COMBINED PARS PLANA VITRECTOMY AND SCLERAL FIXATION OF AN INTRAOCULAR LENS USING GORE-TEX SUTURE: One-Year Outcomes

Dislocated 4-haptic intraocular lens rescue with Gore-tex suture scleral re-fixation

BACKGROUND

Dislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques.

METHODS

Retrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years.

SURGICAL TECHNIQUE

A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure.

RESULTS

Seven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2-2.1) to 0.07 (0.02-0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment.

CONCLUSIONS

Transscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs.

Comparison of Safety and Efficacy of Four-Point Scleral Intraocular Lens Fixation and the Yamane Technique

INTRODUCTION

The purpose of our study was to compare the safety and efficacy of two scleral fixation intraocular lens (IOL) methods of four-point scleral fixation (Akreos AO60) and the Yamane technique (AcrySof MA60AC).

METHODS

This prospective, randomized study was conducted at the Military Institute of Medicine-National Research Institute in Warsaw between 2021 and 2023. We compared both groups for cause of aphakia, ocular history, refractive status, and complication.

RESULTS

Our study included 50 eyes from 47 patients. Four-point fixation was performed in 25 eyes (group 1), and the Yamane technique was used in 25 eyes (group 2). Surgical time was 24.1 min ± 8.9 in group 1 and 25.1 min ± 9.9 in group 2 (p > 0.05). The postoperative BCVA (best-corrected visual acuity) for group 1 and group 2 at 1 year's observation was 0.10 ± 0.15 and 0.09 ± 0.17 logMAR, respectively (p > 0.05). Postoperative total refractive error (RE) was - 0.06 ± 0.71 diopters (D) for four-point scleral fixation and 0.83 ± 0.70 D for Yamane technique (p < 0.05). Endothelial cell density (ECD) loss was 0.9% in group 1 and 3.5% in group 2 (p > 0.05). Bleeding into the anterior chamber and vitreous body was more frequent in the group of patients operated on with the use of the Yamane technique (10 cases, 20%, p = 0.01). IOL displacement was found in one case (2%) in group 2.

CONCLUSIONS

Both analyzed techniques are well tolerated and ensure good refractive results (extremely predictable in four-point scleral fixation) and have a similar safety profile. Four-point scleral fixation of IOL would appear to be safe, effective and beneficial for young, active patients, especially after trauma or recurrent subluxation.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT06389643.

Pars plana vitrectomy and scleral-fixated intraocular lenses: comparison of Gore-Tex suture and flanged intrascleral haptic fixation techniques

OBJECTIVE

To compare clinical outcomes of combined pars plana vitrectomy (PPV) and secondary scleral fixation of an intraocular lens (IOL) using Gore-Tex suture versus flanged intrascleral haptic fixation (FIHF) using double needles.

DESIGN

Single-centre retrospective cohort series.

PARTICIPANTS

Eyes undergoing PPV with simultaneous scleral fixation of an IOL.

METHOD

Eyes that underwent fixation of a Bausch & Lomb Akreos AO60 or enVista MX60E IOL using Gore-Tex suture or a Tecnis ZA9003 or Zeiss CT LUCIA 602 IOL using FIHF were included. The primary outcome was change from baseline visual acuity to postoperative month 3. Secondary outcomes included deviation from refractive target aim and rates of postoperative complications.

RESULTS

Seventy-nine eyes of 72 patients were included. Mean (±SD) follow-up was 16 ± 10.5 months (range, 4.5-45.2 months). Fifty-three eyes (67.1%) underwent Gore-Tex suture fixation, and 26 eyes (32.9%) underwent FIHF. Across all eyes, mean visual acuity improved from 1.30 ± 0.74 logMAR (20/399 Snellen equivalent) preoperatively to 0.36 ± 0.36 logMAR (20/45 Snellen equivalent) at 3 months (p < 0.001). No difference in visual acuity at month 3 was noted between the 2 techniques (p = 0.34). Mean deviation from refractive target aim was not significantly different between the Gore-Tex and FIHF groups (+0.14 ± 1.33 D vs -0.16 ± 0.88 D; p = 0.45). Reoperation rates were similar between groups (2 of 53 eyes in the Gore-Tex group vs 3 of 26 eyes in the FIHF group; p = 0.32).

CONCLUSION

Combined PPV and scleral fixation of IOLs with Gore-Tex suture and FIHF resulted in similar improvements in visual acuity. No significant differences in refractive outcome and postoperative complication profiles were noted.

GORE-TEX SUTURE-ASSOCIATED ENDOPHTHALMITIS IN A SCLERAL-SUTURED INTRAOCULAR LENS

PURPOSE

To describe a unique case of Gore-Tex (Gore Medical, AZ) suture-associated delayed-onset endophthalmitis in a patient with a history of scleromalacia, pathologic myopia, multiple prior vitrectomies in the setting of a scleral-sutured intraocular lens (IOL).

METHODS

A 69-year-old man complained of blurry vision and eye pain 21 months after implantation of a scleral-sutured IOL and was found to have an exposed Gore-Tex suture with scleromalacia, vision loss to hand motion, a hypopyon, and vitritis. He was diagnosed with culture-positive endophthalmitis. He had a previous history of a rhegmatogenous retinal detachment repair and subsequent dislocated IOL in this eye treated with a scleral-sutured IOL. A vitreous tap and injection of broad-spectrum antibiotics and suture removal at the slit lamp were performed at the time of presentation. One week later, he underwent pars plana vitrectomy and removal of the IOL.

RESULTS

After the tap and inject and subsequent lens removal, his vision has returned to his preoperative vision of 20/100 with refraction.

DISCUSSION

Gore-Tex suture is a nonabsorbable and flexible option with great tensile strength that has emerged as a favored alternative to polypropylene for the use in transscleral fixated IOLs. Although endophthalmitis and suture erosion are known complications of this procedure, this report describes one of the first cases of Gore-Tex suture-associated endophthalmitis.

MEMBRANOUS ENCAPSULATION OF AN AKREOS INTRAOCULAR LENS FOLLOWING SCLERAL FIXATION MASQUERADING AS OPACIFICATION

BACKGROUND

To report a case of membranous encapsulation of a scleral-fixated Akreos intraocular lens (IOL) that was successfully treated with vitrectomy and membranectomy without IOL exchange or removal.

