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Levy-Neuman S, Mendel L, Achiron A, Bukelman A, Weinberg T, Avizemer H, Schlesinger M, Marcovich AL, Kleinmann G. Comparison of flanged polypropylene scleral intraocular lens fixation with scleral sutured fixation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00093-0. [PMID: 38636552 DOI: 10.1016/j.jcjo.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket. METHODS Retrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center. RESULTS A total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (-0.63 ± 2 and -2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29). CONCLUSION Comparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.
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Affiliation(s)
| | - Liat Mendel
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Bukelman
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Tamir Weinberg
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Haggay Avizemer
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel
| | - Mor Schlesinger
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Arie L Marcovich
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Guy Kleinmann
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Liu Z, Xie Q, Chen X, Xie B, Cai S. Effect of sutureless scleral fixed intraocular lens implantation on aphakic eyes: a system review and meta-analysis. BMC Ophthalmol 2023; 23:493. [PMID: 38053049 PMCID: PMC10698919 DOI: 10.1186/s12886-023-03223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Sutureless scleral fixed intraocular lens implantation (SF-IOL) has become one of the mainstream schemes in clinical treatment of aphakic eyes because of its advantages, such as avoiding dislocation of intraocular lens or subluxation caused by suture degradation or fracture and significant improvement of postoperative visual acuity. However, a consensus on the relative effectiveness and safety of this operation and other methods is still lacking. This study aimed to compare the efficacy and safety of sutureless SF-IOL with other methods. Aphakia means that the lens leaves the normal position and loses its original function, including absence or complete dislocation and subluxation of the lens which could cause anisometropic amblyopia, strabismus, and loss of binocular function in children and adolescents. For adults, the loss of the lens could lead to high hyperopia and affect vision. Above all this disease can seriously affect the quality of life of patients. METHODS Literature about sutureless SF-IOL in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Technical Journal VIP database, and Wanfang database published from 2000 to 2022 was reviewed. The weighted average difference was calculated by RevMan5.3 software for analysis. Two researchers independently selected the study and used the Cochrane collaboration tool to assess the risk of errors. Cochrane bias risk tool was used to evaluate the quality of evidence. This study is registered on PROSPERO (CRD42022363282). RESULTS The postoperative IOL-related astigmatism of sutureless SF-IOL was lower than that of suture SF-IOL, and there was statistical difference when we compared the absolute postoperative spherical equivalent after sutureless SF-IOL and suture SF-IOL. Indicating that the degree of refractive error after sutureless SF-IOL was lower. Meanwhile, the operation time of sutureless SF-IOL was shorter than that of suture SF-IOL. The subgroup analysis showed that the absolute postoperative spherical equivalent and astigmatism values in Yamane technique were lower than those in suture SF-IOL. CONCLUSION Sutureless SF-IOL has the advantages of stable refraction, short operation time, and less postoperative complications. However, high-quality literature to compare these technologies is lacking. Some long-term follow-up longitudinal prospective studies are needed to confirm the findings.
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Affiliation(s)
- Zhao Liu
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
| | - Qian Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
| | - XingWang Chen
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
- Guizhou Eye Hospital, Zunyi, 563003, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China
| | - Bing Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
- Guizhou Eye Hospital, Zunyi, 563003, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China
| | - ShanJun Cai
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China.
- Guizhou Eye Hospital, Zunyi, 563003, China.
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China.
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China.
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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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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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Minamoto A, Harada Y, Hiyama T, Ohara H, Kiuchi Y. Two Cases of Atopic Dermatitis Patients With Scleral Perforation After Recurrent Scleritis Induced by Scleral-Sutured Posterior Chamber Intraocular Lens Implantation. Cureus 2023; 15:e40153. [PMID: 37431339 PMCID: PMC10329562 DOI: 10.7759/cureus.40153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
This report describes two cases of atopic dermatitis patients with scleral perforation after recurrent scleritis induced by suture exposure after scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. The first patient was a 41-year-old man (case 1), and the second was a 46-year-old man (case 2). Both had a history of atopic dermatitis and scleral-sutured intraocular lens (IOL) implantation. Scleritis recurred at the suture site after scleral-sutured IOL implantation in both patients. Although the scleritis was controlled by topical and/or systemic anti-inflammatory drugs, the sclera was perforated in both cases because of exposure of the suture knots (after seven years in case 1 and after 11 years in case 2). In case 1, the superotemporal IOL haptic was also exposed over the conjunctiva, and in case 2, the ciliary body was incarcerated in the scleral hole with deformation of the pupil superonasally. Considering that there were no signs of severe intraocular inflammation, surgical intervention was performed in both cases. In case 1, IOL repositioning was performed with oral prednisolone cover at a dosage of 15 mg/day, starting two weeks prior to the surgery. The steroid dosage was gradually tapered off until two months after the surgery. In case 2, the scleral patch underwent without IOL extraction, and no steroid or immunosuppression cover was administered. There was no recurrence of scleritis after surgery in either case, and visual acuity was preserved in both cases. The scleral perforation that occurred after scleral-sutured IOL implantation in these patients was thought to be the result of recurrent scleritis caused by suture exposure and chronic mechanical irritation by a suture knot. The scleritis subsided without removal of the IOL by moving the suture site of the IOL haptic and covering the suture with a scleral flap or patch graft.
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Affiliation(s)
- Akira Minamoto
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Yosuke Harada
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Tomona Hiyama
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Hiromi Ohara
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Yoshiaki Kiuchi
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
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Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture. J Cataract Refract Surg 2021; 46:1480-1486. [PMID: 32649434 DOI: 10.1097/j.jcrs.0000000000000309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report intraoperative performance and long-term postoperative outcomes after scleral fixation of intraocular lenses (IOLs) with polytetrafluoroethylene suture (PTFE). SETTING Raghudeep Eye Hospital, Ahmedabad, India. DESIGN Prospective, interventional case series. METHODS One hundred eyes undergoing scleral fixation of IOLs using PTFE suture (Gore-Tex) with 12 months or more postoperative follow-up were included. The primary outcome measures were occurrence of intraoperative and postoperative complications such as glaucoma, suture-related complications, and inflammation within the follow-up period. The secondary outcome measure was improvement in visual acuity (VA). RESULTS Of the 100 eyes, posteriorly dislocated IOLs (53 eyes) followed by dropped nuclei (33 eyes) were the most common surgical indications. Mean follow-up was 23 months (range 12 months to 5 years). Seventy-one patients (77.17%) had 18 months or more follow-up; 21 eyes had a rise in intraocular pressure in the early postoperative period; 12 of them required glaucoma surgery. Early complications were vitreous hemorrhage in 13 eyes, retinal detachment in 6 eyes, and transient hyphema in 1 eye. Late postoperative complications were cystoid macular edema (9 eyes), epiretinal membrane (3 eyes), and bullous keratopathy (3 eyes). Mean VA improved from 0.92 ± 0.16 (SD) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.41 ± 0.27 logMAR. LogMAR at final follow-up was 0.41 ± 0.28 (P < .01). There were no cases of suture-related complications (erosion/breakage/granuloma) or IOL decentration throughout the follow-up period. CONCLUSIONS Scleral fixation of IOLs with PTFE suture was found to be safe and well tolerated. All eyes had well-centered IOLs, with no suture-related complications during long-term follow-up. VA improved significantly with acceptable postoperative complications.
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Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
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Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
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Kristianslund O, Sandvik GF, Drolsum L. Long-Term Suture Breakage After Scleral Fixation of a Modified Capsular Tension Ring with Polypropylene 10-0 Suture. Clin Ophthalmol 2021; 15:2473-2479. [PMID: 34163130 PMCID: PMC8214109 DOI: 10.2147/opth.s310648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
Aim To investigate the long-term risk of suture breakage after implantation of a modified capsular tension ring (MCTR) fixated to the sclera with polypropylene 10–0 suture. Methods Retrospective case series of operations for subluxated phakic lenses in 2007–2015 with implantation of an MCTR secured with a 10–0 polypropylene suture as part of an intraocular lens (IOL)-capsular bag complex. Results We identified 132 eyes (92 patients) operated on with an MCTR. Of these eyes, 26 (20%) had suture breakage requiring re-operation, while another eight eyes (6%) had suture breakage that did not require surgery. The re-operations occurred after a mean 4.8±3.3 years. Suture breakage occurred in patients with a mean age of 34.0±23.3, as compared to 43.2±26.0 years for patients who did not experience this complication (p=0.36). In patients aged 40 years or younger at the time of surgery, 47% experienced suture breakage in one or both eyes, as compared to 19% in the age group 41–69 years and 13% in the age group 70 years and older (p=0.004). Of the 132 eyes that were operated on, we registered one case (0.8%) of possible suture-related late endophthalmitis. Conclusion The long-term risk of suture breakage was quite high after scleral fixation of the MCTR in this patient cohort, and it seems as the risk is increased with young age.
