2021-000935. [PMID: 35537030 PMCID: PMC9058782 DOI: 10.1136/bmjophth-2021-000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To report the long-term postoperative outcomes of transsclerally sutured intraocular lenses (IOLs), in which the haptics were correctly fixated into the ciliary sulcus using an auxiliary device and endoscope. Methods and analysis Data were collected from eyes that were followed up for at least 12 months after ciliary sulcus suture fixation of an IOL using an auxiliary device for securely placing the IOL haptics to the ciliary sulcus, which was confirmed using intraoperative endoscopy in all cases. The corrected distance visual acuity (CDVA), refractive error, anterior chamber depth (ACD), IOL decentration and tilt, corneal endothelial cell density (CECD) and postoperative complications were recorded. ACD and IOL deviations were compared with those of normal controls after standard cataract surgery. Results A total of 146 eyes of 142 patients were included, with a mean follow-up period of 56.0±35.3 (range 12–174) months. Postoperative CDVA from 1 month to 8 years and final CDVA were significantly better, and the mean refraction error, ACD and CECD decline rate were −0.71±0.75 dioptre, 4.01±0.37 mm and −7.4%±16.0%, respectively. Compared with normal controls, ACD was not significantly different but the tilt and decentration were significantly different. The main postoperative complications included vitreous haemorrhage (24.0%), suture thread exposure (19.2%) and corectopia (18.5%). There were no cases of IOL dislocation due to suture breakage or postoperative endophthalmitis Conclusion Long-term postoperative outcomes were favorable with good CDVA and without IOL dislocation and endophthalmitis. The significance and value of fixing haptics to the ciliary sulcus should be re-evaluated.
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Affiliation(s)
| | | | | | | | - Tetsuro Oshika
- Department of Ophthalmology, University of Tsukuba, Clinical Medicine, Ibaraki, Japan
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30
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Carcione J, Astafurov K, Prenner J. Secondary IOL’s and Exchanges from a Retina Surgeon’s Perspective. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00286-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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GamalElDin SA, ElShazly MI, Salama MM. Trocar-assisted flanged transconjunctival intrascleral sutureless intraocular lens fixation. Eur J Ophthalmol 2022; 32:3699-3702. [PMID: 35435770 DOI: 10.1177/11206721221094398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the safety and efficacy of 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation in patients with insufficient posterior capsular support. METHODS Five aphakic eyes with capsular insufficiency were included in this prospective interventional case series study, at Dar El Oyoun Hospital, Cairo, Egypt. Twenty five-gauge trocar-assisted flanged intrascleral sutureless technique was used for IOL fixation, in which retinal microforceps were used to capture and externalize both haptics through a scleral tunnel. CDVA, IOP measurements and IOL centralization were reported pre- and one day, one & 3 months postoperatively. Any intra- or postoperative complications were recorded. RESULTS The mean LogMAR CDVA had significantly improved one day, 1 & 3 months postoperatively (0.74 ± 0.1, 0.42 ± 0.07 and 0.26 ± 0.08 respectively, p < 0.001) compared to the preoperative value (1.7 ± 0.17). The mean IOP showed no significant changes along the follow-up period (16.9 ± 0.1; 16.2 ± 1.1; 16.3 ± 0.9 mmHg, p = 0.68, 0.58, 0.89) respectively at 1st day, 1 & 3 months postoperatively) compared to the preoperative measurement (16.4 ± 1.8 mmHg). The IOL was found to be centralized in all cases. No intra- or postoperative complications were encountered. CONCLUSION 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation is found to be a reliable and effective technique that overcomes Yamane technique's challenges for IOL fixation in cases with posterior capsular insufficiency.
