1
|
Mahapatra SK, Mannem N. Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens. Indian J Ophthalmol 2021; 69:1404-1408. [PMID: 34011709 PMCID: PMC8302310 DOI: 10.4103/ijo.ijo_2192_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens. Methods: In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted. Results: Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases. Conclusion: Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.
Collapse
Affiliation(s)
- Santosh K Mahapatra
- Chief Medical Officer and Vitreoretinal Surgeon, Department of Vitreoretina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack, Odisha, India
| | - Navya Mannem
- Opthalmology Resident, Department of Vitreoretina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack, Odisha, India
| |
Collapse
|
4
|
Stem MS, Todorich B, Woodward MA, Hsu J, Wolfe JD. Scleral-Fixated Intraocular Lenses: Past and Present. ACTA ACUST UNITED AC 2017; 1:144-152. [PMID: 29104957 DOI: 10.1177/2474126417690650] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan's syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement in the anterior chamber (ACIOLs), fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the pre-operative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.
Collapse
Affiliation(s)
- Maxwell S Stem
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Bozho Todorich
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jeremy D Wolfe
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| |
Collapse
|
5
|
Terveen DC, Fram NR, Ayres B, Berdahl JP. Small-incision 4-point scleral suture fixation of a foldable hydrophilic acrylic intraocular lens in the absence of capsule support. J Cataract Refract Surg 2016; 42:211-6. [PMID: 27026444 DOI: 10.1016/j.jcrs.2015.10.068] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/10/2015] [Accepted: 10/25/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the visual outcomes and complications of a new small-incision technique for 4-point fixation of a hydrophilic acrylic posterior chamber intraocular lens (IOL) in the absence of capsule support. SETTING Three North American tertiary referral centers and a private practice. DESIGN Retrospective case series. METHODS Secondary IOL placement was performed from 2011 to 2014. Indications for surgery, clinical results, and complications were analyzed. Primary outcomes included postoperative corrected distance visual acuity (CDVA) and surgical complications. RESULTS Charts of 35 patients (37 eyes) were reviewed. The mean age at surgery was 56 years, and the mean follow-up was 6 months (range 3 to 24 months). Clinical indications included a dislocated IOL (30%), ocular trauma (19%), crystalline lens subluxation (19%), uveitis-glaucoma-hyphema syndrome (5%), post-complicated cataract (8%), congenital cataract (8%), and decompensated cornea (3%). The mean CDVA improved from 20/80 preoperatively to 20/40 postoperatively (P < .01). Thirty-six eyes (97%) had an improved or unchanged CDVA, and 1 eye (3%) had a reduced CDVA because of worsening glaucoma. Postoperative complications included ocular hypertension (24%), iritis (5%), wound leakage (3%), transient corneal edema (3%), glaucoma requiring a tube shunt (3%), and IOL dislocation (3%). CONCLUSION Small-incision 4-point scleral fixation of the Akreos AO60 hydrophilic acrylic IOL in the absence of capsule support appears to be a safe and effective technique for secondary IOL placement. FINANCIAL DISCLOSURES Drs. Berdahl and Ayres are consultants to Bausch & Lomb, Inc. Drs. Ayres and Fram have received speaker fees from Bausch & Lomb. Dr. Terveen does not have a financial or proprietary interest in any material or methods mentioned.
Collapse
Affiliation(s)
- Daniel C Terveen
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Nicole R Fram
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brandon Ayres
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John P Berdahl
- From the University of South Dakota Sanford School of Medicine (Terveen, Berdahl), and Vance Thompson Vision (Berdahl), Sioux Falls, South Dakota, the University of Iowa Hospitals and Clinics (Terveen), Iowa City, Iowa, Advanced Vision Care and Jules Stein Eye Institute (Fram), David Geffen School of Medicine, University of California, Los Angeles, California, the Cornea Service (Ayres), and Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Lockington D, Ali NQ, Al-Taie R, Patel DV, McGhee CNJ. Outcomes of scleral-sutured conventional and aniridia intraocular lens implantation performed in a university hospital setting. J Cataract Refract Surg 2014; 40:609-17. [PMID: 24560552 DOI: 10.1016/j.jcrs.2013.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/09/2013] [Accepted: 09/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the outcomes of transscleral sutured posterior chamber intraocular lens (PC IOL) implantation. SETTING Public university hospital, Auckland, New Zealand. DESIGN Retrospective case series. METHODS A modified no-touch transscleral sutured PC IOL implantation technique with a 1-piece monofocal IOL (Alcon CZ70BD) or an aniridia IOL (type 67G, Morcher) was assessed. RESULTS Seventy-eight cases (80.8% men; 53.9% aphakic) were identified. The mean follow-up was 35.5 months and the mean age at surgery, 41 years±21 (SD). The preoperative corrected distance visual acuity (CDVA) was worse than 6/30 in 66.7%. Indications included ocular trauma (46.2%), nontraumatic crystalline lens subluxation (16.7%), post-complicated cataract surgery (10.3%), idiopathic IOL dislocation (10.3%), and congenital cataract/aphakia (10.3%). An aniridia IOL was required in 39.7% of eyes. There were no significant intraoperative complications in 74.4% of eyes. Postoperative complications included transient corneal edema (15.4%), wound leak requiring resuturing (7.7%), retinal detachment (7.7%), and cystoid macular edema (6.4%). One eye (1.3%) developed suture breakage-related late IOL dislocation. Overall, 91.3% of eyes had improved visual acuity or were within 1 line of the presenting CDVA. In eyes with a guarded prognosis, 34.8% achieved a CDVA of 6/12 or better and 43.5% a CDVA of 6/15 to 6/48. In the better prognosis group, 73.9% achieved a CDVA of better than 6/12 and all achieved better than 6/30. CONCLUSIONS Scleral-sutured IOLs achieved good visual outcomes in a public hospital setting. The rate of complications was moderate in this series with a high proportion of severe ocular trauma and a large percentage of aniridia IOLs. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- David Lockington
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Noor Q Ali
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rasha Al-Taie
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dipika V Patel
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| |
Collapse
|