Safety Barricade Suture for Preventing Pupillary Capture of Intraocular Lens With Scleral Fixation: H-Technique

Evaluations of bridging sutures in preventing iris capture in eyes with intrascleral fixation of implanted intraocular lens

PURPOSE

The study aims to determine the effectiveness of bridging sutures in preventing iris capture and a subsequent reverse pupillary block after an intrascleral fixation of an implanted intraocular lens (IOL).

METHODS

We studied 6 eyes that had an iris capture with reverse pupillary block due to a dislocated IOL after an intrascleral fixation. After the dislocated IOL was repositioned, 10-0 polypropylene sutures were inserted 1.5 mm posterior to the limbus and directed to run between the iris and the IOL. The sutures were placed orthogonal to the haptics of the IOL. Anterior segment optical coherence tomography (AS-OCT) was used in 4 eyes to evaluate the degree of iridodonesis before and after the bridging sutures. The heights of the temporal and nasal sectors of the middle iris from the iris plane (the line between anterior chamber angles) were compared for each 0.2-s AS-OCT image taken immediately after the eye moved from a lateral to a primary position.

RESULTS

None of the eyes had a recurrence of the iris capture after the bridging sutures. The refractive error, anterior chamber depth, and vision were not significantly altered after the bridging sutures were placed. The AS-OCT images showed that the height of the nasal iris was decreased more at 0 s postoperatively blocking the excessive downward movement of the nasal iris but not the iridodonesis.

CONCLUSION

Bridging sutures were effective in preventing iris capture and subsequent reverse pupillary block after an intrascleral fixation of an IOL.

Repairing Cyclodialysis by Riveting: A Flanged Polypropylene Suture

Cyclodialysis causes intraocular lens (IOL) pupillary capture. It requires surgical repair to prevent this risk of IOL pupillary capture. However, since repairing cyclodialysis is often technically difficult, other methods such as barricading by suturing, pupilloplasty, and pars plana fixation of the IOL were preferred. We applied a double-flanged (riveting) technique for repairing cyclodialysis to prevent IOL pupillary capture following intrascleral fixation of the IOL. Cyclodialysis was surgically repaired by riveting with double-flanged 6-0 polypropylene sutures in 3 cases with no recurrence of pupillary capture during at least 12 months of follow-up. When pupillary capture is related to cyclodialysis, repairing cyclodialysis may help prevent pupillary capture after intrascleral fixation of the IOL. Riveting using a double-flanged 6-0 polypropylene suture could possibly make the procedure simpler and more efficient.

Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses

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.

Rectangular loop suture to correct iris capture of the posterior chamber intraocular lens

BACKGROUND

To report a new technique for iris capture of the posterior chamber intraocular lens (IOL) implanted in patients with a posterior capsule defect.

METHODS

In this retrospective case series, a rectangular loop ciliary body suture technique was performed to rectify iris capture. The suture passes between the IOL and iris in a direction perpendicular to the iris edge capturing the IOL.

RESULTS

A total of three IOLs with iris capture underwent a rectangular loop suture technique. No recapture was observed postoperatively. In one case, large astigmatism appeared after the surgery but recovered at 1 month post operation. No further complications were found.

CONCLUSIONS

The rectangular loop suture technique is an effective, convenient, and minimally invasive method for iris capture of the IOL.

Risk factors for and management of pupillary intraocular lens capture after intraocular lens transscleral fixation

PURPOSE

To analyze risk factors and management of pupillary intraocular lens (IOL) capture after IOL transscleral fixation.

SETTING

Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.

DESIGN

Retrospective case series.

METHODS

A chart review was performed of patients who had transscleral fixation of IOLs between January 1, 2012, and December 31, 2013. Eyes were divided into 2 groups depending on whether the IOL was pupillary captured. Perioperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), spherical equivalent (SE) with refraction, axial length (AL), and total follow-up time were compared between the 2 groups. Ultrasound biomicroscopy images were used to analyze iris morphology and IOL position.

RESULTS

The chart review identified 138 patients, 112 patients of whom were included in this analysis. The preoperative and final mean CDVA, IOP, SE, AL, and most iris morphologic parameters were not significantly different between the 2 groups. In the pupillary capture IOL group, the mean age of patients with was younger, the anterior chamber depth (ACD) was narrower, and the rate of reverse pupillary block was higher (P = .003, P = .03, and P = .016, respectively). Intraocular lens decentration in the captured group was significantly larger (P = .002). Multiple logistic regression analysis showed that ACD, reverse pupillary block, and main decentration were associated with pupillary capture of the IOL.

CONCLUSIONS

Pupillary capture of an IOL occurred more in eyes with reverse pupillary block and poor IOL positioning. Accordingly, laser iridotomy must be considered for treatment.