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Affiliation(s)
| | - Malak I ElShazly
- Assistant Professor of Ophthalmology, 63527Cairo University, Cairo, Egypt
| | - Marwa M Salama
- Assistant Professor of Ophthalmology, 63527Cairo University, Cairo, Egypt
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Sun Y, Zhang Z, Wei Y, Chi W, Zhang S. Intraocular Lens Fixation Technique Without Corneal Incision in Minimally Invasive Vitrectomized Eyes. Ophthalmol Ther 2022; 11:729-737. [PMID: 35122608 PMCID: PMC8927512 DOI: 10.1007/s40123-022-00464-4] [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] [Received: 10/25/2021] [Accepted: 01/12/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION To introduce a modified technique for primary/secondary intraocular lens (IOL) fixation without corneal incision in vitrectomized eyes. METHODS Consecutive case series who had undergone previous or concomitant pars plana vitrectomy (PPV) to have primary/secondary IOL fixation were prospectively included. A self-sealing scleral incision was made underneath the superior scleral flap, through which the IOL was inserted into the anterior chamber. The suture tied with the IOL passed through the sclera to fix the IOL in the ciliary sulcus. Patients were followed up for at least 3 months. Main outcomes were best corrected visual acuity (BCVA), intraocular pressure (IOP), surgically induced astigmatism (SIA), and intraoperative and postoperative complications. RESULTS A total of 31 patients were included in the study. The mean follow-up time was 5.35 ± 4.14 months. The BCVA (log MAR unit) improved from 0.97 ± 0.58 preoperative to 0.42 ± 0.36 postoperative (P < 0.001). Mean IOP remained unchanged (preoperative IOP 14.03 ± 2.90 mmHg, postoperative IOP 13.26 ± 3.46 mmHg, P = 0.130). The mean SIA was 0.91 ± 0.76 diopters. No obvious intraoperative and postoperative complications were observed. CONCLUSION This method has favorable postoperative visual recovery and IOP control. This modified method could be taken into account as an option by surgeons in vitreoretinal surgery.
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Affiliation(s)
- Yimeng Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yantao Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Shaochong Zhang
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, 18 Zetian Road, Shenzhen, 518040, Guangdong, China.
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Zyablitskaya M, Hong E, Chen RWS, Chang S, Suh LH. Outcomes of four-point suture fixated and two-point sutureless posterior chamber IOLs combined with pars plana vitrectomy. BMC Ophthalmol 2022; 22:57. [PMID: 35123431 PMCID: PMC8818229 DOI: 10.1186/s12886-022-02290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background While each scleral fixation method has its own advantages, there is a lack of strong evidence to suggest a superior technique. Advances in cataract surgery expand patient eligibility for successful cataract extraction, benefitting a growing population of pseudophakic patients. However, implantation of secondary intraocular lens (IOL) with compromised anterior or posterior capsule is a more challenging task. Each method of scleral fixation has its own advantages and none of them has strong evidence to be superior. This paper describes postsurgical outcomes of two scleral intraocular(IOL) fixation techniques combined with pars plana vitrectomy(PPV) from a single tertiary referral eye center. Methods Patients underwent PPV and IOL implantation with either four-point sutured scleral fixation (Akreos AO60(AK); n = 24) or two-point sutureless flanged intrascleral fixation (CT Lucia(CTL); n = 7). Reports include IOL and sclerotomy placement, fixation techniques, and IOL model. Results Thirty-one eyes of thirty patients were analyzed. Average change in vision from baseline measurement was LogMAR − 0.68 ± 0.66 and − 0.90 ± 0.63 for AK and CTL groups, respectively. Average postoperative refractive error was − 0.3 ± 1.03 D (AK) and 0.4 ± 0.60 D (CTL). No opacification cases of Akreos lens were found in this study with the longest follow up of 53 months. Conclusions Both methods of implantation (sutured and sutureless) could provide good visual and refractive outcomes. Minimal complication rates were reported despite including patients with multiple comorbidities, making both techniques an attractive choice for secondary IOL implantation.
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Silva N, Ferreira A, Ferreira N, Pessoa B, Meireles A. Intrascleral Knotless Zigzag Suture Fixation of Four-Haptic Hydrophilic Acrylic Foldable IOL: Clinical Outcomes. Clin Ophthalmol 2022; 16:33-41. [PMID: 35023899 PMCID: PMC8747796 DOI: 10.2147/opth.s340039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL). Purpose To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL. Methods Retrospective cohort study of consecutive cases. Results Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1±15.2 years (range 18–94), and the median follow-up duration was 19.5 months (range 3–81). The best-corrected visual acuity improved from a mean±SD of 1.34±0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49±0.56 logMAR at the end of follow-up (p<0.001). The mean±SD final SE was −1.24±1.82 diopters. The mean±SD prediction error was −0.51±1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7). Conclusion This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.
