Suture fixation of a foldable acrylic intraocular lens for ectopia lentis

Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support

There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficient approach for paediatric aphakic patients.

New Management Strategies for Ectopia Lentis

Ectopia lentis refers to displacement of the crystalline lens in the setting of various systemic and metabolic disorders. A literature review was conducted to investigate the management of non-traumatic ectopia lentis in the pediatric population, particularly focusing on surgical intervention. Both limbal and pars plana approaches for lensectomy are well established in the literature. Surgical options for intraocular lens implantation in pediatric eyes with ectopia lentis include anterior chamber intraocular lenses and iris-fixated or scleral-fixated posterior chamber intraocular lenses. Recently, the use of capsular tension rings has also been described with promising results. Visual rehabilitation and treatment of amblyopia are essential for patients within the amblyogenic age group following surgical intervention.

Haptic breakage after transscleral fixation of a single-piece acrylic intraocular lens

PURPOSE

To report the case of a patient with a damaged haptic of an acrylic intraocular lens (IOL) after transscleral IOL fixation.

METHODS

This is a retrospective and descriptive case report.

RESULTS

A 40-year-old man presented with sudden visual loss in the left eye. He had undergone phacoemulsification/aspiration and IOL implantation 3 years previously and IOL repositioning with transscleral fixation 2 years before the initial visit. His visual acuity was 0.3 in the left eye due to corneal edema caused by a foreign body, i.e., the severed haptic tip of the single-piece acrylic IOL, which was surgically removed. The IOL itself was tilted and therefore explanted. The surface of the tip of the haptic suggested that the monofilament suture thread had exerted continuous force across the haptic.

CONCLUSIONS

The haptics of acrylic IOLs can be damaged after transscleral fixation.

Axial growth and binocular function following bilateral lensectomy and scleral fixation of an intraocular lens in nontraumatic ectopia lentis

PURPOSE

To evaluate binocular function (BF) and changes in axial length (AL) bilaterally in pseudophakic eyes of children after lensectomy and scleral fixation of an intraocular lens (IOL) for nontraumatic ectopia lentis.

METHODS

In 15 children who had undergone bilateral lensectomy and scleral fixation of an IOL for nontraumatic ectopia lentis, AL was measured preoperatively and at last follow-up, and BF was assessed at last follow-up. Axial growth was compared with the expected and observed patterns of normal eyes, and the results were compared between patients with isolated ectopia lentis and those with Marfan syndrome.

RESULTS

Ten of the 15 patients had Marfan syndrome. Mean age at surgery was 5.2 +/- 2.4 years; mean follow-up was 51.7 +/- 29.2 months. A mean axial growth rate of 0.39 mm/year during 51.7 postoperative months was greater than the expected (0.07 mm/year) or the observed (0.09-0.24 mm/year) rates in age-matched normal eyes. The axial growth rates in isolated ectopia lentis patients and Marfan patients were not significantly different (P = 0.159). Binocular fusion and stereoacuity of < or =800 seconds of arc were achieved by nine patients, and worse or no BF was achieved by the remaining six patients. These six patients were significantly more likely to have pre- or postoperative anisometropia of > or =3.0 D (66.6%) than the other nine patients (0%).

CONCLUSIONS

Because of greater than normal axial growth, more undercorrection of the IOL power is required than is usual in bilateral surgery for nontraumatic ectopia lentis. Good or moderate levels of postoperative BF were achieved in more than half of patients.

Transscleral fixation of single-piece hydrophilic acrylic lenses with no eyelets

Scleral fixation ofsulcus intraocular lenses is performed by most surgeons to correct aphakia in eyes with insufficient capsular support in which intraocular lenses cannot be implanted into the bag or sulcus. The implantation of foldable lenses maintains the advantages of small incision surgery, working with a closed system, less astigmatism, faster wound healing, and early visual rehabilitation. The authors describe a technique for using a single-piece hydrophilic foldable acrylic lens with no eyelets for scleral fixation.

Suture fixation technique for a single-piece foldable closed-loop intraocular lens

Purpose

We describe a suture fixation technique for a single-piece foldable acrylic closed-loop intraocular lens (IOL) (C-flex™, Rayner).