Repair of angle recession prevents pupillary capture of intrasclerally fixed intraocular lenses

PURPOSE

We evaluated a new concept for treating pupillary capture of the intraocular lens (IOL) following intrascleral fixation of the IOL. Pupillary capture of the IOL is a common postoperative complication that occurs after suturing and intrascleral fixation of the IOL. In such cases, blunt trauma is often related to zonular dialysis, iris retraction, iridodonesis, and angle recession. Several methods such as barricading by suturing, pupilloplasty, and pars plana fixation are reported to prevent pupillary capture. Although effective, none of these techniques fix iris-malposition and angle recession. We considered that repairing angle recession could correct the iris position and prevent pupillary capture recurrence.

METHODS

We repaired angle recession in four cases and have followed up.

RESULTS

Pupillary capture was not observed in all three cases of larger IOLs for more than 9 months, but observed after 1 month in an IOL with normal 6 mm diameter, in which the angle was not properly lifted.

CONCLUSION

In select cases, repairing angle recession may be useful for preventing pupillary capture after IOL suturing and intrascleral fixation.

Intermittent pupillary capture of intraocular lens after transscleral fixation in congenital ectopia lentis patient triggered by dark environment: A case report

RATIONALE

Although transscleral-fixated intraocular lens (IOL) implantation has been the most frequently chosen treatment for patients with inadequate capsule support, the ghost pupillary capture phenomenon did not cause enough attention.

PATIENT CONCERNS

We present an unusual case withintermittent pupillary capture of intraocular lens.

DIAGNOSIS

After 5 minutes staying in the dark environment, the pentacam examination revealed a mild nasal pupillary capture of the IOL.

INTERVENTIONS

A clear observation using the slit-lamp was attempted, and the light shining on the pupil sped up the sliding of the captured IOL.

OUTCOMES

The captured portion of the IOL recovered rapidly accompanied with pupil retraction when the patient was exposed in the light.

CONCLUSIONS

Pupillary capture of an IOL is an uncommon but potentially serious postoperative complication of transscleral fixation. Many pupillary capture cases may have been overlooked in the past. Physicians should be aware of its potential side effect, recognize its clinical manifestation, and knowledgeable of effective management.

PREVENTING PUPILLARY CAPTURE AFTER VITRECTOMY AND TRANSSCLERAL FIXATION OF AN INTRAOCULAR LENS: Iridotomy Using a Vitrectomy Probe

PURPOSE

To investigate the effects of concurrent iridotomy using a vitreous cutter probe on the prevention of pupillary capture in patients undergoing transscleral fixation of intraocular lens implantation.

METHODS

A total of 79 eyes from 79 patients, who underwent transscleral fixation of intraocular lens without preexisting vitreoretinal disorders and who were followed up for 6 months were included. Subjects were divided into a noniridotomy group (51 eyes) and an iridotomy group (28 eyes). After conventional 23-gauge vitrectomy and transscleral fixation of intraocular lens implantation in all patients, 28 patients underwent concurrent iridotomy intraoperatively. The patients were followed up to evaluate the incidence of surgery-related complications, including pupillary capture.

RESULTS

There were no statistically significant differences in the preoperative demographic findings between the two groups (all P > 0.05). There was a significant difference in pupillary capture in 15 eyes (29.4%) of the noniridotomy group, compared with 1 eye (3.6%) of the iridotomy group (P = 0.007). There were no differences in postoperative best-corrected visual acuity between the two groups, and no iridotomy-related complications were observed.

CONCLUSION

Concurrent iridotomy using a vitreous cutter probe is an easy, rapid, and effective procedure to prevent possible pupillary capture after combined vitrectomy and transscleral fixation of intraocular lens implantation.

Tram-Track Suture Technique for Pupillary Capture of a Scleral Fixated Intraocular Lens

Purpose

To report a new technique using tram-track suture for pupillary capture of a scleral fixated posterior chamber intraocular lens (PC-IOL) to reposition the tilted IOL.

Methods

In this prospective interventional case series, we describe a tram-track suture for pupillary capture of a scleral fixated PC-IOL. A long straight needle with double-armed 10-0 polypropylene is passed behind the iris and just above the optic portion (tilted forward) of the IOL. The other straight needle with double-armed 10-0 polypropylene is passed just below the optic portion (tilted backward) of the IOL. After the IOL is repositioned properly, the polypropylene sutures are gently pulled and tied.

Results

Four eyes of 4 patients underwent tram-track suture for pupillary capture of a scleral fixated PC-IOL. No intra- or postoperative complications were noted, and no pupillary captures were detected during the follow-up period.

Conclusions

The tram-track suture technique provides good centration and stability of a PC-IOL. This technique is an easy and effective way to reposition pupillary capture of an IOL. Further, it is also minimally invasive as it maintains a closed system.