METHODS

Case report.

RESULTS

A 58-year-old woman with a history of bilateral chronic anterior and intermediate uveitis underwent scleral fixation of Akreos IOL for dislocated 3-piece IOL in the vitreous cavity. She presented one year later with progressively worsening vision (decreased to 20/200) and was found to have a complete encapsulation of the IOL. The patient underwent successful vitrectomy and membranectomy with return of vision to 20/25 within three months of surgery.

CONCLUSION

There are numerous case reports of opacification after scleral fixation of Akreos IOL. To our knowledge, this is the first report of complete encapsulation of the IOL with a membrane of this type and character. The etiology for this patient's presentation is unclear, but was presumed to be related to her history of chronic intraocular inflammation.

Four-Point Scleral Fixation of An Akreos Adapt AO Intraocular Lens Using Double-Strand 9-0 Polypropylene Suture

PURPOSE

To report the results of a novel surgical four-point transscleral suture fixation of intraocular lens (IOL) with four hollow haptics using the double-suture technique.

METHODS

We retrospectively reviewed the medical records of 15 eyes of 15 patients who underwent 4-point transscleral suture fixation of a foldable IOL using the double-suture technique. Preoperative data and follow-up data for at least 4 months were collected for all patients.

RESULTS

The IOLs were fixed and centered well. The mean preoperative corrected distance visual acuity was 0.70 ± 0.54 logarithm of the minimum angle of resolution (Snellen 20/102), and it improved to 0.29 ± 0.26 logarithm of the minimum angle of resolution (Snellen 20/39) at the final follow-up ( P = 0.001). No vitreous hemorrhage, hypotony, suture breakage, retinal detachment, IOL dislocation, and iris capture was detected during the follow-up period in any of the patients.

CONCLUSION

We have developed a novel technique for 4-point transscleral suture fixation of IOL using the double-suture technique with 9-0 polypropylene suture. This technique seemed to be safe and it may not require the surgeon to learn any new technique.

Long term outcomes of Yamane technique in various indications

INTRODUCTION

To describe the clinical and refractive outcomes of Yamane transconjunctival sutureless intrascleral intraocular lens (SIS IOL) fixation technique in aphakic and dislocated IOLs.

METHODS

The aphakic and IOL dispositioned patients who underwent Yamane surgery in Bozyaka Research and Training Hospital were evaluated retrospectively. The demographic data, preoperative & postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), indication for surgery, additional surgical interventions, complications, the final status of retina, and central macular thickness (CMT) through spectral-domain optic coherence tomography (SD-OCT) were recorded.

RESULTS

A total of 30 eyes of 30 patients were evaluated. The indication for surgery was aphakia in 24 patients, lens dislocation in 1 patient, and IOL dislocation in 5 patients. The mean age of participants was 64.17 ± 14.69 years, and the mean follow-up was 46.07 ± 7.96 months. The mean BCVA was improved from 0.25 ± 0.22 (-0.94 ± 0.83 log MAR) to 0.49 ± 0.24 in decimals (-0.37 ± 0.27 log MAR) (p:0.041). The mean subjective refraction improved from 10.06 ± 3.10 to -1.45 ± 0.73 D in the final visit (p < 0.05). The mean of cylindrical refraction was -1.22 ± 1.03 D in the postoperative period. At the time surgery, 36.6% of patients required at least one additional surgical procedure. During follow-up period, two (6.7%) out of 30 of patients had retinal detachment, two of the patients (6.7%) occured epiretinal membrane, one of the patients (3.3%) had cystoid macular edema.

CONCLUSION

Yamane SIS IOL fixation technique is an effective and reliable surgical option in complicated cases that require additional surgical interventions in long-term follow-up.

Technique for Sutured Scleral Fixation of One-Piece Hydrophobic Acrylic Intraocular Lenses Dislocated Into the Vitreous

PURPOSE

To present a suturing technique for safe refixation of posteriorly dislocated one-piece hydrophobic acrylic intraocular lenses (IOLs).

METHOD

Retrospective data analysis of a series of 12 cases operated with vitrectomy, followed by IOL relocation to the retropupillary area, after which polypropylene sutures are passed through the optic-haptic junctions of the dislocated IOL and subsequently secured to the sclera.

RESULTS

In all cases, the IOL remained centered throughout the follow-up period (mean 10.5 months, range 3 weeks-36 months). One case was complicated by vitreous hemorrhage the first postoperative day and later cystoid macular edema. Visual acuity was not compromised at the end of follow-up.

CONCLUSION

The presented technique is safe and provides long-term stable refixation in cases of late posterior dislocation of a one-piece hydrophobic acrylic IOL. The risk that sutures looped around haptics will slip off the haptic is thereby avoided.

Scleral flaps, pars plana vitrectomy and gore-tex sutured posterior chamber intraocular lens placement: a case series and review of literature

Introduction

Cataract surgery is one of the most common surgical procedures performed worldwide. Intraocular lens (IOL) implants are placed routinely in the capsular bag after successful cataract extraction. However, in the absence of adequate capsular support, IOL may be placed in the anterior chamber, fixated to the iris or fixated to the sclera. The purpose of this study is to report the clinical outcomes and safety profile of a trans-scleral sutured intraocular lens (IOL) technique using scleral flaps, vitrectomy, and Gore-Tex suture to place posterior chamber IOL.

Methods

Retrospective, interventional case series of eyes undergoing scleral fixation of an IOL using Gore-Tex suture with concurrent vitrectomy. Ocular examination with the logarithm of the minimum angle of resolution visual acuity (logMAR BCVA), tonometry, and slit-lamp biomicroscopy was performed on all patients at 1, 3, 6, and 12 months after the operation. All post-operative complications were recorded.

Results

Twenty-five eyes of 25 patients were included. Mean logMAR BCVA improved from 0.43 ± 0.36 (20\40 Snellen equivalent) preoperatively to 0.13 ± 0.18 (20\25 Snellen equivalent) postoperatively at 12 months (p<0.01). Indications included surgical aphakia (16) and dislocated lens implant (9). No cases of IOL opacification, suprachoroidal haemorrhage, post-operative endophthalmitis, IOL dislocation, Gore-Tex exposure, or retinal detachment were observed during the follow-up period.