Methods

In our experimental model analyzing the stability of acrylic haptics, we confirmed that the IOL could be in counterpoise without tilt using only a two-point fixation. This new surgical technique was performed in seven patients.

Results

The unique haptic design allows easy and secure suture fixation. The clinical outcomes were encouraging.

Conclusions

It is conceivable that better stabilization can be achieved by the broad arc of distal haptic-tissue contact, in addition to suture fixation, using our surgical technique with the C-flex™ IOL.

[Injector implantation of a scleral-fixated intraocular lens]

BACKGROUND

In this pilot study, a new injector technique for small-incision implantation of scleral-fixated intraocular lenses (IOLs) was evaluated for IOL stability and visual rehabilitation.

PATIENTS AND METHODS

Secondary lens implantation was performed in 18 aphakic eyes using a new small incision technique with injector implantation. This allowed for haptic suturing with the lens body inside the cartridge. All patients were followed-up for best-corrected visual acuity, refraction, IOL evaluation and ultrasound biomicroscopy.

RESULTS

In all eyes the IOL was stable without tilt or torque. Best-corrected visual acuity improved 2.2 ETDRS lines after 1 week and 3.1 lines after a mean follow-up time of 7.9+/-2.8 months. Two eyes were complicated with small, peripheral transillumination defects (n=2), but no pigmentary glaucoma occurred.

CONCLUSION

By using a self-sealing tunnel incision and injector technique, significant fluid egress and consecutive transient hypotony is minimized throughout the whole procedure. The technique shows a high IOL stability without tilt and assures rapid visual rehabilitation.

Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses

PURPOSE

To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results.

SETTING

Department of Ophthalmology, Medical University of Lodz, Lodz, Poland.

METHODS

This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral-fixated posterior chamber IOLs in 20 eyes. The follow-up mean was 5.2 month (range 1 to 16 months).

RESULTS

No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 +/- 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 +/- 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral-fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication.

CONCLUSION

Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.

Transscleral fixation of foldable intraocular lenses

PURPOSE

To report the results of transscleral implantation of foldable intraocular lenses (IOLs).

SETTING

Department of Ophthalmology Dokuz Eylül University School of Medicine, Izmir, Turkey.

METHODS

Twenty eyes of 20 patients had transscleral fixation of a foldable IOL combined with conventional 3-port pars plana vitrectomy or anterior vitrectomy. Twelve eyes had lens luxation, 8 traumatic and 4 idiopathic. Six eyes were aphakic, 3 after extracapsular cataract extraction and 3 as a result of complicated phacoemulsification. One patient with a mature cataract and pseudoexfoliation had a wide zonular dialysis during phacoemulsification. One patient had an opacified hydrophilic acrylic IOL.

RESULTS

The mean age of the patients was 52.9 years (range 17 to 80 years). The mean preoperative best corrected visual acuity (BCVA) was 20/63 (range counting fingers to 20/25). The mean preoperative refraction was +10.8 diopters (D) (range +10 to +13 D) and the mean preoperative astigmatism, 1.8 D (range 1.0 to 5.5 D). Sixteen IOLs were hydrophobic acrylic, 14 of which were 3-piece AcrySof MA60BM (Alcon) and 2 of which were Sensar AR40 (Allergan). Four IOLs, all VisaAcryl(Staar), were hydrophilic acrylic. The mean power of the IOLs was +22.0 D (range 19.0 to 26.0 D). The mean follow-up was 12 months (range 1 to 18 months). The postoperative BCVA ranged between 20/100 and 20/20, and the mean postoperative astigmatism was 1.1 D (range 0.5 to 4.0 D) at the last follow-up visit. The difference was statistically significant (P<.05). Suture exposure and cystoid macular edema were the only complications, each occurring in 2 eyes.

CONCLUSION

Transscleral fixation of foldable IOLs takes less time and results in fewer complications and better visual outcomes.

Surgical technique for suture fixation of an acrylic intraocular lens in the absence of capsule support

We present a technique for suture fixation of an intraocular lens (IOL) in the absence of capsule support. This technique is useful for the treatment of aphakia and the management of IOL complications or cataract surgery when all capsule support is lost.