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Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunhild F Sandvik
- Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Forlini M, Bedi R. Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses. J Cataract Refract Surg 2021; 47:792-801. [PMID: 33278236 DOI: 10.1097/j.jcrs.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Cataract surgery via phacoemulsification with intraocular lens (IOL) placement in the capsular bag is the gold standard in the presence of adequate capsular support. However, when capsule and/or zonular fibers are weak or absent, alternate fixation strategies are required. Common alternative options include retropupillary iris-claw IOLs (RP-IC IOLs) and scleral-fixated IOLs (SF IOLs). In the present review of 87 articles with 2174 eyes implanted with RP-IC IOLs and 2980 eyes with SF IOLs, we discuss the published literature with respect to safety and efficacy. Although the studies reporting outcomes of these IOLs have been performed in patients with different concomitant conditions, visual and refractive outcomes were found to be comparable between RP-IC IOLs and SF IOLs. RP-IC IOL implantation seemed to provide equivalent or a potentially lower rate of complications than SF IOL implantation. Data from the literature also suggest that the surgical technique of RP-IC IOL implantation is relatively simpler with correspondingly shorter surgical times.
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Affiliation(s)
- Matteo Forlini
- From the Domus Nova Hospital, Ravenna, Italy (Forlini); Iris Advanced Eye Center, Chandigarh, India (Bedi)
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Sutureless Intrascleral Posterior Chamber Intraocular Lens Fixation: Analysis of Clinical Outcomes and Postoperative Complications. J Ophthalmol 2021; 2021:8857715. [PMID: 33510907 PMCID: PMC7826223 DOI: 10.1155/2021/8857715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a technique for performing sutureless intrascleral fixation of a posterior chamber intraocular lens (PC-IOL) and analyzing the clinical outcomes and postoperative complications. Study Design. 68 eyes of 66 patients who received the technique were studied retrospectively. Methods The best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), IOL tilt and decentration, corneal topography (K1 and K2), and postoperative complications were determined at 3 months. Results The mean preoperative BCVA was 1.63 ± 1.24 logMAR units, and the mean postoperative BCVA was 0.74 ± 0.59 logMAR units at 3 months (P < 0.05). The mean preoperative IOP was 21.9 ± 12.6 mmHg, and the mean postoperative IOP was 16.9 ± 4.5 mmHg at 3 months (P = 0.001). The mean preoperative corneal topography (K1 and K2) was K1 = 42.14 ± 1.91 and K2 = 43.54 ± 1.51; the mean postoperative corneal topography (K1 and K2) was K1 = 43.03 ± 2.18 and K2 = 43.40 ± 1.71 at 3 months (P = 0.678 and 0.468, respectively). The mean preoperative spherical equivalent was +11.00 ± 13.19 diopters (D), and the mean postoperative spherical equivalent was +0.06 ± 0.86 D (P < 0.005). The mean IOL tilt was 2.4 ± 1.7°, and the mean decentration was 0.35 ± 0.21 mm. The mean ACD was 4.31 ± 0.29 mm. Conclusions The 27-gauge sutureless intrascleral PC-IOL implantation technique minimizes intraoperative injury, simplifies procedure, and provides good PC-IOL fixation with few postoperative complications.
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Comparison of Different IOL Types in the Flanged IOL Fixation Technique. J Ophthalmol 2020; 2020:8534028. [PMID: 32051766 PMCID: PMC6995482 DOI: 10.1155/2020/8534028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare short-term clinical outcomes between two different intraocular lens (IOL) types in the flanged IOL fixation technique. Methods This study was a retrospective case series and included the patients who underwent flanged IOL fixation between June 2017 and July 2018 at the Hiroshima University Hospital. Two different 3-piece IOLs (NX-70 and PN6A) were used. Recipients of NX-70 and PN6A IOLs were classed into groups 1 (15 eyes) and 2 (25 eyes), respectively. Patient characteristics, surgical results, and postoperative complications were analyzed. We excluded patients with a postoperative follow-up of <1 month. Results The mean follow-up period was 13.3 ± 11.7 weeks. The postoperative best corrected visual acuity, in logarithm of the minimum angle of resolution (logMAR), was 0.10 ± 0.33 in group 1 and 0.26 ± 0.42 in group 2. The mean operation times for groups 1 and 2 were 11.2 ± 4.54 minutes and 7.00 ± 2.20 minutes, respectively (p=0.0024). Detachment of the IOL haptic from the optic during surgery occurred in four eyes in group 2 (16%), but did not occur in group 1. Iris capture of the optic was observed in 3 of the 13 eyes (23%) without a peripheral iridotomy in group 2. No peripheral iridotomies were performed on group-1 eyes, but iris capture did not occur in that group. Conclusions There was a trend to fewer intraoperative and postoperative complications when using NX-70 IOLs. On the other hand, PN6A IOLs was easy to maneuver within the anterior chamber, and the operation time was shorter when using PN6A IOLs. Selection of optimal IOLs for flanged IOL fixation necessitates an understanding of their characteristics in terms of intraoperative and postoperative complications.
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Koçluk Y, Kasım B. Descemet membrane endothelial keratoplasty and intraocular lens implantation in cases of aphakic bullous keratopathy. Semin Ophthalmol 2020; 35:86-93. [PMID: 32105503 DOI: 10.1080/08820538.2020.1733031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To present the results of a modified sutured transcleral or sutureless intrascleral three-piece foldable intraocular lens (IOL) implantation with Descemet membrane endothelial keratoplasty (DMEK) in cases of aphakic bullous keratopathy (ABK) with inadequate capsular support.Methods: Twenty-one eyes of 21 patients with ABK and inadequate capsular support who underwent DMEK with three-piece foldable IOL implantation from September 2015 to June 2018 were analyzed, retrospectively. Two techniques were used in IOL implantation; sutureless intrascleral fixation of the IOL (ISF-IOL) and sutured transscleral-fixated IOL (TSF-IOL) implantation.Results: Rebubblings due to the graft detachment were needed in 9 (43%) of 21 eyes in the early postoperative period. At the last follow-up visit, 18 (85.7%) of DM grafts were attached. Any complication related to IOL implantation was not observed in the ISF-IOL cases. Exposure of the fixation suture in 1 (25%) of 4 TSF-IOL cases was seen, postoperatively. The increase in the mean best-corrected visual acuity (BCVA) at the last follow-up visit was statistically significant when compared to the mean preoperative BCVA (p < .001). The mean preoperative central corneal thickness was decreased from 883.3 ± 111.8 (700-1150) μm to 582.3 ± 118.2 (490-990) μm at the last follow-up visit (p < .001).Conclusion: DMEK combined with sutureless/sutured three-piece foldable IOL implantation appears to be a feasible method for the management in ABK without adequate capsular support. A faster visual recovery can be obtained with the techniques presented.