Conclusion

Ab externo scleral fixation of IOLs with Gore-Tex suture plus scleral flap is well tolerated and associated with a very low rate of suture exposition. Moreover, our study confirms excellent refractive outcomes after surgery.

Refractive outcomes of scleral-sutured posterior chamber intraocular lenses in post-traumatic eyes

PURPOSE

To evaluate the refractive outcomes of scleral-sutured IOL 2 mm posterior to the limbus in post-traumatic eyes using SRK/T formula.

METHODS

This single-center retrospective case series included 35 eyes from 35 post-traumatic patients undergoing scleral-suture of ErgomaX IOLs by a single experienced surgeon. Preoperative predicted refraction, procedure-related complications, and postoperative spherical equivalent (SE) at least 1 month after surgery were recorded. The prediction error (PE) was calculated as the difference between the postoperative SE and preoperative predicted refraction.

RESULTS

Of the 35 post-traumatic patients, 28 patients were aphakia without capsular support, and 7 patients were traumatic lens dislocation or subluxation. The mean age at surgery was 56.03 ± 14.56 years and 28 patients were men (80%). The mean postoperative spherical equivalent (SE) and postoperative astigmatism were - 1.23 ± 0.82 D and 1.57 ± 1.14 D, respectively. The mean prediction error (ME) of SRK/T formula was - 0.17 D. The mean absolute error (MAE) was 0.48D. The prediction accuracy was 60.0% for refractive errors of ± 0.50 D and 85.7% for refractive errors of ± 1.00D. Multiple linear regression analyses revealed that IOL power has positive correlation with PE.

CONCLUSION

Assumption of in-the-bag IOL position when calculating IOL (52501TY, ErgomaX) power for standardizing scleral-sutured IOL 2 mm posterior to the limbus demonstrates acceptable refractive outcomes. The accuracy of IOL power calculation using the SRK/T formula for eyes needing low IOL power or high IOL power may be affected by the uncertain position of postoperative IOL and further studies are needed.

A novel surgical approach for fixation of a posterior chamber intraocular lens of Rayner 620 H with Gore-Tex suture

PURPOSE

To report a novel surgical approach for the scleral fixation of the Rayner 620 H intraocular lens (IOL) with Gore-Tex suture and its outcomes at 6 months postoperatively.

METHODS

19 consecutive patients who underwent novel surgical approach for the scleral fixation of Rayner 620 H IOL with Gore-Tex suture at Peking Union Medical College Hospital between June 2020 and June 2021 were included. Data on best-corrected visual acuity (BCVA), spherical equivalent, total astigmatism/axis, short-term and long-term complications, and corresponding management with a follow-up of 6 months were collected.

RESULTS

Nineteen patients (11 men and 8 women) with a mean age of 62.7 ± 10.6 years were included. The median BCVA improved significantly from 0.90 ± 0.90 (Snellen 20/160) preoperatively to 0.20 ± 0.30 (Snellen 20/32) at postoperative 6 months follow-up (P < 0.001). The stratification of the accuracy of refractive outcomes was 53% of patients within ± 0.5 D and 84% of patients within ± 1.0 D of the refractive target. Corneal edema (n = 3, 16%) and increased intraocular pressure (IOP) (n = 4, 11%) were short-term complications. Long-term complications included increased IOP (n = 1, 5%), and macular edema (n = 1, 5%).

CONCLUSION

The novel surgical approach for scleral fixation of the Rayner 620 H IOL with Gore-Tex suture is a reasonable option for patients who need secondary IOL placement without adequate capsular support.

Outcomes of Pars Plana Vitrectomy and 4-Point Sutured Scleral Fixation of Akreos AO60 Intraocular Lens in Clinical Settings: A Case Series

PURPOSE

To determine the long-term anatomic outcomes and surgical complications of pars plana vitrectomy (PPV) and 4-point Gore-Tex-sutured Akreos AO60 intraocular lens (IOL) scleral fixation.

DESIGN

Retrospective, multicenter, multisurgeon case series.

PARTICIPANTS

Ninety-seven patients in tertiary eye care centers.

METHODS

The patients underwent PPV and intraocular fixation of the Akreos AO60 IOL using Gore-Tex CV-8 sutures between January 2015 and April 2020. The inclusion criteria were aphakia, no capsular support, and a minimal 1 year of follow-up.

MAIN OUTCOME MEASURES

Uncorrected visual acuity (VA), complication rates or types, and refraction.

RESULTS

Data from 101 eyes of the 97 patients were analyzed (mean follow-up duration, 33.4 months; range, 12-62 months). The mean ± standard deviation uncorrected logarithm of the minimum angle of resolution VA improved from 1.04 ± 0.73 (20/200 Snellen equivalent) before surgery to 0.66 ± 0.65 (20/80) at 6 months after surgery (P < 0.001). The most prevalent complications included hypotony (12.9%), ocular hypertension (12.9%), corneal edema (8.9%), cystoid macular edema (6.9%), and vitreous hemorrhage (5.9%). Refraction was measured between 3 and 6 months after surgery, and 61.8% of the patients had spherical equivalent of ± 2.0 diopters. Most complications occurred in the first postoperative month and resolved spontaneously or with medical treatment.

CONCLUSIONS

The results demonstrated that this surgical technique is well tolerated by the eyes, with a low complication rate in the long term. The rates of IOL opacification were infrequent for up to 62 months of follow-up.

Surgical management of aphakia

Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.

A systematic approach to the management of microspherophakia

Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.

Outcomes of Transscleral Two-Point Fixation Versus Closed Continuous-Loop Four-Point Fixation of Intraocular Lens in Subluxated Lens Secondary to Marfan Syndrome

Introduction

To compare the outcome of two different transscleral fixation approaches for posterior chamber intraocular lens (IOL) implantation, a two-point fixation of the Sensar (Allergan) or CZ70BD (Alcon) IOL and a four-point fixation of the Akreos Adapt (Bausch & Lomb) foldable IOL, for treatment of subluxated lenses in Marfan syndrome (MFS).

Methods

Fifty-three eyes of 33 consecutive patients with subluxated lenses secondary to MFS were studied. Eighteen patients with MFS (30 eyes) received two-point fixation of the Sensar (16 patients, 26 eyes) or CZ70BD (2 patients, 4 eyes) IOL, and 15 patients with MFS (23 eyes) received four-point fixation of the Akreos Adapt IOL. Preoperative and postoperative ophthalmologic examinations were performed. A primary outcome measure of postoperative complication was studied.

