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Boz AAE, Atum M, Özmen S, Yuvacı İ, Çelik E. Comparison of three different intraocular lens implantation techniques in the absence of capsular support: sutured scleral, haptic flanged intrascleral, and four flanged intrascleral fixations. Int Ophthalmol 2023; 43:5045-5053. [PMID: 37851141 DOI: 10.1007/s10792-023-02907-8] [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: 02/12/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION After lens extraction, if the capsular bag insufficiency occurs, there are different IOL implantation techniques. IOL implantation in the posterior chamber is safer in eyes with low endothelial cell count, peripheral anterior synechiae, shallow anterior chamber, and glaucoma. Alternative approaches for scleral fixation techniques, both with and without sutures, continue to undergo development. In this study, we aimed to compare the postoperative outcomes of the sutured scleral fixation (SSF), haptic flanged intrascleral fixation (HFISF) and four flanged intrascleral fixation (FFISF) IOL implantation techniques in eyes with the absence of capsular support. MATERIALS AND METHODS A hundred and thirty-seven aphakic eyes with the absence of capsular support were included in the study. The patients were divided into three groups: group 1-SSF, group 2-HFISF (Yamane technique), and group 3-FFISF. Surgical time in minutes, preoperative and postoperative parameters such as best corrected visual acuity (BCVA), corneal astigmatism, lenticular astigmatism, intraocular pressure (IOP), specular microscopy, central macular thickness (CMT) were recorded. Pseudophacodonesis was assessed at 6 months postoperatively using a slit lamp, and early and late complications were recorded. RESULTS Of the 137 eyes, 69 eyes were included in the SSF group, 41 eyes in the HFISF group, and 27 eyes in the FFISF group. No statistically significant differences were observed among the three groups in terms of age, gender, preoperative mean BCVA, corneal astigmatism, IOP, endothelial cell density, and CMT. It was observed that the mean BCVA significantly improved compared to the preoperative visual acuity in all three groups. Postoperative lenticular astigmatism, pseudophacodonesis score, percentage of the endothelial cell loss were found to be higher in FFISF groups. The surgical time was found to be shorter in the HFISF group. IOL decentration was observed in 1.44% of the SSF group and 7.40% of the FFISF group. Cystoid macular edema was observed in 5.79% of the SSF group, 4.87% of the HFISF group, and 7.40% of the FFISF group. Retinal detachment was observed in 1.44% of the SSF group and 7.31% of the HFISF group. CONCLUSIONS The optimal technique for treating aphakia without capsular support remains uncertain. Surgeons are tasked with a complex decision, aiming for both excellent vision and minimal risk. This decision is based on their expertise, the distinctive ocular condition of the patient, and the availability of essential operating room equipment. In this study, the following findings were observed: in the HFISF technique, the average surgical time was found to be shorter, the SSF technique demonstrated greater stability in terms of astigmatism and pseudophacodonesis and the FFISF technique was recognized for its relatively straightforward application method. It is important to note that the three IOL implantation techniques yielded comparable outcomes in terms of postoperative BCVA, as well as early and late complications.
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Affiliation(s)
- Ali Altan Ertan Boz
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey.
| | - Mahmut Atum
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Sedat Özmen
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - İsa Yuvacı
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
| | - Erkan Çelik
- Sakarya University Training and Research Hospital, Korukent Sitesi Mimoza 1/12 Korucuk Adapazarı, Sakarya, Turkey
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Wang Y, Zhou L, Bao X, Peng T, Lei R, Ortega-Usobiaga J. Four-Point Flange Intrascleral Fixation With Double Suture Through the Dislocated Plate-Haptic Trifocal Intraocular Lens. Am J Ophthalmol 2023; 255:68-73. [PMID: 37354926 DOI: 10.1016/j.ajo.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To describe a technique for the replacement of dislocation of plate-haptic trifocal intraocular lens (IOL) through double-suture 4-point flange intrascleral fixation. DESIGN Retrospective, interventional, noncomparative, case series. METHODS A total of 7 eyes of 7 patients with a dislocated plate-haptic trifocal IOL were enrolled for 4-point flange intrascleral fixation with double 7-0 polypropylene suture. Preoperative and postoperative visual acuity, operating time, refractive results, postoperative IOL tilt and decentration, and intraoperative and postoperative complications were recorded. RESULTS The mean postoperative uncorrected distance visual acuity (UDVA) was 0.05 ± 0.06 logarithm of the minimum angle of resolution (logMAR). The mean postoperative uncorrected intermediate visual acuity (UIVA) at 80 cm was 0.09 ± 0.06 logMAR and the mean postoperative uncorrected near visual acuity (UNVA) at 40 cm was 0.06 ± 0.07 logMAR. The mean postoperative residual spherical equivalent values were -0.27 ± 0.39 diopters. The visual function index-14 questionnaire showed that no difficulty was found in >80% of subjects for all tasks. The mean surgical time was 16.23 ± 5.64 min. The mean tilt of IOL was 3.74° ± 1.31° and the mean decentration of the IOL was 0.18 ± 0.09 mm. No important complications appeared. CONCLUSION We have described the technique of 4-point flange intrascleral fixation for plate-haptic trifocal IOL.