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Affiliation(s)
- Yusuf Koçluk
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | - Burcu Kasım
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
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Dalby M, Kristianslund O, Drolsum L. Long-Term Outcomes after Surgery for Late In-The-Bag Intraocular Lens Dislocation: A Randomized Clinical Trial. Am J Ophthalmol 2019; 207:184-194. [PMID: 31194950 DOI: 10.1016/j.ajo.2019.05.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the long-term efficacy and safety of 2 operation methods for late in-the-bag intraocular lens (IOL) dislocation. DESIGN Prospective, randomized, parallel group surgical clinical trial. METHODS During a 3-year period, 104 patients (104 eyes) were assigned one group for IOL repositioning by scleral suturing (n = 54) or one group for IOL exchange by retropupillary fixation of an iris claw IOL (n = 50). A single surgeon performed all operations using an anterior approach. Patients were examined before surgery and at 6 months and 1 and 2 years after surgery. The present study included the 66 patients (63%) who completed the 2-year follow-up, and the main outcaome measurement was corrected distance visual acuity (CDVA) 2 years after surgery. RESULTS After 2 years, the mean CDVA was 0.20 ± 0.29 logarithm of the minimum angle of resolution (logMAR) units (range, -0.18 to 1.10) in the repositioning group and 0.22 ± 0.30 logMAR (range, -0.10 to 1.22) in the exchange group (P = .69). A CDVA of 20/40 or better was achieved by 76% of all patients. Four eyes (12%) had cystoid macular edema in the repositioning group compared with 5 eyes (15%) in the exchange group. Two eyes underwent redislocation (1 in each group). There were no cases of endophthalmitis or retinal detachment. CONCLUSIONS There were no significant differences between the visual acuity using IOL repositioning and that using IOL exchange 2 years after surgery. The two methods were equally efficient and safe from a long-term perspective and are both considered acceptable treatments.
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Scleral IOL fixation using limbal mini-pockets: description of the method and clinical cases. OPHTHALMOLOGY JOURNAL 2019. [DOI: 10.17816/ov2019285-90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The search for new techniques of fixation intraocular lenses (IOL) cases of its dislocation or inadequate capsular support continues to be an actual problem. The most physiological is the IOL position in the posterior chamber. In this article, a new method for scleral IOL fixation using limbal mini-pockets proposed by the authors will be presented.
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Toro MD, Longo A, Avitabile T, Nowomiejska K, Gagliano C, Tripodi S, Choragiewicz T, Kaminska A, Figus M, Posarelli C, Forlini M, Jünemann AGM, Reibaldi M, Rejdak R. Five-year follow-up of secondary iris-claw intraocular lens implantation for the treatment of aphakia: Anterior chamber versus retropupillary implantation. PLoS One 2019; 14:e0214140. [PMID: 30970023 PMCID: PMC6457484 DOI: 10.1371/journal.pone.0214140] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of aphakia without sufficient capsule support. METHODS AND FINDINGS Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test). CONCLUSIONS Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of aphakia in eyes without capsule support.
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Affiliation(s)
- Mario Damiano Toro
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Katarzyna Nowomiejska
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- Institute for Ophthalmic Research, University Eye Hospital, Tuebingen, Germany
| | | | - Sarah Tripodi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Tomasz Choragiewicz
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kaminska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Matteo Forlini
- Institute of Ophthalmology, University of Parma, Parma, Italy
| | | | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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John T, Tighe S, Hashem O, Sheha H. New use of 8-0 polypropylene suture for four-point scleral fixation of secondary intraocular lenses. J Cataract Refract Surg 2018; 44:1421-1425. [PMID: 30314754 DOI: 10.1016/j.jcrs.2018.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/26/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
We describe 4-point scleral fixation of a posterior chamber intraocular lens (PC IOL) using 8-0 polypropylene (Prolene) sutures, without the handshake technique. First, 4 sclerotomy sites are marked 2.5 mm from the limbus, and 2 scleral grooves are created in between. Two sets of 8-0 polypropylene sutures are then passed through the IOL haptics. The PC IOL is inserted behind the iris, and the sutures are pulled ab interno and tightened for optimum IOL centration. The sutures and exposed knots are imbedded within the scleral groove and sealed with fibrin glue. This 4-point scleral fixation technique was performed uneventfully in 9 cases (4 men, 5 women; mean age 71.4 years ± 12.2 [SD]) and the PC IOL was stable for 10 months (range 8 months to 1 year) with no signs of IOL subluxation, dislocation, tilt, or suture-related complications such as erosion or infection.
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Affiliation(s)
- Thomas John
- From the Thomas John Vision Institute (John), Tinley Park, Illinois, Loyola University at Chicago (John), Chicago, Illinois, Ocular Surface Center and TissueTech Inc. (Tighe, Sheha), Miami, Florida, Florida International University Herbert Wertheim College of Medicine (Tighe, Sheha), Miami, Florida, and Hofstra University School of Medicine (Sheha), Hempstead, New York, USA; Military Medical Academy (John), Belgrade, Serbia; Research Institute of Ophthalmology (Hashem, Sheha), Cairo, Egypt
| | - Sean Tighe
- From the Thomas John Vision Institute (John), Tinley Park, Illinois, Loyola University at Chicago (John), Chicago, Illinois, Ocular Surface Center and TissueTech Inc. (Tighe, Sheha), Miami, Florida, Florida International University Herbert Wertheim College of Medicine (Tighe, Sheha), Miami, Florida, and Hofstra University School of Medicine (Sheha), Hempstead, New York, USA; Military Medical Academy (John), Belgrade, Serbia; Research Institute of Ophthalmology (Hashem, Sheha), Cairo, Egypt
| | - Omar Hashem
- From the Thomas John Vision Institute (John), Tinley Park, Illinois, Loyola University at Chicago (John), Chicago, Illinois, Ocular Surface Center and TissueTech Inc. (Tighe, Sheha), Miami, Florida, Florida International University Herbert Wertheim College of Medicine (Tighe, Sheha), Miami, Florida, and Hofstra University School of Medicine (Sheha), Hempstead, New York, USA; Military Medical Academy (John), Belgrade, Serbia; Research Institute of Ophthalmology (Hashem, Sheha), Cairo, Egypt
| | - Hosam Sheha
- From the Thomas John Vision Institute (John), Tinley Park, Illinois, Loyola University at Chicago (John), Chicago, Illinois, Ocular Surface Center and TissueTech Inc. (Tighe, Sheha), Miami, Florida, Florida International University Herbert Wertheim College of Medicine (Tighe, Sheha), Miami, Florida, and Hofstra University School of Medicine (Sheha), Hempstead, New York, USA; Military Medical Academy (John), Belgrade, Serbia; Research Institute of Ophthalmology (Hashem, Sheha), Cairo, Egypt.
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Mizuno Y, Sugimoto Y. A comparative study of transscleral suture-fixated and scleral-fixated intraocular lens implantation. Int Ophthalmol 2018; 39:839-845. [PMID: 29502212 DOI: 10.1007/s10792-018-0883-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare short-term clinical outcomes between scleral-fixated and transscleral suture-fixated intraocular lens (IOL) implantation. SEETING Hiroshima Prefectural Hospital, Japan. DESIGN A retrospective, nonrandomized, comparative case series. METHODS Eighty-nine eyes of 87 patients were included in this study; 45 eyes underwent transscleral suture-fixated IOL implantation (group 1), and 44 eyes underwent scleral-fixated IOL implantation (group 2) between February 2009 and June 2017 in the department of Ophthalmology, Hiroshima Prefectural Hospital, Japan. The postoperative best corrected visual acuity (BCVA), degree of astigmatism, IOL astigmatism (total astigmatism-corneal astigmatism), and refractive error were all measured at 1-week and 1-month intervals. RESULTS The mean preoperative BCVA in logarithm of minimum angle of resolution (log MAR) was 0.39 ± 0.56 and 0.46 ± 0.51 in groups 1 and 2, respectively, and the mean postoperative BCVA was 0.25 ± 0.41 and 0.34 ± 0.49 at 1 month. The postoperative degree of astigmatism in group 2 was significantly less than that in group 1 at 1 week and 1 month (p = 0.0046 and p = 0.021, respectively). The postoperative IOL astigmatism in group 2 was significantly less than that in group 1 at 1 week (p = 0.021), while the refractive error between the two groups was not significantly different at 1 week or 1 month. CONCLUSIONS Scleral-fixated IOL implantation has equivalent BCVA and refractive error outcomes as transscleral suture-fixated IOL implantation during the early postoperative period without serious complications. Scleral-fixated IOL implantation appears to provide more stable fixation than suture-fixated IOL implantation.