Results

The mean preoperative best corrected visual acuity (BCVA) in the two-point group was 0.68 ± 0.38 logarithm of the minimum angle of resolution (logMAR), and it improved to 0.30 ± 0.32 logMAR at the final follow-up (p < 0.05). The mean preoperative BCVA in the four-point group was 0.68 ± 0.45 logMAR, and it improved to 0.28 ± 0.28 logMAR at the final follow-up (p < 0.05). The BCVA results did not differ significantly between groups. The intraocular pressure was increased at the final follow-up in the two-point group (p < 0.05). Transscleral two-point fixation of IOL has relatively high incidences of pupillary capture of the IOL.

Conclusion

The closed continuous-loop transscleral four-point fixation of the Akreos Adapt foldable IOL is more suitable than two-point fixation of a two-haptic IOL in treating subluxated lenses due to MFS.

Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications

Purpose

“In-the-bag” placement of an IOL is the Holy Grail for any cataract surgeon. However, in the absence of capsular integrity, alternative surgical options to place the IOL must be sought. We aim to report the clinical outcomes and safety profile of scleral-fixated Akreos AO60 intraocular lens implantation using Gore-Tex suture, combined with pars plana vitrectomy.

Methods

This is a single-center, retrospective case series descriptive study. Electronic clinical records of all patients subjected to scleral fixation of a Bausch and Lomb Akreos AO60 IOL combined with pars plana vitrectomy, between April 1, 2017, and August 1, 2021, were reviewed. Data concerning age, sex, laterality, past ophthalmological history, pre- and postoperative best-available visual acuity, surgical indication, and intra- and postoperative complications were collected. Measured outcomes were the differences in best-available visual acuity and frequency of postoperative complications.

Results

A total of 37 eyes (20 right eyes and 17 left eyes) from 36 patients (16 females and 20 males) were included in the statistical analysis. The mean age at time of surgery was 72.0 ± 12.4 years. The mean follow-up period was 548.9 days (range 39–1564 days). Globally, the mean best-available logMAR visual acuity improved from 1.61 preoperatively (0.025 decimal equivalent) to 0.57 postoperatively (0.3 decimal equivalent), this difference being statistically significant (P < 0.001). Indications for surgery included aphakia due to complicated cataract surgery (24.3%; n = 9); subluxated IOL due to closed trauma (21.6%; n = 8); PEX-related subluxated IOL (16.2%; n = 6); non-traumatic, non-PEX-related subluxated IOL (18.9%; n = 7); subluxated crystalline lens due to closed trauma (8.1%; n = 3); aphakia due to open-globe injury (5.4%; n = 2); silicone-induced IOL opacification (2.7%; n = 1); and aphakia post-endophthalmitis (2.7%; n = 1). Postoperative complications included transient ocular hypertension (27.0%; n = 10), transient corneal edema (18.9%; n = 7), cystoid macular edema (18.9%, n = 7), self-limited hypotension (5.4%, n = 2), self-limited vitreous hemorrhage (2.7%, n = 1), central retinal vein occlusion (2.7%, n = 1), late retinal detachment (2.7%, n = 1), and Akreos IOL opacification (2.7%, n = 1). No suture-related complications were observed.

Conclusion

There was a statistically significant improvement in visual acuity after scleral fixation of Akreos AO60 intraocular lens using Gore-Tex suture, with no suture-related problems recorded. This procedure seems to be a valuable alternative for posterior chamber IOL placement when secondary IOL implantation is required.

CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS

PURPOSE

To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage.

METHODS

Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B).

RESULTS

Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory).

CONCLUSION

In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.

Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy

Purpose

To compare the visual outcomes and complications of patients who underwent flanged transconjunctival sutureless intrascleral intraocular lens (SIS IOL) implantation after anterior and pars plana vitrectomy.

Methods

All patients who underwent flanged transconjunctival SIS IOL fixation using a 27-gauge needle between September 2017 and November 2019 and were followed up for at least six months were evaluated. The cases in which anterior vitrectomy was performed were classified as Group 1, and those that underwent pars plana vitrectomy were classified as Group 2. The best-corrected visual acuity (BCVA), spherical equivalent values, corneal endothelial cell density, and intraocular pressures were compared between the two groups before and after the operation. Intraoperative and postoperative complications were assessed.

Results

The study included 108 eyes of 108 patients who were included in the study. Group 1 consisted of 48 patients and Group 2 comprised of 60 patients. When the findings between Groups 1 and 2 were compared in the postoperative period, there was no statistically significant difference in terms of the mean intraocular pressure increase, endothelial cell density, BCVA, and spherical equivalent value (P=0.818, 0.601, 0.368, and 0.675, respectively). When all the patients were considered as a single group, the mean spherical value at the sixth postoperative month was 0.3 ± 2.2 D (min-max, (−5.5)–(+6)), the mean cylindrical value was −1.7 ± 2.4 D (min-max, (−9.25)–(+4)), and the mean spherical equivalent value was −0.5 ± 2.3 D (min-max, (−6.5)–(+6)).

Conclusion

The flanged transconjunctival SIS IOL fixation technique performed using a 27-gauge needle is safe and effective in the patient group with aphakia and lens/IOL dislocation or subluxation. However, in patients planned to undergo flanged transconjunctival SIS IOL implantation, pars plana vitrectomy seems to be a more suitable option than anterior vitrectomy to reduce complications.

Delayed-Onset Propionibacterium acnes Endophthalmitis in the Absence of Capsular Complex Following Scleral-Fixated Intraocular Lens: A Case Report

PURPOSE

This work reports a case of delayed-onset Propionibacterium acnes endophthalmitis in a patient with scleral-fixated intraocular lens (IOL), successfully treated with intravitreal antibiotics and steroids.

METHODS

Patient underwent complete ophthalmic examinations over 2 years. Vitreous cultures, optical coherence tomography, anterior segment and fundus photographs, and fluorescein angiogram were performed.

RESULTS

A 78-year-old man with dislocated IOL underwent IOL removal and scleral-fixated AO60. He did well for 2 months but returned 9 months later with vision loss. Examination revealed low-grade inflammation and multiple IOL opacities. Vitreous culture grew P acnes. He was treated with intravitreal clindamycin followed by dexamethasone for macular edema without IOL explantation. A year after treatment no inflammation or macular edema was noted.