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Affiliation(s)
- Nisa Silva
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal.,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal
| | - Natália Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - Bernardete Pessoa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
| | - Angelina Meireles
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
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Yilmaz S, Mavi Yildiz A, Avci R. A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation. Indian J Ophthalmol 2021; 70:131-137. [PMID: 34937224 PMCID: PMC8917568 DOI: 10.4103/ijo.ijo_551_21] [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: 11/30/2022] Open
Abstract
Purpose: To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques. Methods: In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared. Results: The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2). Conclusion: Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.
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Affiliation(s)
- Sami Yilmaz
- Department of Ophthalmology, Bursa Retina Eye Hospital, Bursa, Turkey
| | | | - Remzi Avci
- Department of Ophthalmology, Bursa Retina Eye Hospital, Bursa, Turkey
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36
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Singhal A, Kaushik J, Singh A, Shetty R. Descemet Stripping Endothelial Keratoplasty in Microcornea for Pseudophakic Bullous Keratopathy With Anterior Chamber Intraocular Lens. Cureus 2021; 13:e19262. [PMID: 34900458 PMCID: PMC8648131 DOI: 10.7759/cureus.19262] [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] [Accepted: 11/03/2021] [Indexed: 11/05/2022] Open
Abstract
To report a case of bilateral pseudophakic bullous keratopathy (PBK) in a patient having bilateral microcornea with pre-existing anterior chamber intraocular lens (ACIOL) who underwent Descemet stripping endothelial keratoplasty (DSEK) with a successful postoperative visual outcome. A 36-year-old female, diagnosed with microcornea and congenital cataract in both eyes underwent lens aspiration sequentially followed by ACIOL implantation in both eyes. The patient reported to our centre and was diagnosed with bilateral PBK with ACIOL with microcornea. She also had associated secondary glaucoma, postoperative chronic uveitis, and hyphaema, which were controlled with medical management first and taken into consideration while planning DSEK. The patient underwent manual DSEK without intraocular lens exchange under local anaesthesia in both eyes sequentially with a good visual recovery postoperatively in both eyes. Descemet stripping automated endothelial keratoplasty (DSAEK)/DSEK seems a viable option in patients with microcornea who develop PBK following cataract surgery with retained ACIOL where there is absence of capsular support as well as deficiency of iris tissue.
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Affiliation(s)
| | - Jaya Kaushik
- Ophthalmology, Armed Forces Medical College, Pune, IND
| | - Ankita Singh
- Ophthalmology, Armed Forces Medical College, Pune, IND
| | - Rakesh Shetty
- Ophthalmology, Armed Forces Medical College, Pune, IND
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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.
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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
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Corneal endothelial cell damage after scleral fixation of intraocular lens surgery. Jpn J Ophthalmol 2021; 66:68-73. [PMID: 34751858 DOI: 10.1007/s10384-021-00884-y] [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: 04/04/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To analyze corneal endothelial cell damage after scleral fixation of intraocular lens (SFIOL) surgery. STUDY DESIGN Retrospective study. METHODS Medical records of consecutive eyes undergoing SFIOL surgery performed by a single surgeon were reviewed between January 2011 and June 2019. The patients were classified into three groups according to surgical methods: Group I, re-fixating the existing intraocular lens (IOL) or fixating a new IOL in an aphakic eye; Group II, removing the existing IOL and fixating a new IOL; and Group III, phacoemulsification and fixating a new IOL simultaneously. Preoperative and postoperative specular microscopy (SM) status were compared. Changes in SM were compared among the three groups. RESULTS Ninety-four eyes were included. Thirty-four eyes in Group I, 39 in Group II, and 21 in Group III. The endothelial cell density (ECD) loss in Group I was 1.5%, less than the ECD loss of 14.3% (p < 0.001) in Group II and 15.4% (p = 0.005), in Group III. In no eye was there an ECD decrease to < 1000/mm2 following the surgical procedure. CONCLUSIONS ECD loss was related to IOL removal or phacoemulsification rather than SFIOL surgery. SFIOL using the existing IOL should be considered preferential in eyes with low ECD and dislocated IOL.