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Affiliation(s)
- Yu Mizuno
- Department of Ophthalmology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minamiku, Hiroshima, 734-8530, Japan.
| | - Yosuke Sugimoto
- Department of Ophthalmology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minamiku, Hiroshima, 734-8530, Japan
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Long-term outcome of scleral-fixated posterior chamber intraocular lens implantation with the knotless Z-suture technique. J Cataract Refract Surg 2018; 44:182-185. [PMID: 29502860 DOI: 10.1016/j.jcrs.2017.11.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/18/2017] [Accepted: 11/19/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. SETTING University Eye Hospital, Tübingen, Germany. DESIGN Retrospective case series. METHODS Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3 years were reviewed. RESULTS Sixty-six eyes of 62 patients were included. The mean preoperative corrected distance visual acuity (CDVA) was 0.71 logarithm of the minimum angle of resolution (logMAR) ± 0.58 (SD). The mean CDVA was 0.67 ± 0.54 logMAR (P = .257; n = 66) after 3 years, 0.73 ± 0.55 logMAR (P = .399; n = 60) after 5 years, 0.8 ± 0.68 logMAR (P = .348; n = 30) after 8 years, and 1.09 ± 0.76 logMAR (P = .069; n = 13) after 10 years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5 years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10 years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P = .049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). CONCLUSIONS Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture.
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Transscleral Suture-Fixated Versus Intrascleral Haptic-Fixated Intraocular Lens: A Comparative Study. Eye Contact Lens 2018; 43:389-393. [PMID: 27243351 DOI: 10.1097/icl.0000000000000287] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the clinical outcomes between sutured transscleral-fixated and intrascleral haptic-fixated posterior chamber intraocular lens (IOL). SETTING Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. DESIGN A comparative case series. METHODS Forty eyes of 40 patients were included; 20 in each group. Patients in group 1 underwent sutured transscleral-fixated IOL and those in group 2 underwent intrascleral haptic-fixated IOL augmented by fibrin glue. Parameters evaluated were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), IOL tilt on ultrasound biomicroscopy (UBM), and pseudophakodonesis on slitlamp and UBM. RESULTS The most common cause of aphakia was complicated cataract surgery (50%). The mean preoperative UCVA in logarithm of minimum angle of resolution (logMAR) was 1.59±0.24 and 1.63±0.26 in group 1 and 2, respectively (P=0.45). There was significant improvement in UCVA in both groups (P=0.001) at 6 months (group 1: 0.33±0.17; group 2: 0.22±0.10); the improvement being greater in group 2 (P<0.05). Mean percentage endothelial cell loss and IOP change were comparable. Mean CMT (μm) was 250.95±23.98 and 225.85±21.13 in group 1 and 2, respectively (P=0.009). Pseudophakodonesis was more in group 1 as assessed on slitlamp (P=0.037) and as assessed on UBM (P=0.046). Macular edema was the most common complication seen more in group 1. CONCLUSIONS Intrascleral haptic-fixated IOL provides more stable fixation, better visual outcome, and lesser complication in comparison with sutured transscleral-fixated IOL.
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Yilmaz A, Başer Z, Yurdakul NS, Maden A. Posterior Chamber Lens Implantation Techniques in Posterior Capsular Rupture. Eur J Ophthalmol 2018; 14:7-13. [PMID: 15005579 DOI: 10.1177/112067210401400102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate posterior chamber lens implantation techniques and their results in patients in whom posterior capsular rupture and zonular dialysis arose during cataract operation. METHODS Forty-three cataractous eyes of 43 consecutive patients with complicated cataract operations such as posterior capsular rupture or zonular dialysis were accepted into this prospective study between November 1999 and January 2001. Intraocular lens implantation to ciliary sulcus was achieved without sutures in 19 cases (Group 1), with one suture from 12 o'clock quadrant in 14 cases (Group 2), and with two sutures from 3 to 9 o'clock quadrants in 10 cases (Group 3). Patients were followed up for 3 months after operation and evaluated for best-corrected visual acuity, refractive astigmatism, corneal edema, anterior chamber depth and inflammation, synechia at angle, intraocular pressure, lens tilt and decentration, intraocular hemorrhage, cystoid macular edema, and retinal detachment. Results There was no difference among groups in best-corrected visual acuity, refractive astigmatism, corneal edema, anterior chamber depth and inflammation, intraocular pressure, lens tilt and decentration, cystoid macular edema, or retinal detachment. Anterior chamber and vitreous hemorrhage and peripheral anterior synechia were significantly higher in Group 3 when compared with Group 1 (p=0.009, p=0.009, and p=0.004). CONCLUSIONS In all cases with posterior capsular rupture and zonular dialysis, different posterior chamber lens implantation techniques could be performed, beginning with the least invasive procedure suitable for the conditions with the least complications.
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Affiliation(s)
- A Yilmaz
- Ophthalmology Department, Mersin University, Faculty of Medicine Hospital, Mersin, Turkey.
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Tripathy K. Regarding successful use of 23G cutter for anterior vitrectomy and scleral-fixated intraocular lens implantation. Int J Ophthalmol 2017; 10:1947-1948. [PMID: 29259921 DOI: 10.18240/ijo.2017.12.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/26/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Koushik Tripathy
- ICARE Eye Hospital & Postgraduate Institute, Uttar Pradesh 201301, India
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Abstract
INTRODUCTION Understanding the evolution of complications after scleral-fixated lens placement demonstrates advantageous surgical techniques and suitable candidates. MATERIALS/METHODS A literature search in PubMed for several terms, including "scleral intraocular lens complication," yielded 17 relevant articles. RESULTS Reviewing complication trends over time, lens tilt and suture erosion have decreased, cystoid macular edema has increased, and retinal detachment has remained the same after scleral-fixated lens placement. The successful reduction in complications are attributed to several alterations in technique, including positioning sclerotomy sites 180 degrees apart and using scleral flaps or pockets to bury sutures. Possible reduction in retinal risks have been proposed by performing an anterior vitrectomy prior to lens placement in certain settings. DISCUSSION Complications after scleral-fixated lens placement should assist patient selection. Elderly patients with a history of hypertension should be counseled regarding risk of suprachoroidal hemorrhage, while young patients and postocular trauma patients should be considered for concurrent anterior vitrectomy.
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Affiliation(s)
- Emma C Davies
- a Department of Ophthalmology, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
| | - Roberto Pineda
- a Department of Ophthalmology, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
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Obeng FK, Vig VK, Singh P, Singh R, Dhawan B, Sahajpal N. Posterior Chamber Scleral Fixation of Intraocular Lenses in Post-Vitrectomised Aphakic Eyes. J Clin Diagn Res 2017; 11:NC09-NC13. [PMID: 28511422 PMCID: PMC5427348 DOI: 10.7860/jcdr/2017/20989.9533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/23/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The best method of aphakia correction is in the bag implantation of Posterior Chamber Intraocular Lens (PCIOL). When this ideal procedure is not possible due to lack of integrity of posterior capsule or zonules, the other alternatives are broadly categorized into two: extraocular and intraocular. Whereas, the former includes contact lenses and aphakic glasses, the latter ones are further divided into anterior and posterior chamber methods. Anterior Chamber Intraocular Lenses (ACIOL) can be with or without iris claw. At the posterior chamber, fixation of the lenses can be with glue or sutures. When there is combined Pars Plana Vitrectomy (PPV) and lensectomy or if the indication of PPV is dropped nucleus or intraocular lens, a modality of aphakia correction should be devised. Posterior Chamber Scleral Fixation of Intraocular Lenses (PCSFIOL) with sutures is a preferred method because of its low complication profile. However, data on correction of aphakia after combined PPV and lensectomy is limited. To fill in this gap in knowledge, we evaluated the secondary PCSFIOL in aphakic eyes after previous PPV and lensectomy. AIM To assess the outcome and complication profile of a large series of patients who underwent secondary PCSFIOL implantation with sutures after combined PPV and lensectomy. MATERIALS AND METHODS Records of all patients who had undergone secondary PCSFIOL implantation with sutures after combined PPV and lensectomy from 2010 to 2014 were reviewed retrospectively for visual outcomes and complications. Patients' demographic data, indication for PPV, best corrected preoperative and postoperative visual acuities, complications of surgery, and indications of PCSFIOL and length of follow up were collected and analyzed. RESULTS A total of 148 eyes of 148 patients (127 males and 21 females) were identified. Mean age at surgery was 32.5±8 years (range 2.5-73 years) with a mean follow up 23±14 months (range 3-114 months). A total of 95.27%, 2.70% and 2.02% of patients had improvement, maintenance and worsening of their final postoperative visual acuities respectively. A total of 32 (21.62%) of 148 eyes had postoperative complications from PCSFIOL with Epiretinal Membrane (ERM) formation being the most common. They all required one form of management or the other. Suture breakage leading to PCSFIOL subluxation or dislocation occurred in four eyes (2.70%). CONCLUSION PCSFIOL with sutures is a preferred method in the management of post-vitrectomised aphakic eyes when the capsular or zonular support is not adequate for in the bag implantation of posterior chamber intraocular lenses.