CONCLUSION

To our knowledge, this is the first case of P acnes endophthalmitis following scleral sutured IOL. Treatment with intravitreal injections alone, without IOL explantation, was effective, possibly because of the absence of capsular complex.

Scleral fixation using a hydrophilic four-haptic lens and polytetrafluoroethylene suture

To assess the safety of scleral fixation using the Akreos AO60 intraocular lens (IOL) and Gore-Tex suture. Prospective evaluation of 20 patients who underwent scleral fixation of an Akreos AO60 with Gore-Tex. Patients presenting with aphakia or dislocated IOL without capsular support were enrolled in the study. Main outcome measures included visual acuity, endothelial cell density, and postoperative complications over 6 months of follow-up. Mean ± standard deviation (SD) uncorrected logMAR visual acuity improved from 1.92 ± 0.23 (20/1600 Snellen equivalent) preoperatively to 0.80 ± 0.56 (20/125) at 6 months postoperatively (p < 0.001). Mean ± SD best-corrected visual acuity (BCVA) logMAR was 0.43 ± 0.23 preoperatively and 0.37 ± 0.24 (20/50) at 3-6 months postoperatively (p = 0.312). The mean ± SD endothelial cell density was 1740.50 ± 522.92 cells/mm² and 1187.19 ± 493.00 cells/mm² (p < 0.001) pre and postoperatively, respectively. Mean ± SD postoperative spherical equivalent was - 1.12 ± 1.50D. Postoperative complications included exposure of suture in 40% of the patients, hypotony in 15%, ocular hypertension in 10%, transient vitreous hemorrhage in 10%, retinal detachment in 5%, and transient lens opacification in 5%. Scleral fixation with an Akreos AO60 and Gore-Tex appears generally safe. However, given the high incidence of suture erosion observed, the use of scleral flaps or rotating and burying the knots is recommended in order to reduce the risk of this complication.

Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture

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.

Short-term outcomes of a modified technique for small-incision scleral-fixated intraocular lens implantation using Gore-Tex sutures

PURPOSE

To report the short-term outcomes of a modified small-incision technique for implantation of scleral-fixated intraocular lenses (IOLs) using Gore-Tex sutures.

METHODS

A retrospective, interventional, consecutive case series was conducted. From June 2019 to February 2020, 10 patients underwent small-incision scleral-fixated IOL implantation using Gore-Tex sutures at a tertiary referral center. Visual and anatomical outcomes and complications were recorded with a minimum follow-up period of 3 months. Surgically induced astigmatism (SIA) and IOL-induced astigmatism were measured.

RESULTS

The mean follow-up duration (range) was 396 (240-573) days. Best-corrected visual acuity improved significantly from logarithm of the minimal angle of resolution (logMAR) 0.88 ± 0.65 (Snellen equivalent: 20/153) preoperation to logMAR = 0.30 ± 0.51 (Snellen equivalent: 20/40) at final follow-up (P = .008). The estimated SIA and IOL-induced astigmatism were 0.61 diopters (D) ± 0.49D and 0.40D ± 0.36D, respectively. No intraoperative complications occurred. The postoperative complications, which included ocular hypertension (20%), cystoid macular edema (30%), and vitreous hemorrhage (20%), were transient and resolved with topical medication.

CONCLUSIONS

The modified small-incision technique for implantation of scleral-fixated IOLs using Gore-Tex sutures was well tolerated in all patients, with favorable postoperative visual outcomes and minimal SIA and IOL-induced astigmatism.

Clinical Outcomes of Secondary Scleral-Sutured Foldable Hydrophilic Acrylic Intraocular Lens Placement by Trainees: A Single-Site Analysis

PURPOSE

To evaluate the outcomes of a 4-point scleral-fixated foldable Akreos AO60 intraocular lens (IOL) insertion using Gore-Tex suture performed by trainees under supervision of a single attending surgeon.

METHODS

Retrospective chart review for 53 eyes of 50 patients whose surgery was performed by trainees under supervision of a single surgeon between 2015 and 2018 at a tertiary care hospital (Johns Hopkins Wilmer Eye Institute, Baltimore, MD). Indications for surgery, preoperative risk factors, and intraoperative techniques were analyzed. Outcome measures included final best-corrected visual acuity (BCVA), change in BCVA, difference between expected and final spherical equivalent (SE), and postoperative complications.

RESULTS

Mean patient age was 62.8 years (range 26.9 to 88.4). The most common indication for surgery was IOL dislocation (59.6%) due to trauma in 21 cases (40.4%) and pseudoexfoliation in 6 (11.5%). Combined pars plana vitrectomy was performed simultaneously in 46 cases (88.5%). Mean BCVA improved from 20/100 to 20/40 (p < 0.001). The difference between expected and final SE was within 1.0 D in 28 cases (53.8%). Postoperative hypotony occurred in 12 eyes (21.2%) on day 1; all were resolved at last follow-up. Postoperative cystoid macular edema (CME) occurred in 20 cases (38.5%); 11 (21.2%) persisted through last follow-up.

CONCLUSION

Scleral-fixation of Akreos AO60 IOL in absence of capsular support can be performed by trainees under supervision and results in effective visual rehabilitation. Postoperative CME occurred at a higher rate than previously reported in the literature. Future studies should assess the rates of postoperative complications amongst different techniques of secondary IOL fixation performed by trainees to determine which is the safest.

Scleral-Sutured Intraocular Lens Dislocations Secondary to Eyelet Fractures

OBJECTIVE

To report clinical features and visual outcomes following eyelet fractures of scleral-sutured enVista MX60 (Bausch + Lomb) intraocular lenses (IOL).

DESIGN

Retrospective, multi-center, multi-surgeon, observational case series.

METHODS

Study Population: Patients with scleral-sutured enVista MX60 IOLs that experienced either an intraoperative or post-operative eyelet fracture associated with dislocation or subluxation.

PROCEDURES

All records were reviewed for patients with a dislocated or subluxed scleral-sutured enVista MX60 IOL. Clinical features and outcomes were gathered. Main Outcome Measures: Clinical setting, surgical technique, complications, and visual acuity.