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Sevimli N, Karadag R, Çakıcı Ö. A review of techniques and challenges in performing sutureless intrascleral fixation of intraocular lens. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1999807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Neslihan Sevimli
- Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - Özgür Çakıcı
- Ophthalmology, Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
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40
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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.
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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
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41
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Foo VHX, Bong TSH, Tsai A, Lim LS, Perera SA. 1 Year Surgical Outcomes and Safety of Combined Trans Pars Plana Vitrectomy with Iris Fixated Posterior Chamber Intraocular Lens for Subluxated Intraocular Lens and Cataracts. Clin Ophthalmol 2021; 15:4049-4057. [PMID: 34675473 PMCID: PMC8504711 DOI: 10.2147/opth.s333302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Importance/Background To describe the characteristics and 1-year postoperative surgical outcomes of primary combined trans pars plana vitrectomy (TPPV) with iris-fixated posterior-chamber intraocular lens (IF-PCIOL) implantation for subluxated cataracts and intraocular lenses (IOLs). Methods Consecutive cases of significantly subluxated cataracts and IOLs from January 2014 to May 2019 were included in this retrospective case series. Results A total of 103 eyes of 103 patients were included. Median age was 67.4 (interquartile range [IQR] 27–89) years. Thirty-two (31.1%) had subluxated cataracts, while 71 (68.9%) had subluxated IOLs. Overall median preoperative logMAR BCVA was 0.9 (IQR 0–2.5). Median logMAR BCVA improved to 0.3 (0–1.9) and 0.2 (0–1.8) for the subluxated cataract and IOL groups, 81.2% and 75% of eyes achieved logMAR ≤ 0.3, and 94% and 97% achieved IOL stability at month 12, respectively. Eyes with subluxated IOLs had a significantly less myopic median SE if a new IOL was implanted compared to iris-fixating the dislocated IOL. Conclusion Combined primary TPPV and IF-PCIOL implantation is a good surgical option for subluxated IOL or cataract without sufficient capsular support, with at least 75% achieving logMAR BCVA ≤ 0.3 and 95% IOL stability at postoperative year 1. In eyes with subluxated IOLs, explanting that IOL and iris-fixating a new IOL led to a reduced SE and better visual outcome at postoperative month 12 when compared to iris-fixating the dislocated IOL.
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Affiliation(s)
- Valencia Hui Xian Foo
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tiffany Sin Hui Bong
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Andrew Tsai
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Eye-Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Laurence Shen Lim
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Eye-Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Shamira Asith Perera
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Eye-Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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Goyal K, Shekhawat N, Khilnani K. Management of traumatic dislocation of crystalline lens: Retropupillary iris-claw versus sutureless intrascleral-fixated intraocular lens. Taiwan J Ophthalmol 2021; 11:389-394. [PMID: 35070669 PMCID: PMC8757526 DOI: 10.4103/tjo.tjo_48_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/08/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: The purpose of this study was to compare the long-term efficacy and safety of posterior iris-claw lens and scleral-fixated posterior chamber lens for aphakia after traumatic posterior dislocation of the crystalline lens. MATERIAL AND METHODS: Out of 120 evaluated cases, 60 were randomly assigned in each group. A 23G vitrectomy was done and intraocular lens was implanted by two different techniques. Extensive preoperative and postoperative evaluation was performed including optical coherence tomography and Scheimpflug imaging. Follow-up was done on days 1, 7, and 28 at 3 months, 6 months, and 12 months. RESULTS: A significant improvement was found in uncorrected visual acuity in both the groups. Surgical time in iris fixation was significantly less (P < 0.001), whereas pupil peaking and pigment release were more. Difference in mean intraocular pressure and change in astigmatism in both the groups were insignificant. CONCLUSION: Both the techniques had similar good visual results. Although operating time was shorter for iris fixation, it had several disadvantages, including immediate postoperative inflammation and ovalling of the pupil. However, scleral fixation had a better outcome in terms of postoperative complications.
