Repositioning of the Dislocated Intraocular Lens With Sutureless 20-Gauge Vitrectomy

Scleral fixation of intraocular lenses

PURPOSE OF REVIEW

To review current, effective and more popular techniques for scleral fixation of intraocular lens (IOLs) and IOL-capsular bag complex.

RECENT FINDINGS

Scleral fixation of IOLs became popular, originally with sutured scleral fixated IOLs and later the Scharioth technique of intrascleral haptic fixation. This was further developed as the Glued IOL technique which enjoys widespread adoption all over the world. Recently the Yamane technique has also become popular and is being widely adopted as well.

SUMMARY

Scleral fixated IOLs have evolved in the last 2 decades with technical modifications, extended indications and improvised instrumentation. Though sutured and sutureless techniques have been growing equally, the sutureless scleral fixation techniques have attracted special interest. Reduced suture-related complications, technical ease and high-quality functional outcomes may be possible reasons. Sutureless capsular bag fixation also has distinct advantages.

Glued intrascleral haptic fixation of an intraocular lens

Glued intrascleral haptic fixation of an intraocular lens (glued IOL) has evolved as a technique with various modifications that are adopted and practiced by several surgeons. With adequate and appropriate haptic tuck, glued IOL imparts a stable IOL fixation and is a secured method of secondary IOL placement with no pseudophacodonesis.

SURGICAL OUTCOME OF SIMULTANEOUS INTRAOCULAR LENS RESCUE AND SUTURELESS INTRASCLERAL TUNNEL FIXATION OF DISLOCATED INTRAOCULAR LENSES

PURPOSE

To report short-term surgical outcomes of single-stage simultaneous rescue and sutureless intrascleral fixation of dislocated intraocular lens (IOLs).

METHODS

Sixteen eyes of 16 patients who underwent simultaneous rescue and intrascleral fixation of dislocated 3-piece IOLs were retrospectively evaluated. Partial thickness limbal-based scleral flaps (2.0 × 2.0 mm) were created, and a 22-gauge round needle was used to create a sclerotomy at 1.5 mm from the limbus under the previously created scleral flap, and a 23-gauge trans pars plana vitrectomy was performed. Bimanual maneuvers using two 23-gauge end-grasping forceps under chandelier illumination and a wide-angle viewing system enabled 1 step rescue of IOLs from the posterior vitreous cavity with 1 hand and simultaneous haptic externalization through sclerotomy with the other hand. An externalized haptic was placed into the 3-mm intrascleral tunnel created using a bent 26-gauge needle. Fibrin glue was used to fixate haptics and close the scleral flaps.

RESULTS

Intraocular lenses were successfully rescued and sclera-fixated through intrascleral tunnels in all 16 eyes (mean age, 56.56 ± 19.89 years). The mean preoperative logarithm of the minimum angle of resolution best-corrected visual acuity was 0.92 ± 0.68, and this significantly improved at 6 months to 0.289 ± 0.36 (P = 0.003). During the follow-up period (10.1 ± 3.21 months), no significant change of endothelial cell count or central foveal thickness was noted postoperatively (P = 0.203 and P = 0.979, respectively). There were no significant postoperative complications such as IOL dislocation, IOL decentration, retinal detachment, endophthalmitis, or postoperative hypotony.

CONCLUSION

Simultaneous rescue and sutureless intrascleral haptic fixation of dislocated 3-piece IOLs using bimanual maneuvers is an effective, safe, and minimally invasive surgical method to rescue and fixate the dislocated IOL without further explant.

Modification of externalized haptic support of glued intraocular lens technique

The original technique for scleral fixation of an intraocular lens using fibrin glue requires an assistant to grasp and hold an externalized haptic with forceps. We present a modification of the technique in which the externalized haptic is maintained by a silicone "tire" without the aid of an assistant.

Glued intrascleral fixation of posterior chamber intraocular lens in children

PURPOSE

To evaluate the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular support.

DESIGN

Noncomparative retrospective observational case series.

PATIENTS

SETTING

Institutional practice.

METHODS

Forty-one eyes of 33 children who underwent glued IOL implantation were retrospectively evaluated. The indications were postsurgical aphakia, subluxated cataract, ectopia lentis, traumatic subluxation, and decentered IOL.

MAIN OUTCOME MEASURES

Visual acuity (VA), endothelial cell changes, intraoperative and postoperative complications.