RESULTS

A total of 25 scleral-sutured enVista MX60 IOLs displacements secondary to eyelet fractures in 23 eyes of 23 patients were included. There were 20 IOLs that sustained a postoperative fracture and 5 IOLs that sustained an intraoperative fracture. Of the postoperative fractures, 7 were dislocated and 13 were subluxed. Gore-Tex was the suture of choice for 19 of the postoperative fractures and all 5 of the intraoperative fractures, and Prolene was used for 1 postoperative fracture. The mean time until postoperative fracture was 96 ± 125 days, and the median time was 61 (IQR 48-144) days. Of the postoperative fractures, new MX60s were sutured in 10 patients, and 2 of them experienced repeat displacements due to a new eyelet fracture. In the intraoperative fracture group, new MX60s were sutured in 4 patients and an Akreos AO60 lens was placed in the 5th patient. The mean preoperative best-corrected logMAR visual acuity for all patients improved from 1.2 ± 0.8 (20/317 Snellen equivalent) to 0.5 ± 0.5 (20/63 Snellen equivalent) at most recent follow-up after lens replacement.

CONCLUSIONS

Scleral-sutured MX60 intraocular lenses can experience intraoperative or postoperative eyelet fractures, resulting in lens subluxation or dislocation. Surgeons should be aware of this complication when evaluating secondary intraocular lens options.

Refractive Outcomes of Four-Point Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture

Background/Objective

To determine the refractive outcomes after 4-point scleral fixation of the Akreos AO60 intraocular lens with Gore-Tex suture.

Methods

This was a single referral center, multi-surgeon, retrospective consecutive case series. A total of 63 eyes met the inclusion criteria for having received surgical implantation of the Akreos AO60 intraocular lens with Gore-Tex suture from August 2014 to December 2018. Exclusion criteria included all ocular pathology that precluded an accurate refraction, concurrent ocular surgery, poor corrected pre-operative visual potential, among other factors. Main outcome measures included post-operative uncorrected visual acuity (VA), best-corrected VA, and spherical equivalent deviation from target.

Results

Mean pre-operative BCVA was 0.67 ± 0.64 LogMAR (20/93 Snellen). Mean final post-operative BCVA was 0.17 ± 0.18 (20/28 Snellen) and mean final post-operative UCVA was 0.31 ± 0.22 (20/41 Snellen). Mean post-operative spherical equivalent was −0.57 D. Mean post-operative astigmatism was 0.85 D.

Conclusion

Refractive outcomes after secondary implantation with Akreos AO60 are favorable in eyes with good visual potential.

Management of subluxed and dislocated intraocular lenses in patients with uveitis: a practical approach

PURPOSE

To describe practical approaches to the management of subluxed or dislocated intraocular lenses (IOL) in patients with uveitis.

PATIENTS AND METHODS

Retrospective case series from a specialist uveitis clinic.

RESULTS

Fifteen IOLs in 13 patients were subluxed inferiorly (12) or dislocated into anterior chamber (2) or vitreous (1) at a mean delay of 12 years after cataract surgery. Six eyes required vitrectomy and seven IOL explantation. A dislocated IOL was repositioned by scleral fixation in one, and a new IOL was implanted in three (two scleral-sutured, one iris-claw). Eight were observed without surgery and 7 were left functionally aphakic (4 corrected with contact lens). The mean final best-corrected visual acuity was 0.6 LogMAR.

CONCLUSIONS

There are several management choices for IOL dislocation which should take into account the degree of uveitis, patient age and expectations. We present a pragmatic approach: surgery can often be avoided in this high-risk group.

Refractive outcomes and accuracy of IOL power calculation with the SRK/T formula for sutured, scleral-fixated Akreos AO60 intraocular lenses

BACKGROUND

Scleral fixation of intraocular lenses has become a popular procedure for treating aphakia in the absence of capsular support. However, the lens formulas used to predict refractive outcomes were designed for in-the-bag lens placement. This study evaluates the accuracy of the SRK/T formula in predicting a target postoperative refraction when suturing a scleral-fixated intraocular lens (IOL) implant 3 mm posterior to the limbus.

METHODS

This is a retrospective, case series including 20 eyes of 20 patients who underwent scleral fixation of Akreos AO60 IOLs (Bausch & Lomb, Rochester, NY) by a single surgeon at the OSU Wexner Medical Center. Preoperative measurements were performed with optical biometry, and IOL power was calculated with the SRK/T formula. Following surgery, the actual refractive spherical equivalent (SE) was performed and compared with the preoperative prediction. Prediction error (PE), defined as the deviation of actual postoperative SE refraction in diopters (D) from preoperative predicted SE refraction, was the primary outcome measure.

RESULTS

The mean attempted (predicted) SE was - 1.12 D (± 0.87). Mean achieved SE was - 0.96 D (± 1.04). Mean PE (actual postoperative SE versus predicted preoperative SE) was 0.16 D (± 0.69). A total of 9 eyes (45%) were within ± 0.5 D of the predicted SE, 16 eyes (80%) were within ± 1.0 D, and all 20 eyes (100%) were within ± 1.5 D.

CONCLUSION

IOL power calculation using the SRK/T formula with optical biometry demonstrates reliable postoperative refractive outcomes in patients undergoing scleral fixation of an IOL (Akreos AO60). Further studies are needed to refine the predictive value of the SRK/T and other formulas for application in scleral fixation of IOLs.

Sutureless intrascleral fixation using different three-piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study

We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral (SIS) fixation of a standard three-piece PCIOL. Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL: transient/permanent corneal oedema (9-66.6%), uveitis (1.1-39.3%); iris-fixated IOL: pupil ovalization (16-47.7%); and sutured scleral-fixated IOL: suture breakage/exposure (6.1-11%), vitreous haemorrhage: (5.5-16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony (n = 20; 19.4%), corneal decompensation (n = 7; 6.7%), IOL dislocation (n = 6; 5.8%), cystoid macular oedema (n = 5; 4.8%), vitreous haemorrhage (n = 4; 3.8%) and retinal detachment (n = 4; 3.8%). Mean best corrected visual acuity improved from logMAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.

Outcomes and Complications of Concurrent Pars Plana Vitrectomy and Scleral-Fixated Intraocular Lens Placement Using Gore-Tex Suture

Purpose:

The authors aim to describe the visual outcomes and postoperative complications of concurrent pars plana vitrectomy and scleral-fixated intraocular lens (IOL) placement using Gore-Tex suture.