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Affiliation(s)
- Karishma Goyal
- Department of Ophthalmology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Nagendra Shekhawat
- Department of Ophthalmology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Kamlesh Khilnani
- Department of Ophthalmology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
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Jiang B, Dong S, Sun MH, Zhang ZY, Sun DW. Clinical effect of peripheral capsule preservation in eyes with silicone oil tamponade. World J Clin Cases 2021; 9:7729-7737. [PMID: 34621823 PMCID: PMC8462261 DOI: 10.12998/wjcc.v9.i26.7729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/16/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At present, silicone oil has been widely used in vitrectomy to deal with complex fundus diseases. Usually, cataract extraction is combined with vitrectomy. However, reducing the complications of silicone oil tamponade and facilitating the secondary implantation of intraocular lens (IOL) are still an urgent problem.
AIM To evaluate the clinical effect of vitrectomy combined with peripheral capsule preservation (PCP) in eyes with silicone oil tamponade.
METHODS This single-center retrospective analysis included 70 patients (73 eyes) who underwent vitrectomy and silicone oil tamponade combined with cataract surgery (stage I) between January 2015 and July 2019. All patients underwent selective reoperation for silicone oil extraction and IOL implantation (stage II) more than 3 mo after stage I. These patients were divided into three groups according to the different lens capsule preservation methods: 28 patients (31 eyes) in a whole capsule preserved (WCP) group, 17 (17 eyes) in a capsule absent (CA) group, and 25 (25 eyes) in a peripheral capsule preserved (PCP) group. Intraocular pressure (IOP), best-corrected visual acuity, surgery time, and other complications were recorded at each time point (1 d, 1 wk, and 1 mo after stages I and II).
RESULTS The IOP values were 14.9 ± 8.2 mmHg in the WCP group, 20.3 ± 13.0 mmHg in the CA group, and 14.2 ± 9.7 mmHg in the PCP group (P < 0.05) at 1 mo after stage I operation. Five eyes had IOP higher than 30 mmHg, and one eye in the WCP group appeared to have silicone oil entering the anterior chamber. There was no significant difference in IOP among the three groups at any other time point (P > 0.05). With IOL implantation, visual acuity improved significantly compared to stage I. The incidence rate of posterior capsule opacity was higher in the WCP group than in the other groups (P < 0.001). In the CA group, IOL deviation due to suture relaxation occurred in one case. There was no significant difference in the surgery time among the three groups in stage I (P = 0.618). In stage II, the surgery time of the PCP group and WCP group was significantly shorter than that of the AC group (P = 0.031).
CONCLUSION Preservation of the peripheral capsule in vitrectomy combined with lens removal is a better option. This method has significant advantages in reducing intraoperative and postoperative complications.
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Affiliation(s)
- Bo Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Su Dong
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Ming-Hao Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Zhong-Yu Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Da-Wei Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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Lee SY, Cho YK. The Effect of Scleral Sutured Intraocular Lens with Optic-haptic Junction Fixation in the Capsular Bag. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.9.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare the stability of intraocular lens (IOL) insertion methods of sutured haptics in the bag with scleral fixation to those of in the bag insertion and scleral sulcus fixation. Methods: In group of only phacodonesis, two IOL insertion methods, in the bag insertion and sutured haptics in the bag with scleral fixation were compared. In group of phacodonesis with less than 90° zonulysis, two IOL insertion methods, sutured haptics in the bag with scleral fixation and scleral sulcus fixation were compared. Postoperative 2 months and 12 months refraction were compared with target refraction and the refractive change between postoperative 2 and 12 months were compared in each group. The change of anterior chamber depth (ACD) at postoperative 2 and 12 months were compared with preoperative ACD, and the change of ACD between postoperative 2 and 12 months were compared in each group. Results: In group of only phacodonesis, the typical in the bag insertion group showed significant ACD change between postoperative 2 and 12 months (<i>p</i> = 0.010), but the group of sutured haptics in the bag with scleral fixation didn’t show the significant ACD change (<i>p</i> = 0.515). In group of phacodonesis with less than 90° zonulysis, the sulcus scleral fixation method showed significant ACD change and significant refractive change (<i>p</i> = 0.015, <i>p</i> = 0.004), but the group of sutured haptics in the bag with scleral fixation method didn’t show the significant ACD nor refractive change (<i>p</i> = 0.713, <i>p</i> = 0.106) between postoperative 2 and 12 months. Conclusions: In eyes with zonular instability, sutured haptics in the bag with scleral fixation method can promote the postoperative stability of IOL.