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Affiliation(s)
- Francis Kwasi Obeng
- Long Term Vitreoretinal Fellow, Department of Vitreoretinal, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India
| | - Vipan Kumar Vig
- Consultant Vitreoretinal Surgeon, Department of Vitreoretinal, Member Vitreoretinal Society of India, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India
| | - Preetam Singh
- Consultant Vitreoretinal Surgeon, Department of Vitreoretinal, Member Vitreoretinal Society of India, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India
| | - Rajbir Singh
- Consultant Vitreoretinal Surgeon, Department of Vitreoretinal, Member American Academy of Ophthalmology, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India
| | - Bodhraj Dhawan
- Consultant Vitreoretinal Surgeon, Department of Vitreoretinal, NKP Salve Institute of Medical Sciences, Hingna, Nagpur, Maharashtra, India
| | - Nikhil Sahajpal
- Medical Statistician, Department of Medical Statistics, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India
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Kelkar A, Shah R, Vasavda V, Kelkar J, Kelkar S. Primary iris claw IOL retrofixation with intravitreal triamcinolone acetonide in cases of inadequate capsular support. Int Ophthalmol 2017; 38:111-117. [PMID: 28185180 DOI: 10.1007/s10792-017-0467-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the outcomes and analyze complication rates following primary iris claw IOL retrofixation with intravitreal triamcinolone acetonide. METHODS This is a retrospective interventional case series. Patients with poor capsular support-diagnosed preoperatively or owing to intraoperative complications-were treated with iris claw IOL retrofixation with intravitreal triamcinolone acetonide. The data were retrospectively analyzed. RESULTS 104 eyes of 102 patients with poor capsular support who underwent the procedure between 2010 and 2013 were analyzed. The minimum follow-up period was 12 months (ranging from 12 to 36 months). Iris claw IOL was implanted in-traumatic subluxated cataracts-24 cases (23.07%), non-traumatic subluxated cataracts in 16 cases (15.38%), or as a complication of cataract surgery-intraoperative posterior capsular rent in 48 cases (46.15%) and intraoperative nucleus drop in 16 cases (15.38%). The final mean best-corrected logMAR visual acuity improved from 1.36 ± 0.64 preoperatively to 0.36 ± 0.32 at 1-year follow-up. Complications included pupil ovalization in 11 cases (10.57%), transient elevation in intraocular pressure in 7 eyes (6.73%), postoperative hypotony in 5 eyes (4.80%), cystoid macular edema in 2 eyes (1.92%), retinal detachment in 1 eye (0.96%), vitreous hemorrhage in 1 eye (0.96%), and hyphema in 1 eye (0.96%). CONCLUSION Primary iris claw IOL retrofixation provided excellent alternative in patients with inadequate capsular support. The visual outcomes were good along with favorable rates of complications. The addition of triamcinolone acetonide helps in reducing the chances of cystoid macular edema.
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Affiliation(s)
- Aditya Kelkar
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India.
| | - Rachana Shah
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India
| | - Viraj Vasavda
- Raghudeep Eye Clinic, Near Shreeji Complex, Gurukul Road, Memnagar, Ahmedabad, Gujarat, 380052, India
| | - Jai Kelkar
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India
| | - Shreekant Kelkar
- National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Phule Museum, Shivaji Nagar, Pune, 411005, India
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Pars Plana Vitrectomy Combined With Either Secondary Scleral-Fixated or Anterior Chamber Intraocular Lens Implantation. Am J Ophthalmol 2016; 168:177-182. [PMID: 27189930 DOI: 10.1016/j.ajo.2016.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare visual outcomes among eyes that underwent pars plana vitrectomy (PPV) in combination with either anterior chamber intraocular lens implantation (ACIOL) or scleral suturing of posterior chamber lens (PCIOL). DESIGN Retrospective comparative case series. METHODS All eyes presented with aphakia or luxated or subluxated posterior chamber intraocular lens (IOL) following complicated cataract surgery, trauma, or spontaneous dislocation. Eyes involving visually significant macular pathology, past retinal detachment, follow-up of less than 6 months, and surgeries requiring the removal of an ACIOL were excluded. The main outcomes measured were final best-corrected visual acuity (BCVA) and surgical complication rates. RESULTS Fifty-seven eyes met inclusion criteria; median follow-up was 13.2 months. Initial median BCVA for ACIOL patients was logMAR 1.301 (Snellen equivalent 20/400, range 20/20 to light perception); final median BCVA was logMAR 0.477 (Snellen equivalent 20/60, range 20/20 to light perception, P < .001). Initial median BCVA for PCIOL patients was logMAR 1.239 (Snellen equivalent 20/347, range 20/60 to light perception); final median BCVA was logMAR 0.301 (Snellen equivalent 20/40, range 20/20 to hand motions, P < .001). The change in BCVA between the 2 groups over the course of the study was similar (P > .05). More epiretinal membrane (ERM) formations occurred postoperatively in the ACIOL group (P = .011). Other complication rates were similar between both groups. CONCLUSIONS PPV with secondary IOL placement is safe and effective, resulting in improved visual outcomes regardless of the technique used. Patients undergoing ACIOL placement have a higher incidence of ERM formation.
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Long C, Wei Y, Yuan Z, Zhang Z, Lin X, Liu B. Modified technique for transscleral fixation of posterior chamber intraocular lenses. BMC Ophthalmol 2015; 15:127. [PMID: 26432550 PMCID: PMC4592543 DOI: 10.1186/s12886-015-0118-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/28/2015] [Indexed: 12/19/2022] Open
Abstract
Background Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens (PCIOL). We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of PCIOL. Methods The modified surgical technique is as following: at first, two 3 mm × 4 mm square scleral pockets were created from groove incisions at opposite positions. A straight needle attached to a 10–0 polypropylene suture was passed through one incision groove. Then, a 27-Gauge hollow needle passed through the opposite sclera incision bed was used to retrieve the straight fine needle via its barrel. The sutures were tied to themselves after one more bite on the scleral bed. At last, the suture ends were left long (about 4 mm) and laid flat into corresponding laminar scleral pockets. This modified technique of PCIOL was performed in 48 post-traumatic aphakic vitrectomized eyes from 48 patients (47 male, one female) with mean age of 34.8 ± 14.8 years. Main outcome measures included best corrective visual acuity (BCVA), IOL decentration, IOL tilt, and postoperative complications. Results The mean follow-up was 32.3 ± 10.8 months (3–67 months). The LogMAR BCVA remained stable, from a preoperative value of 0.46 ± 0.34 to postoperative 0.44 ± 0.34 (p = 0.69). Mild IOL tilt (5–10°) was observed in five eyes, and slight IOL decentration (0.5–1.0 mm) was seen in three cases. No case of suture exposure, suture breakage, IOL dislocation, or endophthalmitis was observed during the follow up period. Conclusion The modified technique allowed stable placement of PCIOLs in post-traumatic aphakic eyes with a wide range of follow-up. Our procedure might have the potential benefit to avoid suture exposure in scleral-fixated IOL implantation. Electronic supplementary material The online version of this article (doi:10.1186/s12886-015-0118-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chongde Long
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Yantao Wei
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Zhaohui Yuan
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Zhiqing Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Xiaofeng Lin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Bingqian Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
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Comparision of surgical outcomes of intraocular lens refixation and intraocular lens exchange with perfluorocarbon liquid and fibrin glue-assisted sutureless scleral fixation. Eye (Lond) 2015; 29:757-63. [PMID: 25853441 DOI: 10.1038/eye.2015.22] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/23/2015] [Indexed: 11/08/2022] Open
Abstract
AIM The purpose of this study was to compare the surgical outcomes of intraocular lens (IOL) refixation with intraocular lens exchange using perfluorocarbon liquid (PFCL) and fibrin glue-assisted sutureless scleral fixation surgery in patients with dislocation of the IOL. METHODS Twenty-five eyes of 25 patients who underwent surgery for dislocated IOLs with PFCL and fibrin glue-assisted scleral fixation were studied; 13 eyes experienced IOL refixation (in-the-bag and out-of-the-bag), and 12 eyes experienced IOL exchange. Preoperative and postoperative clinical features from patient charts and 25 eyes with >6 months' follow-up information were reviewed and analyzed. RESULTS At postoperative 6 months, best-corrected visual acuity (BCVA) and spherical equivalent of IOL refixation and exchange were significantly improved (P=0.042, P=0.001), and endothelial cell density was significantly decreased in the two groups with no significant difference between them. Surgically induced astigmatism of IOL refixation improved from 0.90±0.47 to 0.61±0.37 (P=0.012), and IOL exchange improved from 1.17±0.64 to 0.73±0.37 (P=0.037) at postoperative 6 months, with no significant difference between the two groups. Complications occurred in four eyes in the IOL refixation group and in three eyes in the IOL exchange group. CONCLUSION PFCL and fibrin glue-assisted IOL sutureless scleral refixation or exchanged fixation was an effective surgical treatment for IOL dislocation. Also, because postoperative BCVA, surgical outcomes, and complications did not differ significantly between IOL refixation and exchange surgery, if IOL exchange surgery is not indicated, IOL refixation surgical techniques should be considered.