Methods:

A retrospective review of medical records was performed on 27 eyes of 27 patients undergoing concurrent pars plana vitrectomy and scleral-fixated IOL with Gore-Tex suture. Outcome measures were change in preoperative and postoperative visual acuity, final manifest refraction, and incidence of intraoperative and postoperative complications.

Results:

The mean age was 69.2 ± 11.3 years; there were 16 male patients (59%). The duration of follow-up ranged from 33 to 576 days with a mean of 200 ± 143 days. All patients received Bausch + Lomb Akreos AO60 IOL. The overall mean best-corrected visual acuity in Snellen equivalent improved from 20/276 preoperatively to 20/44 postoperatively ( P < .001). The mean postoperative manifest spherical equivalent refraction was –0.35 ± 1.34 diopters (D). Seventy-five percent of eyes were ± 1.0 D of target refraction. Postoperative complications included corneal edema (26.0%), ocular hypertension (25.9%), hypotony (7.4%), cystoid macular edema (7.4%), vitreous hemorrhage (7.4%), and hyphema (3.7%). No cases of suture breakage, IOL dislocation, retinal detachment, or uveitis–glaucoma–hyphema syndrome were identified.

Conclusions:

The use of Gore-Tex suture for posterior chamber IOL fixation resulted in favorable outcomes. No suture-related complications occurred during the follow-up period. Final refraction in this setting is typically within ± 1.0 D of target.

Indications and Outcomes for the Removal of Intraocular Lens Implants in a Retinal Surgery Practice

BACKGROUND AND OBJECTIVE

To describe the reasons for and clinical outcomes of intraocular lens (IOL) removal, with or without exchange, in the setting of retina surgery.

PATIENTS AND METHODS

This is a retrospective, noncomparative, consecutive, interventional case series of patients undergoing IOL removal at an academic referral center performed by a single surgeon between 2002 and 2013. Data collected included baseline patient characteristics, visual acuity (VA), type of IOL, reason for IOL removal, and postoperative complications.

RESULTS

The study cohort included 63 eyes with IOL removal. Of these, 51 (81%) were left aphakic. For cases of IOL opacification or dislocated IOL (56), the decision to remove was made for 35 (63%) during concurrent retinal surgery due to obstruction in visualization. Overall, the most common reason for removal of the IOL was IOL opacities in 42 eyes (67%), followed by nonspecific nature of opacities (n = 19; 45%), oil artifact (n = 17; 40%), opaque nonvascular membranes (n = 4; 10%), and fibrovascular proliferation (n = 2; 5%). Other causes for removal were IOL dislocation (n = 14; 22%), endophthalmitis (n = 7; 11%), and broken IOL haptic (n = 1; 2%). The composition of the 42 IOLs with opacification included 19 (45%) silicone, 14 (33%) unspecified, five (12%) polymethyl methacrylate, and four acrylic (10%). From the 17 IOLs removed due to oil opacification, 15 (83%) were silicone, and two (17%) were unspecified. Postoperative complications included recurrent retinal detachment (n = 13; 21%), hypotony (n = 8; 13%), phthisis bulbi (n = 8; 13%), corneal edema (n = 7; 11%), cystoid macular edema (n = 5; 8%), elevated intraocular pressure (n = 3; 5%), vitreous hemorrhage (n = 3; 5%), hyphema (1; 2%), anterior synechiae (1; 2%), and subretinal hemorrhage (1; 2%) The mean (SD) immediate, 3 months, and final best-corrected VA in logMAR were 2.18 (0.47), 1.85 (0.82), and 1.97 (0.85).

CONCLUSION

The vitreoretinal surgeon must be prepared for IOL removal, especially if IOL opacification and dislocation compromise the view or capability to achieve primary retinal reattachment objectives. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:504-508.].

Scleral Fixation of Intraocular Lenses with Gore-Tex Suture: Refractive Outcomes and Comparison of Lens Power Formulas

PURPOSE

To report refractive outcomes of scleral-fixated intraocular lens (IOL) implantation with Gore-Tex (W.L. Gore & Associates, Newark, DE) suture and combined pars plana vitrectomy and compare predicted refractive outcomes among 5 IOL power calculation formulas.

DESIGN

Retrospective case series.

PARTICIPANTS

Patients undergoing scleral-fixated IOL implantation with Gore-Tex suture at our institution between January 2015 and June 2018.

METHODS

Comparison of preoperative biometrics with postoperative refraction and calculation of predicted refractive outcome with 5 different IOL formulas.

MAIN OUTCOME MEASURES

Prediction error and absolute error to compare postoperative refraction with refraction predicted by lens power calculation formulas.

RESULTS

Thirty-one eyes of 31 patients were included. All power calculations assumed in-the-bag position of the IOL. The Akreos A060 (Bausch & Lomb, Rochester, NY) was implanted in 23 eyes and the CZ70BD (Alcon, Fort Worth, TX) in 8 eyes, and all lenses were sutured 3 mm behind the limbus. Average postoperative spherical equivalent (SE) was -0.79±0.95 diopters (D). Average prediction error (postoperative SE refraction minus target refraction) was -0.19±0.72 D. Postoperative SE was within 1.0 D of target in 25 of 31 patients (81%) and 2.0 D of target in 31 of 31 patients (100%). The repeated-measures analysis of variance of absolute error by lens power formula was significant (P = 0.012), with Haigis demonstrating greater error. There was no significant difference among Barrett II, Sanders-Retzlaff-Kraff theoretical (SRK/T), Holladay 2, or Hoffer Q.

CONCLUSIONS

For eyes undergoing pars plana vitrectomy with scleral-sutured IOL implantation, assumption of in-the-bag IOL position when calculating lens power leads to acceptable refractive outcomes. Barrett II, SRK/T, Holladay 2, and Hoffer Q formulas were noninferior to each other.

Outcomes of intraocular lens scleral fixation with the friction knot technique

PURPOSE

To examine the clinical outcomes of intraocular lens (IOL) scleral fixation with the friction knot technique.

METHODS

Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot IOL scleral fixation technique by a single surgeon. The fixated IOLs were one-piece or three-piece models all with open loop haptics. Main outcome measures were change in corrected distance visual acuity (CDVA) and postoperative complications.