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Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy. J Ophthalmol 2021; 2021:4617583. [PMID: 34513084 PMCID: PMC8428990 DOI: 10.1155/2021/4617583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare the visual outcomes and complications of patients who underwent flanged transconjunctival sutureless intrascleral intraocular lens (SIS IOL) implantation after anterior and pars plana vitrectomy. Methods All patients who underwent flanged transconjunctival SIS IOL fixation using a 27-gauge needle between September 2017 and November 2019 and were followed up for at least six months were evaluated. The cases in which anterior vitrectomy was performed were classified as Group 1, and those that underwent pars plana vitrectomy were classified as Group 2. The best-corrected visual acuity (BCVA), spherical equivalent values, corneal endothelial cell density, and intraocular pressures were compared between the two groups before and after the operation. Intraoperative and postoperative complications were assessed. Results The study included 108 eyes of 108 patients who were included in the study. Group 1 consisted of 48 patients and Group 2 comprised of 60 patients. When the findings between Groups 1 and 2 were compared in the postoperative period, there was no statistically significant difference in terms of the mean intraocular pressure increase, endothelial cell density, BCVA, and spherical equivalent value (P=0.818, 0.601, 0.368, and 0.675, respectively). When all the patients were considered as a single group, the mean spherical value at the sixth postoperative month was 0.3 ± 2.2 D (min-max, (−5.5)–(+6)), the mean cylindrical value was −1.7 ± 2.4 D (min-max, (−9.25)–(+4)), and the mean spherical equivalent value was −0.5 ± 2.3 D (min-max, (−6.5)–(+6)). Conclusion The flanged transconjunctival SIS IOL fixation technique performed using a 27-gauge needle is safe and effective in the patient group with aphakia and lens/IOL dislocation or subluxation. However, in patients planned to undergo flanged transconjunctival SIS IOL implantation, pars plana vitrectomy seems to be a more suitable option than anterior vitrectomy to reduce complications.
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One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens. J Ophthalmol 2021; 2021:3838456. [PMID: 34484813 PMCID: PMC8413050 DOI: 10.1155/2021/3838456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess one year results and stability of the implantation of a scleral anchored intraocular lens (IOL). Design Interventional prospective case series. Methods Sixty eyes of 60 patients affected by either aphakia or IOL dislocation were included in this study. Patients underwent vitrectomy, scleral fixation of the IOL, and, if present, dislocated IOL removal. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery by best-corrected distance visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, corneal specular microscopy, and optical coherence tomography (OCT) of both the macula and anterior segment. Results At twelve months, mean BCVA significantly improved (p < 0.0001), and none of the patients experienced a decrease of visual acuity. A 10% decrease of endothelial cell count occurred after surgery. Cystoid macular edema occurred in three patients (5%). A transient increase of intraocular pressure was noted in 7 cases (12%). At one month, horizontal and vertical IOL tilt was 1.04 ± 0.87 and 0.74 ± 0.71 degrees, respectively, and did not significantly change in the follow-up (p > 0.05). None of the patients had decentration or dislocation of scleral-fixated IOL during the follow-up. Conclusion Implantations of scleral plug fixated IOL provide good visual results, low complication rate, and excellent stability of the lens until one-year follow-up.