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Joshi M, Walsh MK. Scleral-Fixated Intraocular Lenses: An Update on the Current Surgical Approaches. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ahn YS, Park YL, Kim HS. Refractive Change after Transscleral Fixation of Intraocular Lens. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.4.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Sun Ahn
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yu Li Park
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea
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Elsayed T, Solaiman K, Shawky M, Elmasry A. Implantation of posterior chamber foldable intraocular lens in the absence of adequate capsular support: iris fixation versus scleral fixation. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.4103/2090-0686.168681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Posteriorly enclavated iris claw intraocular lens for aphakia: long-term corneal endothelial safety study. Eur J Ophthalmol 2014; 25:208-13. [PMID: 25363856 DOI: 10.5301/ejo.5000527] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support. METHODS In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion. RESULTS All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between -1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2 at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred. CONCLUSIONS Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.
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Brockmann T, Gonnermann J, Brockmann C, Torun N, Joussen AM, Bertelmann E. Morphologic alterations on posterior iris-claw intraocular lenses after traumatic disenclavation. Br J Ophthalmol 2014; 98:1303-7. [DOI: 10.1136/bjophthalmol-2014-305364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rogers G, Mustak H, Hann M, Steven D, Cook C. Sutured posterior chamber intraocular lenses for traumatic cataract in Africa. J Cataract Refract Surg 2014; 40:1097-101. [PMID: 24874771 DOI: 10.1016/j.jcrs.2014.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/26/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the outcomes of sutured scleral fixation of posterior chamber intraocular lenses (PC IOLs) after trauma in an African population. SETTING State hospital and affiliated district hospital, Cape Town, South Africa. DESIGN Case series. METHODS A retrospective review was performed of the medical records of patients in whom a sutured PC IOL had been implanted for traumatic aphakia in the preceding 5 years. RESULTS Eighty-five percent of the 59 patients had a significant improvement in uncorrected distance visual acuity (UDVA) at the final visit. Two-thirds of patients achieved an UDVA of 6/18 or better. Those not improving had severe preexisting macular or corneal pathology. A significant number of patients (28%) with angle recession developed ocular hypertension during the postoperative period. CONCLUSION After careful preoperative selection, sutured PC IOLs were effective in the visual rehabilitation of eyes with traumatic subluxated cataract in which the capsular bag could not be retained. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Graeme Rogers
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa.
| | - Hamzah Mustak
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - Mignon Hann
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - David Steven
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - Colin Cook
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
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Gonnermann J, Maier AKB, Klamann MKJ, Brockmann T, Bertelmann E, Joussen AM, Torun N. Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty. Br J Ophthalmol 2014; 98:1291-5. [DOI: 10.1136/bjophthalmol-2014-304948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ahmed Bhutto I, Qadir Kazi G, Mahar PS, Ahmed Qidwai U. Visual outcome and complications in Ab-externo scleral fixation IOL in aphakia in pediatric age group. Pak J Med Sci 2013; 29:947-50. [PMID: 24353665 PMCID: PMC3817764 DOI: 10.12669/pjms.294.3791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 05/20/2013] [Accepted: 06/18/2013] [Indexed: 11/29/2022] Open
Abstract
Objective: To assess the visual outcome and complications in patients after Ab-externo scleral fixation of intraocular lens in pediatric age group (15 years or less). Methods: This quasi experimental study was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2012 to December 2012. All cases included were worked up according to the protocol. All patients underwent Ab-externo scleral fixation of IOL under general anesthesia. Patients were followed up at 1stday, 1stweek, 1stmonth, 2ndmonth and 3rdmonth. Complete eye examination including best-corrected visual acuity and complications were noted on each visit. Results: Thirty patients were included in the study, with mean age of 8.6 years (±3.93569). Most of the patients, 20 (66.7%), had visual acuities of 6/18 or better. No complication was seen in 18 (60%) of the patients intra operatively while soft eye was observed in 7 (23.3%) of the patients. Another complication noted was vitreous hemorrhage, which was seen in 5 (16.7%) patients. Most common post-operative complication was Uveitis followed by astigmatism. Lens dislocation and iris abnormalities were seen in only one patient. Most of the patients showed significant visual improvement after surgery. Conclusion: Ab-externo scleral fixation of an IOL was found to be safe and showed favorable postoperative results with fewer complications.
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Affiliation(s)
- Isra Ahmed Bhutto
- Dr. Isra Ahmed Bhutto, FCPS, Assistant Professor, Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, Pakistan
| | - Ghulam Qadir Kazi
- Prof. Ghulam Qadir Kazi, FRCS, Professor, Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, Pakistan
| | - P S Mahar
- Prof. P.S Mahar, FRCS, FRC Ophth, Professor, Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, Pakistan
| | - Umair Ahmed Qidwai
- Dr. Umair Ahmed Qidwai, FCPS, Senior Registrar, Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, Pakistan
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Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens. J Cataract Refract Surg 2013; 39:1835-45. [DOI: 10.1016/j.jcrs.2013.05.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/30/2013] [Accepted: 05/31/2013] [Indexed: 11/23/2022]
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Abstract
PURPOSE Implantation of a scleral-fixated intraocular lens (SFIOL) for the surgical management of aphakia in the absence of capsular support is a safe procedure with a low risk of complications in the early postoperative period. However, data on long-term functional outcome are limited. The purpose of this study is to assess the long-term outcome and complication profile of SFIOL implantation in a cohort of Chinese patients. METHODS All patients who had undergone primary or secondary SFIOL implantation between 1997 and 2008 were retrospectively reviewed for visual outcomes and complications. Patients' demographic data and information on baseline preoperative visual acuity, indication for surgery, postoperative complications, latest postoperative visual acuity and indication for any subsequent surgical procedures were collected and analysed. RESULTS 104 eyes of 99 patients (51 males and 48 females) were identified. Mean age at surgery was 67.1 ± 13 years (range 32-88 years), with a mean follow-up of 73.4 ± 43 months (range 12-180 months). 72% of patients had unchanged or improved final postoperative visual acuity. 25 of 104 eyes (24.0%) had postoperative complications, with suture-related complications being the most common. 13 eyes (12.5%) required further procedures for postoperative complications. Suture breakage leading to lens subluxation occurred in two eyes (1.9%). CONCLUSIONS SFIOL implantation is valuable for the management of aphakia in the absence of capsular support, and our visual outcomes and complication rates are comparable to other case series. The long-term outcomes and safety profile are favourable, but potential long-term suture-related problems should be discussed with the patients before surgery.
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Affiliation(s)
- Abbie S W Luk
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, , Shatin, Hong Kong
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Ram J, Gupta N, Chaudhary M, Verma N. A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses. Indian J Ophthalmol 2013; 61:749-51. [PMID: 23619504 PMCID: PMC3917395 DOI: 10.4103/0301-4738.111217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.
