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Chen L, Wang Z, Sun L, Tang Y, Sui W, Bian A, Zhang X, Zhong Y, Zhang S. Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique. BMC Ophthalmol 2023; 23:481. [PMID: 37996816 PMCID: PMC10668428 DOI: 10.1186/s12886-023-03235-2] [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: 09/23/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND IOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags. METHODS A bent 30-gauge needle threaded with 8 - 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 - 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment. RESULTS UCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks. CONCLUSIONS We presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.
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Affiliation(s)
- Lulu Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Zaowen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China.
| | - Lu Sun
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Yongxiang Tang
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, 563000, Zunyi, Guizhou, China
| | - Wenda Sui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
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Jin H, Zhang Q. Flapless Intrascleral Knotting Technique for Suture Fixation of Intraocular Implants. Retina 2023; 43:1031-1034. [PMID: 32568983 DOI: 10.1097/iae.0000000000002895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We will describe a flapless/grooveless/pocketless and minimally invasive technique for scleral suture fixation of intraocular implants. METHODS After introducing the suture into the eye, the two ends of the suture were left exterior to the globe, the free end and the end connected to a curved needle (the needle side). A back-and-forth intrascleral suture passage was performed with the aid of a curved needle. The suture was thus supported by adequate scleral tissue. The suture was fixated to the sclera by knotting it into the sclerotomy. The ends of the suture were finally anchored intrasclerally with the aid of a 30-gauge needle. RESULTS The technique was used in 15 eyes of 15 patients. The mean postoperative follow-up period was 9.1 ± 4.6 months. Postoperatively, the intraoperative lenses of all the eyes remained well-positioned and stable. The postoperative visual acuities for all of the eyes were also improved. No suture erosion, suture loosening, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. CONCLUSION The present technique provides minimal surgical invasion for the scleral suture fixation of intraocular implants.
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Affiliation(s)
- Haiying Jin
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated to Shanghai Tongji University, School of Medicine, Shanghai, China; and
| | - Qi Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Intrascleral sewing-machine technique: A Grooveless/flapless cyclopexy technique for large traumatic Cyclodialysis cleft repairs in pars plana vitrectomy. Retina 2023; 43:152-157. [PMID: 32134801 DOI: 10.1097/iae.0000000000002772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To describe a minimally invasive technique for the repair of large traumatic cyclodialysis clefts using intrascleral sewing machine suture and overhand friction knot techniques in pars plana vitrectomy. METHODS This prospective, noncomparative, interventional case series included seven eyes of seven patients with a large traumatic cyclodialysis cleft. The sewing machine technique was modified by an intrascleral approach. The procedure was transconjunctival or subconjunctival performed without scleral flaps/grooves. An overhand friction knot was used to lead the cutting ends of the suture buried in the scleral tunnel. RESULTS The closure of the cyclodialysis cleft was achieved in seven eyes. The mean follow-up duration was 49.1 ± 15.6 weeks (range, 30-70 weeks). The intraocular pressure increased from 7.3 ± 2.1 mm Hg (range, 5-11 mmHg) preoperatively to 13.6 ± 2.4 mm Hg (range, 10-17 mmHg) postoperatively ( P < 0.01). The best-corrected visual acuity improved from a mean of 2.76 ± 2.77 logarithm of the minimum angle of resolution preoperatively to 0.63 ± 0.82 logarithm of the minimum angle of resolution at the final follow-up ( P < 0.01). CONCLUSION In conclusion, the present technique is safe and effective in the treatment of large traumatic cyclodialysis clefts with minimal surgical trauma and a decreased surgical duration.
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Single-string, Closed-loop Fixation Technique as a Modified Approach to Repositing a Dislocated Triple-looped Haptic Intraocular Lens: Local Experience. J Cataract Refract Surg 2022; 48:859-862. [PMID: 35546428 DOI: 10.1097/j.jcrs.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT A technique using the single-string, closed-loop fixation method to reposit dislocated triple-looped haptic IOL-capsular bag complexes is described. The long needle or curved needle with 10-0 / 8-0 polypropylene suture and 27 / 30g needle were used as the guide needle to pass through the fenestrated haptics for two times. The scleral interlaminar course was used as the fixed point. last, A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached needle.Four eyes from 4 consecutive patients were studied retrospectively; During all follow-up visits, the IOLs were well centered and stable, No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed.
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Intraocular Suture Looping Technique for Flapless Four-Point Refixation of Dislocated Intraocular Lenses. J Ophthalmol 2021; 2021:6648777. [PMID: 33628477 PMCID: PMC7884157 DOI: 10.1155/2021/6648777] [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: 12/01/2020] [Revised: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe a flapless/grooveless technique for four-point refixation of a dislocated intraocular lens (IOL) with four fenestrated haptics. Methods An intraocular suture looping technique was performed with the assistance of two 27-gauge needles. A looping needle was passed into the eye through paracentesis and was used to loop both fenestrated haptics on the same side with an 8-0 polypropylene thread. A guiding needle was used to guide the looping needle out of the eye at the scleral fixation sites. After looping each pair of fenestrated haptics on nasal/temporal sides with 8-0 polypropylene sutures, the IOL was refixated by definitive knotting. The exterior suture ends were buried into the sclera without the creation of scleral flaps/grooves. Results The technique was employed in four eyes (three patients). The mean postoperative follow-up period was 13.8 ± 2.2 months. Postoperatively, the IOLs of all the eyes remained well positioned and stable. The postoperative visual acuities of all the eyes were improved. No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. Conclusion The present technique provides minimal surgical invasion for the transscleral refixation of a dislocated IOL with four fenestrated haptics.
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Intrascleral Suture Anchoring: A Flapless/Grooveless Four-Point Intraocular Lens Fixation Technique. J Ophthalmol 2020; 2020:6642007. [PMID: 33343934 PMCID: PMC7727019 DOI: 10.1155/2020/6642007] [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: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose We describe a minimally invasive suture fixation technique for four-point fixation of intraocular lenses (IOLs) in the treatment of aphakic eyes, namely, the intrascleral suture anchoring technique. Neither scleral flaps nor large conjunctival dissections are required. Methods This study included 11 eyes (11 patients). After looping the eyelets on the IOL haptics and externalizing the threads, the curved needle attached to the externalized thread was started with two sequential intrascleral passes from the first fixation point to reach the second fixation point. The same procedure was performed for the other side of the IOL. A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached curved needle. Results The mean postoperative follow-up period was 9.7 ± 5.8 months (range 5-15 months). The IOLs of all eyes remained well positioned and stable postoperatively. The postoperative visual acuities were improved. No suture erosion, suture loosening, hypotony, scleral atrophy, chronic inflammation, retinal tear, and/or detachment were observed within the follow-up period. Conclusion The present technique is an alternative, flapless method for the four-point suture fixation of IOLs. It provides both minimal surgical trauma and reliable stability.
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