In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

Evaluation of Intraocular Lens Tilt and Decentration in Congenital Ectopia Lentis by the Pentacam Scheimpflug System

Purpose

The purpose of this study was to quantify the characteristics of the tilt and decentration of the IOL after trans-scleral suture fixation surgery in congenital ectopia lentis (CEL) patients.

Methods

The clinical characteristics of 70 CEL patients at Zhongshan Ophthalmic Center in China were retrospectively analyzed. The tilt and decentration of intraocular lens (IOL) were measured by using a Pentacam and compared between different axial length (AL) subgroups. The correlation between IOL tilt, decentration, and ocular characteristics was investigated using Spearman's correlation analysis.

Results

The postoperative IOL position of CEL patients was mainly located nasally inferiorly. The average tilt of the IOL in CEL patients was less than 7° (for temporal: 2.21 ± 1.53°, for nasal: −1.84 ± 2.04°, for superior: 2.22 ± 2.18°, and for inferior: −1.70 ± 1.62°), and the average decentration of the IOL in CEL patients was larger than 0.4 mm (for temporal: 0.49 ± 0.38 mm, for nasal: −0.69 ± 0.46 mm, for superior: 0.72 ± 0.58 mm, and for inferior: −0.68 ± 0.54 mm). The decentration of CEL patients in the AL ≥ 26 subgroup was greater than those with AL < 24 mm and AL 24 to 26 mm subgroups (for superior: 0.72 ± 0.28 mm vs. 0.46 ± 0.25 mm and 0.48 ± 0.22 mm, all P < 0.05; for inferior: -0.94 ± 0.56 mm vs. −0.44 ± 0.26 mm and -0.44 ± 0.46 mm, all P < 0.05). IOL decentration was positively correlated with AL (for superior: r = 0.44, P=0.019; for inferior: r = 0.54, P=0.006). IOL tilt was positively correlated with AL on the superior side (r = 0.38, P=0.041).

Conclusions

The extent of IOL decentration after trans-scleral suture fixation was great in CEL patients, and the IOL decentration in CEL patients was significantly associated with AL.

The Effect of Scleral Sutured Intraocular Lens with Optic-haptic Junction Fixation in the Capsular Bag

Purpose: To compare the stability of intraocular lens (IOL) insertion methods of sutured haptics in the bag with scleral fixation to those of in the bag insertion and scleral sulcus fixation. Methods: In group of only phacodonesis, two IOL insertion methods, in the bag insertion and sutured haptics in the bag with scleral fixation were compared. In group of phacodonesis with less than 90° zonulysis, two IOL insertion methods, sutured haptics in the bag with scleral fixation and scleral sulcus fixation were compared. Postoperative 2 months and 12 months refraction were compared with target refraction and the refractive change between postoperative 2 and 12 months were compared in each group. The change of anterior chamber depth (ACD) at postoperative 2 and 12 months were compared with preoperative ACD, and the change of ACD between postoperative 2 and 12 months were compared in each group. Results: In group of only phacodonesis, the typical in the bag insertion group showed significant ACD change between postoperative 2 and 12 months (<i>p</i> = 0.010), but the group of sutured haptics in the bag with scleral fixation didn’t show the significant ACD change (<i>p</i> = 0.515). In group of phacodonesis with less than 90° zonulysis, the sulcus scleral fixation method showed significant ACD change and significant refractive change (<i>p</i> = 0.015, <i>p</i> = 0.004), but the group of sutured haptics in the bag with scleral fixation method didn’t show the significant ACD nor refractive change (<i>p</i> = 0.713, <i>p</i> = 0.106) between postoperative 2 and 12 months. Conclusions: In eyes with zonular instability, sutured haptics in the bag with scleral fixation method can promote the postoperative stability of IOL.

Whole anterior segment and retinal swept source OCT for comprehensive ocular screening

Whole eye visualization and morphometry are of high relevance in clinical practice. However, most standard ophthalmic OCT instruments are dedicated either to retinal or to anterior segment imaging. We demonstrate a swept source optical coherence tomography system (SS-OCT) that images both the whole anterior segment and the retina alternately using a single source and detector. A pilot population was imaged with the proof of concept prototype. We demonstrate the clinical potential of whole eye OCT screening for the description and early detection of relevant clinical features in the anterior segment and retina of several patients.

Intraocular lens intracapsular fixation with unilateral loop suture for 180 degree Zinn's zonule dialysis

We developed intraocular lens (IOL) fixation procedure that only uses one suture during Zinn’s zonule dialysis portion of the combined surgery for IOL intracapsular fixation and unilateral loop suture for preserving the lens capsule. We treated 15 eyes in 15 patients which were confirmed to have almost 180° zonular dialysis during cataract surgery. After removing the lens, a scleral flap was created on the dialysis side. A straight needle for suturing was then inserted into the anterior chamber from the opposite side of the dialysis. The needle was used to attach the equatorial segment of the capsule on the dialysis side from the inside to the outside and then pull the suture thread under the scleral flap. After the thread was bound to a preceding loop of IOL, the IOL was inserted into the bag. Our procedure was found to be simple and less invasive, as our technique required no vitrectomy to be performed.