RESULTS

The mean follow-up time was 11.7 months (median 4.9, range 0.7-64.8). The mean logarithm of the minimum angle of resolution CDVA improved from preoperative 0.77 ± 0.73 (Snellen 20/118 ± 7.3 lines) to 0.44 ± 0.56 (Snellen 20/55 ± 5.6 lines) at the final visit (p < 0.001). The main postoperative complications were ocular hypertension (30.3%), uveitis-glaucoma-hyphaema syndrome (12.5%; UGHS), vitreous haemorrhage (11.2%) and retinal detachment (8.6%). Two (1.3%) cases of suture breakage were seen. In multivariate Cox regression analysis, age under 60 years [hazard ratio (HR) = 5.41; 95% confidence interval (CI) 1.95-15.01] and scleral fixated one-piece IOL (HR = 4.23; 95% CI 1.44-12.44) were found as significant independent risk factors for developing new UGHS.

CONCLUSION

The friction knot technique provides a firm scleral fixation. Scleral fixation may successfully be utilized in dislocated three-piece IOLs with loop haptics. We recommend avoiding scleral fixation of one-piece IOLs in young patients due to a high risk of UGHS.

Opacification of Akreos Hydrophilic Acrylic Lens After Retinal Detachment Repair with Silicone Oil Tamponade: A Case Report

We report localized opacification of a sclera-fixated Akreos^® hydrophilic acrylic intraocular lens after successful repair of rhegmatogenous retinal detachment with silicone oil tamponade in a nondiabetic patient. No intraoperative lens opacification during air-fluid exchange or lens dislocation was encountered. Granular opacities within the optic were noted at 5 months after surgery, and did not relent to scrubbing with a vitrector during oil removal. Akreos lens opacification under silicone oil is not well documented in the literature. Surgeons must be aware of this potential complication, which is known to occur with various types of hydrophilic acrylic lenses after exposure to air or gas.

Refractive Outcomes after Pars Plana Vitrectomy and Scleral Fixated Intraocular Lens with Gore-Tex Suture

PURPOSE

To evaluate refractive outcomes after combined pars plana vitrectomy (PPV) and scleral fixation of an intraocular lens (IOL) using Gore-Tex suture.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Fifty-five eyes from 53 patients who underwent PPV with a Gore-Tex sutured IOL from June 2013 through December 2017.

METHODS

Patients who underwent combined PPV and scleral fixation of an IOL with Gore-Tex suture were identified. All eyes underwent scleral fixation of either an Akreos A060 or enVista MX60 IOL and were fixated either 2 mm or 3 mm posterior to the limbus. Postoperative manifest refractions were performed at least 3 months after surgery and were compared with preoperative predicted target refraction based on in-the-bag IOL calculations. Subgroup analyses based on sclerotomy placement and IOL models were performed.

MAIN OUTCOME MEASURES

Postoperative manifest refraction and difference with sclerotomy placement and IOL model.

RESULTS

The mean postoperative spherical equivalent (SEQ) was -0.99±1.00 diopters (D). The mean difference in SEQ (ΔSEQ) from preoperative predicted target was -0.64±1.00 D. The IOL was fixated 2 mm posterior to the limbus in 14 eyes and 3 mm in 41 eyes. Within these 2 subgroups, the mean postoperative SEQ was -1.53±1.35 D for fixation 2 mm posterior to the limbus and -0.82±0.83 D for fixation 3 mm posterior to the limbus (P = 0.09). The mean ΔSEQ was -0.43±0.71 D for fixation 3 mm posterior to the limbus and -1.35±1.32 D for fixation 2 mm posterior to the limbus (P = 0.03). The mean amount of surgically induced astigmatism in the overall cohort was 0.77±0.65 D. The mean ΔSEQ and induced astigmatism were similar between IOL models.

CONCLUSIONS

After combined PPV and Gore-Tex-sutured IOL implantation, mean postoperative refractive outcomes were more myopic when the IOL was fixated 2 mm from the limbus compared with 3 mm from the limbus. No significant difference was found between IOL models. Based on these results, future implant power calculations may be adjusted to approximate preoperative target refraction more accurately.

Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture

Purpose

To report the visual outcomes and complications of scleral fixated intraocular lenses (IOLs) using Gore-Tex suture.

Methods

The current study is a retrospective noncomparative case series including patients who underwent scleral fixation of IOL (Akreos AO60) using Gore-Tex suture from August 2015 to March 2017 at a university teaching center. Primary outcome measures were visual acuity and complications at last follow-up.

Results

The current study included 49 eyes of 48 patients. Mean follow-up duration postsurgery was 6.9 months (range: 0.9–29.4 months). The indications for secondary IOL surgery were dislocated IOL in 16/49 (33%), subluxed IOL in 9/49 (18%), dislocated or subluxed crystalline lens in 9/49 (18%), traumatic cataract in 8/49 (16%), and complicated cataract surgery in 7/49 (14%). Mean best-corrected logMAR visual acuity improved from 1±0.7 (20/200 Snellen equivalent) preoperatively to 0.5±0.5 (20/63 Snellen equivalent) at last follow-up. There were no intraoperative complications noted. Early postoperative complications included significant persistent corneal edema (longer than 1 week) in 4/49 (8.2%), ocular hypertension (intraocular pressure ≥25 mmHg) in 8/49 (16.3%), hypotony (intraocular pressure ≤5 mmHg) in 6/49 (12.2%), cystoid macular edema 3/21 (6.1%), IOL tilt 2/49 (4.1%), hyphema in 2/49 (4.1%), and vitreous hemorrhage in 5/49 (4.8%). There was one case of recurrent retinal detachment. One patient presented with an erosion of the Gore-Tex suture through the conjunctiva resulting in a purulent scleritis 6 months after the initial surgery, and was managed with removal of the IOL, debridement, and cryotherapy. Forty-one of 49 patients completed 3-month follow-up, among which visual acuity improved, deteriorated, or remained same compared to baseline in 27/49 (55.1%), 8/49 (16.3%), and 6/49 (12.2%) eyes, respectively.

Conclusion

In the current study, visual acuity outcomes were generally favorable. The complications were largely transient. Significant complications included a suture-related infection, which required removal of the IOL, and a recurrence of a retinal detachment.