RESULTS

The mean age at the time of glued IOL was 10.7±3.6 years (range 5-15). The mean duration of follow-up after surgery was 17.5±8.5 months (range 12-36). The mean postoperative best spectacle-corrected visual acuity (BCVA in decimal equivalent) was 0.43±0.33 and there was significant change noted (P<0.001). Postoperatively, 20/20 and >20/60 BCVA was obtained in 17.1% and 46.3% of eyes respectively. BCVA improvement more than 1 line was seen in 22 eyes (53.6%). The mean postoperative refraction was myopic (-1.19±0.7 diopters [D]) in 19 eyes and hyperopic (+1.02±0.7 D) in 22 eyes. The mean endothelial loss was 4.13% (range 1.3%-5.94%). The 3 causes of reduced BCVA were the preexisting corneal, retinal pathology, and amblyopia. Postoperative complications included optic capture in 1 eye (2.4%), macular edema in 2 eyes (4.8%), and clinical decentration in 2 eyes (4.8%). There was no postoperative retinal detachment, IOL dislocation, endophthalmitis, or glaucoma.

CONCLUSION

Short-term results in children after glued IOL were favorable, with a low rate of complications. However, regular follow-ups are required since long-term risks are unknown.

Fibrin glue-assisted fixation of decentered posterior chamber intraocular lens

OBJECTIVE

To report the feasibility and outcome of the technique of glue-assisted fixation of decentered posterior chamber intraocular lens (PCIOL) in the posterior chamber using the same IOL.

METHODS

The procedure was performed in three eyes having decentered PCIOL with inadequate capsular rim to support the IOL. The haptics were exteriorized under a partial thickness scleral flap at 1.5 mm behind the limbus and placed into a partial thickness scleral pocket and fixed with fibrin glue. No suture was placed at any site.

RESULTS

On day 1 and at 6 weeks, the IOLs were well centered. There was no significant anterior or posterior segment inflammation, and the intraocular pressure was normal.

CONCLUSION

Fibrin glue-assisted fixation of PCIOL is a feasible technique with good outcome in eyes with decentered IOL with inadequate capsular support.

Glued intraocular lens implantation for eyes with defective capsules: A retrospective analysis of anatomical and functional outcome

PURPOSE

To analyze the anatomical and functional outcome of glued intra ocular lens (IOL) implantation technique and its modifications.

DESIGN

Retrospective observational case series.

METHODS

This is a retrospective analysis of the patients who underwent glued intra ocular lens implantation from December 2007 to August 2010. Post operative uncorrected vision, best corrected visual acuity (BCVA), intra ocular pressure, IOL position, endothelial cells and anterior chamber reaction at their last follow up are analyzed from their concerned case sheets documentation. Subjective changes are analyzed via individual questionnaire. Immediate and late postoperative complications are also evaluated. Surgical modifications and the difference in the operated eyes are analyzed.

RESULTS

Total 210 glued IOL eyes have been reviewed. Out of this 210, there are 152 (PMMA glued IOL), 21 (three piece foldable IOL), 5 (multifocal foldable IOL), 12 (pediatric glued IOL), 5 (20G sutureless vitrectomy), 2 (glued iris prosthesis) and 3 (transposition of posterior chamber IOL into anterior chamber). In combined surgeries there are, 5 (optical penetrating keratoplasty), 2 (descemet's stripping endothelial keratoplasty) and 3 (iridoplasty). The modifications in glued IOL are handshake technique, injectable or foldable glued IOL, Multifocal glued IOL and intraoperative 23/25G trocar cannula infusion. Decentration (1.97%), macular edema (1.97%) and optic capture (2.63%) are the post operative complications encountered in rigid glued IOL. Good patient satisfaction is seen in the eyes with IOL repositioning, IOL exchange and multifocal glued IOL. There is significant improvement in BCVA in PMMA IOL (p = 1.35 × 10(-5)) and foldable IOL (p = 0.000).

CONCLUSION

Glued IOL seems to be a good alternative in IOL implantation in eyes with deficient capsules. The modifications in the existing technique decrease the learning time and risk for complications.

Repositioning a dislocated intraocular lens in the ciliary sulcus using 23-gauge sutureless pars plana vitrectomy

Intraocular lens (IOL) dislocation is a common complication of phacoemulsification. We describe a technique for retrieving a dislocated IOL using 23-gauge transconjunctival sutureless pars plana vitrectomy and repositioning the IOL in the ciliary sulcus in cases with adequate capsule support. This technique provides the benefits of sutureless surgery despite the complication of a dislocated IOL.