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Affiliation(s)
- Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Visual outcomes and complications following posterior iris-claw aphakic intraocular lens implantation combined with penetrating keratoplasty. Graefes Arch Clin Exp Ophthalmol 2012; 251:1151-6. [PMID: 23250481 DOI: 10.1007/s00417-012-2226-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/31/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To evaluate the indication, visual outcome, and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL) during penetrating keratoplasty. METHODS This retrospective study comprised 23 eyes (23 patients) without adequate capsule support undergoing posterior iris-claw aphakic IOL implantation (Verisyse/Artisan) during penetrating keratoplasty between 2005 and 2010. Mean follow-up was 18 months (range from 12 to 37 months). RESULTS The IOLs were inserted during an IOL exchange in 17 eyes and as a secondary procedure in six aphakic eyes. Pseudophakic bullous keratopathy with corneal scar after anterior chamber intraocular lens (ACIOL) was the main indication for penetrating keratoplasty in 16 eyes (69.6 %). The final corrected distance visual acuity (CDVA) in logMAR (mean 1.0 ± 0.46) improved significantly (p < 0.05) compared to the preoperative CDVA (mean 1.8 ± 0.73). Twenty eyes (86.9 %) had a final visual acuity in logMAR better than the pre-operative CDVA. The mean postoperative IOP 16.3 mmHg ± 4.0 was not significantly (p > 0.05) higher compared to the preoperative IOP 15.6 mmHg ± 5.1. Complications included slight temporary pupil ovalization in three eyes (13.0 %) and iris-claw IOL sublocation in three eyes (13.0 %); all IOLs could be easily repositioned. Cystoid macular edema occured in one eye (4.3 %) 8 weeks after primary surgery. All grafts remained clear without any sign of graft rejection. CONCLUSIONS Retropupillar iris-claw IOL during penetrating keratoplasty provides good visual outcomes with a favorable complication rate, and can be used for a wide range of indications in eyes without adequate capsule support.
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Gonnermann J, Klamann MK, Maier AK, Rjasanow J, Joussen AM, Bertelmann E, Rieck PW, Torun N. Visual outcome and complications after posterior iris-claw aphakic intraocular lens implantation. J Cataract Refract Surg 2012; 38:2139-43. [PMID: 23036355 DOI: 10.1016/j.jcrs.2012.07.035] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 07/28/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
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Ganekal S, Venkataratnam S, Dorairaj S, Jhanji V. Comparative evaluation of suture-assisted and fibrin glue-assisted scleral fixated intraocular lens implantation. J Refract Surg 2012; 28:249-52. [PMID: 22386370 DOI: 10.3928/1081597x-20120221-01] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/10/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the visual outcomes and complications after suture-assisted and fibrin glue-assisted scleral fixated intraocular (IOL) implantation. METHODS Scleral fixated IOL implantation was performed in patients with inadequate capsular support. Intraocular lens fixation was achieved using sutures or fibrin glue. Main parameters evaluated were visual outcomes and complications. RESULTS Fifty patients were included in the study (n=25 suture, n=25 glue). The most common indication for scleral fixated IOL implantation was cataract surgery complicated with posterior capsule rupture (29/50 [58%]). No significant differences were noted between demographic characteristics, surgical indications, and preoperative corrected distance visual acuity (CDVA) in either group (P=.680). No intraoperative complications related to IOL fixation were encountered in any case. At last follow-up (6 months), CDVA was 20/40 or better in 88% and 84% of patients in the suture and glue groups, respectively. Postoperative inflammation (48% vs 16%) and glaucoma (40% vs 16%) were seen more frequently in eyes with sutures as compared to eyes with glue. Overall, a significantly higher number of complications were encountered in eyes with suture fixation (14/25 [56%]) compared to eyes with glue fixation (7/25 [28%]) (P=.045). CONCLUSIONS Although visual outcomes were similar at the end of 6 months in eyes that underwent suture- and glue-assisted scleral fixated IOL implantation, fibrin glue was associated with fewer complications.
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Cellini M, Strobbe E, Toschi PG, Campos EC. Secondary IOL Implantation without Capsular Support: A Laser Flare Cell Meter Study. ISRN OPHTHALMOLOGY 2012; 2011:653246. [PMID: 24533188 PMCID: PMC3912603 DOI: 10.5402/2011/653246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/08/2011] [Indexed: 11/29/2022]
Abstract
Phacoemulsification and the contemporary implantation of intraocular lens (IOL) within the capsular bag represent the standard of care in cataract surgery, but sometimes a primary IOL implant is not possible due to intraoperative complications or preexisting conditions so that a secondary implantation of IOL within the anterior or posterior chamber is necessary.
The aim of our study was to assess the degree of inflammation due to a secondary implant of claw lenses, angle-supported IOLs, and scleral-fixated IOLs by means of an objective, repeatable, and noninvasive device, the laser flare cell meter, which evaluates aqueous flare and cells within the anterior chamber in vivo and to show the contribution of the single IOLs to the genesis of inflammation.
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Affiliation(s)
- Mauro Cellini
- Department of Surgery Science and Anesthesiology, Ophthalmology Service, University of Bologna, Via Palagi 9, 40138 Bologna, Italy
| | - Ernesto Strobbe
- Department of Surgery Science and Anesthesiology, Ophthalmology Service, University of Bologna, Via Palagi 9, 40138 Bologna, Italy
| | - Pier Giorgio Toschi
- Department of Surgery Science and Anesthesiology, Ophthalmology Service, University of Bologna, Via Palagi 9, 40138 Bologna, Italy
| | - Emilio C Campos
- Department of Surgery Science and Anesthesiology, Ophthalmology Service, University of Bologna, Via Palagi 9, 40138 Bologna, Italy
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McAllister AS, Hirst LW. Visual outcomes and complications of scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg 2011; 37:1263-9. [PMID: 21700103 DOI: 10.1016/j.jcrs.2011.02.023] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the long-term visual outcomes and complications after implantation of scleral-fixated posterior chamber intraocular lenses (PC IOLs). SETTING Princess Alexandra Hospital, Mater Hospital, and Queensland Eye Institute, Brisbane, Australia. DESIGN Case series. METHODS This study reviewed the records of patients who had anterior vitrectomy and scleral-fixated PC IOL implantation between 1993 and 2008 and had a minimum follow-up of 6 months. RESULTS The study comprised 82 eyes of 72 patients (47 men). The mean follow-up was 83.3 months (range 6.7 to 166.5 months) and the mean age at surgery, 62 years (range 15 to 97 years). The mean improvement in corrected distance visual acuity (CDVA) was 1.6 Snellen chart lines of vision, which was statistically significant; 59 eyes (72%) had an improved or unchanged CDVA, and 23 eyes (28%) had a reduced CDVA. The most common postoperative complication was ocular hypertension (25 eyes [30.5%]). Suture breakage occurred in 5 eyes (6%) after a mean of 4.9 years; 4 of these patients were younger than 40 years. Overall, 44 eyes (53.7%) had at least 1 complication, 36.4% within 1 week postoperatively and 63.6% after 1 week. Thirteen eyes (15.8%) required at least 1 further operation. CONCLUSIONS Scleral-fixated PC IOL insertion provided favorable visual outcomes in many cases. Complications were common, and suture rupture is an important long-term complication, particularly in young patients. These issues affect IOL choice for the surgical treatment of aphakia and should be discussed with patients during the consent process. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Andrew S McAllister
- Princess Alexandra Hospital and the Faculty of Health Sciences University of Queensland, Queensland Eye Institute, Brisbane, Australia.
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Banaee T, Sagheb S. Scleral fixation of intraocular lens in eyes with history of open globe injury. J Pediatr Ophthalmol Strabismus 2011; 48:292-7. [PMID: 20795605 DOI: 10.3928/01913913-20100818-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 06/15/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the results and complications of scleral fixation of intraocular lens (SF-IOL) in traumatized eyes of children with iris defects and inadequate capsular support with technique customized to the condition of the eye. METHODS Retrospective review of pediatric eyes with a history of open globe injury and SF-IOLs. All eyes had undergone pars plana vitrectomy and lensectomy after primary repair of the laceration. Site of scleral fixation and limbal incision were selected according to the site of traumatic scar, remaining capsular support, and keratometry. RESULTS Ten patients with a mean age of 6.1 years were included. Mean duration of aphakia was 18.7 months. Five eyes had adequate capsular support for one haptic of the IOL. The only intraoperative complication was mild ciliary body hemorrhage. Mean follow-up was 11.8 months. Uncorrected visual acuity did not improve postoperatively in only one eye due to severe corneal astigmatism. Best-corrected visual acuity improved in 6 eyes. Mean postoperative sphere and cylinder were 1.8 and -3.05 diopters, respectively. The only postoperative complication was decentration of a sulcus-fixed haptic needing reoperation in one eye. CONCLUSION SF-IOL is a viable option for correcting traumatic aphakia and can have good results if customized to the condition of the eye.