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Mahler OS, Einan-Lifshitz A, Hecht I, Biron R, Pras E, Dubinsky-Pertzov B. Modification of intraocular lens insertion using 4-flanged fixation with a standard cartridge and a 2.4 mm corneal incision in eyes with no capsular support. J Cataract Refract Surg 2021; 47:1227-1233. [PMID: 34468460 DOI: 10.1097/j.jcrs.0000000000000600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
A modification of intraocular lens (IOL) implantation, using the 4-flanged IOL fixation technique, through a 2.4 mm corneal incision using a standard cartridge and injector, is presented. An IOL with 4 eyelets is used, through which a 6-0 polypropylene suture is threaded on one side and then loaded into a provided cartridge and inserted to the anterior chamber through a 2.4 mm corneal incision. Using the handshake technique, the suture ends are eventually threaded through the eyelets and secured outside the eye with the creation of 4 flanges. This technique was used in 6 eyes of 5 consecutive patients with the absence of capsular support. During all follow-up visits, the IOLs were well centered and stable, and the flanges were buried in the sclera and covered with the conjunctiva. No complications were recorded. This modification simplifies the technique and reduces the well-known complications of large corneal incisions.
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Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Wang W, Liu X, Wang YY, Yao K. Chronic scleritis: a potential cause of intraoperative zonular dehiscence. Int J Ophthalmol 2021; 14:1285-1287. [PMID: 34414096 DOI: 10.18240/ijo.2021.08.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wei Wang
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Xin Liu
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Yu-Yan Wang
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou 310009, China
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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.].
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Fiore T, Messina M, Muzi A, Tosi G, Lupidi M, Casini G, Marruso V, Cagini C. Comparison of two different scleral fixation techniques of posterior chamber Carlevale lens. Medicine (Baltimore) 2021; 100:e26728. [PMID: 34397876 PMCID: PMC8360456 DOI: 10.1097/md.0000000000026728] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To investigate the surgical outcomes of 2 different scleral fixation techniques of the new single-piece foldable acrylic Carlevale lens (Soleko) and to compare our results with previous reports of the literature.A retrospective, non-randomized comparative study involving 2 series of patients who underwent 2 different scleral fixation techniques of Carlevale lens was performed. Minimum follow-up of 3 months was requested for inclusion in the study. All the patients underwent a standard ophthalmologic examination including best correct visual acuity, measurement of intraocular pressure, anterior segment, and fundus examination. In the first technique (group 1), plugs were externalized through a 23 gauge sclerotomy and placed within 2 scleral pockets. In the second technique (group 2), plugs were externalized through a 25-gauge sclerotomy and covered by 2 scleral flaps. For an estimation of the refractive prediction error, the postoperative spherical equivalent of objective refraction was calculated (IOL Master 750, Carl Zeiss Meditec AG, Jena, Germany). Spectral domain optical coherence tomography (Spectralis HRA+OCT2, Heidelberg Engineering, Heidelberg, Germany) of anterior segment was used to check plugs positioning postoperatively.Twenty-three eyes in group 1 and 9 eyes in group 2 were included. Preoperative diagnosis was aphakia, dislocated posterior chamber intra ocular lens, dislocated lens, anisometropia, Uveitis-Glaucoma-Hyphema syndrome, perforating trauma with dislocated intra ocular lens, and open globe injury with dislocated intra ocular lens. Respectively, in groups 1 and 2, refractive spherical equivalent prediction error was -0,31 ± 0,74 D and -0,27 ± 0,80 D, and postoperative best-corrected visual acuity was 0,42 ± 0,31 logMAR and 0,47 ± 0,45 logMAR. In group 1, 1 eye developed cystoid macular edema, 1 eye vitreous haemorrhage, and 3 eyes showed plugs located outside the scleral pockets under the conjunctiva. Rupture of 1 of the 2 tips of the plug was observed in 1 patient of group 1 during the externalization.Carlevale lens is a scleral fixated intra ocular lens specifically designed for posterior chamber implantation that could be successfully managed without any significant difference between the 2 surgical techniques, and appears approachable for anterior and posterior segment surgeons. A 25-gauge sclerotomy should be preferred with the aim of a sutureless surgery regardless the technique employed.
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Affiliation(s)
- Tito Fiore
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Marco Messina
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Muzi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Gialuigi Tosi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giamberto Casini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology, and of Critical area, University of Pisa, Italy
| | - Virginia Marruso
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
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