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Affiliation(s)
- Touka Banaee
- Department of Ophthalmology and Eye Research Center, Mashhad University of Medical Sciences, Khatam-al-anbia Hospital, Razavi, Iran.
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Ma DJ, Choi HJ, Kim MK, Wee WR. Clinical comparison of ciliary sulcus and pars plana locations for posterior chamber intraocular lens transscleral fixation. J Cataract Refract Surg 2011; 37:1439-46. [PMID: 21704487 DOI: 10.1016/j.jcrs.2011.02.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the clinical outcomes of transscleral fixation of a posterior chamber intraocular lens (PC IOL) in the ciliary sulcus or pars plana. SETTING Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea. DESIGN Comparative case series. METHODS This retrospective chart review comprised eyes having ciliary sulcus or pars plana fixation of a 3-piece foldable acrylic PC IOL between January 2003 and August 2010. The postoperative corrected distance visual acuity (CDVA), efficacy index, safety index, endothelial cell count (ECC), and complication rates in the 2 groups were compared. RESULTS The ciliary sulcus group comprised 38 eyes and the pars plana group, 56 eyes. There was no significant between-group difference in the postoperative CDVA, efficacy index, safety index, or ECC. The mean spherical equivalent difference was larger in the ciliary sulcus group. Intraocular lens dislocation and pupillary capture of the IOL optic occurred more frequently in the ciliary sulcus group (P=.001 and P=.041, respectively). However, retinal detachment, IOL decentration or tilt, cystoid macular edema, secondary glaucoma, and vitreous hemorrhage did not differ significantly between the 2 groups. CONCLUSION The pars plana location for PC IOL transscleral fixation was as safe and effective as the ciliary sulcus location.
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Affiliation(s)
- Dae Joong Ma
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, South Korea
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Gupta PK, Bordelon A, Vroman DT, Afshari NA, Kim T. Early outcomes of descemet stripping automated endothelial keratoplasty in pseudophakic eyes with anterior chamber intraocular lenses. Am J Ophthalmol 2011; 151:24-28.e1. [PMID: 20970110 DOI: 10.1016/j.ajo.2010.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/02/2010] [Accepted: 07/06/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate complications and clinical outcomes of Descemet stripping automated endothelial keratoplasty in eyes with preexisting anterior chamber intraocular lenses. DESIGN Retrospective review. METHODS Thirty-one patients who underwent Descemet stripping automated endothelial keratoplasty and who had a preexisting anterior chamber intraocular lens were identified from May 2006 through March 2009. Patient follow-up ranged from a minimum of 1 month up to 30 months. Preoperative and postoperative best spectacle-corrected visual acuity, manifest refraction, comorbid conditions, and complications were recorded. Endothelial cell loss, graft dislocation, graft failure rates were calculated. RESULTS The mean age at surgery was 78 ± 9 years (range, 53 to 91 years). All eyes had pseudophakic bullous keratopathy, except 1 patient who had a failed penetrating keratoplasty graft. Excluding those patients with severely limited visual potential because of noncorneal pathologic features, the mean best spectacle-corrected visual acuity improved significantly from 20/200 to 20/400 before surgery to 20/63 at 3 months (P < .0001), 20/60 at 6 months (P = .0006), 20/50 at 12 to 15 months (n = 10; P = .004), and 20/40 between 23 and 30 months (n = 8; median, 25 months; P = .007). The preoperative mean spherical equivalent was -0.3 ± 1.8 diopters compared with -0.15 ± 1.5 diopters after surgery (P = .78). The graft dislocation rate was 13%, and the graft failure rate was 16%. For those patients with endothelial cell density data available, the average endothelial cell loss was 48% at a mean of 14 months. CONCLUSIONS Although Descemet stripping automated endothelial keratoplasty surgery in patients with an anterior chamber intraocular lens remains a controversial topic, the visual and anatomic outcomes from this limited study support this approach as a surgical option in selected cases.
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Kumar DA, Agarwal A, Prakash G, Jacob S, Saravanan Y, Agarwal A. Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye (Lond) 2010; 24:1143-8. [PMID: 20150926 DOI: 10.1038/eye.2010.10] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the post-operative outcome of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation in eyes with deficient capsular support after 1 year. METHODS Eyes operated with fibrin glue-assisted posterior chamber IOL implantation from December 2007 to May 2008 were included. The post-operative best spectacle-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), central macular thickness, and specular count were evaluated. IOL position and centration at 1 year was determined. The 1-year post-operative complications were analysed. RESULTS A total of 53 eyes of 53 patients were analysed. There was significant improvement in UCVA (P=0.000) and BCVA (P=0.000). There was no significant change (P=0.447) in IOP from the pre-operative value. The early post-operative complication was decentration (5.6%). The late complication was pigment dispersion (3.7%) and healed macular oedema (7.5%). No vision threatening complications such as retinal break, retinal detachment, or endophthalmitis were seen. The percentage (%) loss of endothelial cells was 5.23+/-3.4% at 1-year follow-up. No pseudophakodonesis was seen in the follow-up visits. CONCLUSION Results obtained at 1 year after fibrin glue-assisted posterior chamber IOL implantation showed a good visual outcome with minimal complications in eyes with deficient capsular support.
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Affiliation(s)
- D A Kumar
- Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India
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Kir E, Kocaturk T, Dayanir V, Ozkan SB, Dündar SO, Aktunç TO. Prevention of suture exposure in transscleral intraocular lens fixation: an original technique. Can J Ophthalmol 2009; 43:707-11. [PMID: 19020638 DOI: 10.3129/i08-127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure. METHODS Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes). RESULTS The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 (p = 0.006) and group 1 (p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%) (p = 1.000). INTERPRETATION Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.
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Affiliation(s)
- Erkin Kir
- Department of Ophthalmology, Adnan Menderes University Medical School, Aydin, Turkey.
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Kjeka O, Bohnstedt J, Meberg K, Seland JH. Implantation of scleral-fixated posterior chamber intraocular lenses in adults. Acta Ophthalmol 2008; 86:537-42. [PMID: 19175763 DOI: 10.1111/j.1600-0420.2007.01095.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the results of transscleral fixation of posterior chamber intraocular lenses in adults. METHODS We carried out a retrospective analysis of 91 eyes of 81 patients who underwent implantation of posterior chamber lenses with transscleral sutures between 1997 and 2006. The mean age of the patients was 62 years (range 19-94 years). Sixty-eight eyes (74.7%) were aphakic at the time of surgery. In 10 patients (11.0%) an intracapsular cataract extraction and in six patients (6.6%) a pars plana lensectomy was performed prior to the fixation of the posterior chamber intraocular lens. In seven eyes (7.7%) a previously implanted IOL was removed. The mean follow-up was 36 months (range 6-116 months). RESULTS The mean preoperative best corrected visual acuity (BCVA) was 0.37 (range counting fingers to 1.0), which improved to 0.5 (range light perception to 1.0) postoperatively. At the end of follow-up, BCVA was unchanged or improved in 81 eyes (89.0%), reduced by 2 Snellen lines in four eyes (4.4%), and between finger counting and light perception in four eyes (4.4%). The most serious complication was suprachoroidal haemorrhage, which occurred in two eyes. Retinal detachment occurred in three eyes, all of which successfully reattached after surgery. Suture erosion or spontaneous dislocation caused by suture degradation or breakage was not seen. CONCLUSIONS Secondary implantation of posterior chamber intraocular lenses with transscleral fixation is a reasonably safe procedure in adults, with relatively few serious complications. Even in patients with longterm follow-up, suture breakage was not seen.
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Affiliation(s)
- Ole Kjeka
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.
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Park SY, Lee SJ. Relationship Between Needle Thickness and Intraocular Hemorrhage in Scleral Fixation of Intraocular Lenses. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.10.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Yong Park
- Department of Ophthalmology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Sung Jin Lee
- Department of Ophthalmology, Soonchunhyang University School of Medicine, Seoul, Korea
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