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Affiliation(s)
- Yong Wang
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Li Zhou
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Xianyi Bao
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Tingting Peng
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Rong Lei
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Julio Ortega-Usobiaga
- Department of Cataract and Refractive Surgery (J.O-U.), Clínica Baviera (Aier Eye Hospital Group), Bilbao, Spain
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Khoramnia R, Baur ID, Auffarth GU. Aetiology and Management of IOL Dislocations. Klin Monbl Augenheilkd 2023; 240:971-980. [PMID: 37494272 DOI: 10.1055/a-2074-9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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Cui Y, Li Q, Shi X, Zhou D. A comparative study of transscleral sutured intraocular lens fixation and sutureless flanged intraocular lens fixation. BMC Ophthalmol 2023; 23:23. [PMID: 36650453 PMCID: PMC9843930 DOI: 10.1186/s12886-023-02782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To compare the intraocular lens (IOL) tilt and decentration and visual outcomes of transscleral sutured IOL fixation and sutureless flanged IOL fixation. To investigate the influence of IOL tilt and decentration on internal higher-order aberrations (HOAs) in these two techniques. METHODS Patients who received transscleral sutured or sutureless flanged IOL fixation procedures were included in this prospective, non-randomized, comparative study. Corrected distance visual acuity (CDVA) was measured at baseline and at every postoperative visit for 12 months. IOL tilt and decentration were measured using a second-generation anterior segment optical coherence tomography (Casia2) and internal HOAs were measured using iTrace Visual Function Analyzer at 3 months postoperatively. RESULTS The study included 27 eyes from the transscleral sutured IOL fixation group and 26 eyes from the sutureless flanged IOL fixation group. There was no significant difference in CDVA between the two groups at all time points. The two groups did not differ in refractive difference from the predicted value, corneal endothelial cell loss, IOL tilt, IOL decentration, internal astigmatism or internal HOAs. Vertical IOL decentration significantly correlated with total internal optical aberration (r = 0.288, P = 0.036), total internal HOA (r = 0.440, P = 0.001), internal coma (r = 0.348, P = 0.001), vertical internal coma (r = 0.388, P = 0.004), average height of modulation transfer function (r = - 0.364, P = 0.007) and Strehl ratio (r = - 0.297, P = 0.031). Horizontal IOL decentration significantly correlated with horizontal internal coma (r = 0.312, P = 0.023). CONCLUSIONS Transscleral sutured IOL fixation and sutureless flanged IOL fixation had similar IOL positions and visual outcomes. IOL decentrations correlated with internal HOAs and thus should be avoided.
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Affiliation(s)
- Ying Cui
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Qiyan Li
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Xiangyu Shi
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Dan Zhou
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
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Yuan A, Mustafi D, Banitt MR, Rezaei KA. Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses. Graefes Arch Clin Exp Ophthalmol 2022; 260:2887-2895. [PMID: 35389059 DOI: 10.1007/s00417-022-05647-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report the long-term refractive outcomes and complications of two scleral fixation techniques for secondary intraocular lenses (IOL). METHODS Consecutive patients who underwent secondary IOL insertion at a tertiary care academic hospital using either modified glued ("glued") or flanged intrascleral haptic fixation (FISHF) techniques with over 12 months of follow-up were retrospectively reviewed. Pre- and postoperative corrected distance visual acuity (CDVA), postoperative complications, and refractive surprises were reported. RESULTS Thirty-eight patients underwent "glued" fixation and 22 underwent FISHF, with mean follow-up times of 3.1 ± 0.5 and 2.0 ± 1.2 years, respectively. Aphakia secondary to trauma was the main surgical indication. MA50BM or MA60AC IOLs (Alcon Laboratories Inc., Fort Worth, TX) were implanted in 92% of "glued" patients, while CT Lucia 602 IOLs (Carl Zeiss Meditec Inc., Dublin, CA) were used in 96% of FISHF patients. Postoperative spherical equivalent significantly improved compared to preoperative values (p < 0.001). No significant difference in CDVA was seen between the two techniques. FISHF resulted in mean hyperopic surprises of + 0.81D and + 0.69D using the Holladay 2 and Barrett Universal II formulae, respectively, which was significantly greater than the "glued" patients. A higher rate of IOL dislocation was seen in the "glued" cohort (13%) compared to FISHF (0%). CONCLUSIONS Retrospective long-term outcomes of patients with complex ocular comorbidities undergoing a modified "glued" technique demonstrated a higher rate of IOL dislocation but more predictable refractive outcomes compared to the FISHF technique. The FISHF technique resulted in a significant hyperopic shift using fourth-generation IOL calculators.
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Affiliation(s)
- Amy Yuan
- Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA
| | - Debarshi Mustafi
- Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA
| | | | - Kasra A Rezaei
- Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA.
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Sinha R, Asif MI, Kalra N, Bansal M, Chauhan D, Shekhar H, Sharma N, Titiyal JS. Long-term Outcomes of Fibrin Glue-Assisted Intrascleral Haptic Fixation of Posterior Chamber Intraocular Lenses in Children. Eye Contact Lens 2022; 48:33-37. [PMID: 34483244 DOI: 10.1097/icl.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the long-term outcomes of intrascleral haptic fixation of posterior chamber intraocular lens (PCIOL) with fibrin glue in children. METHODS This is a retrospective case study conducted in a tertiary eye institute in North India. A total of 118 eyes of 82 children who underwent glued intrascleral haptic fixation of PCIOLs were retrospectively analyzed. Detailed analysis of the indication for surgery and ocular and systemic associations was performed. The outcome measures included intraoperative complications, final visual and refractive outcomes, and postoperative complications. RESULTS The mean age of the patients was 10.16±3.94 years. Fifty-one patients (62.2%) were male and 31 (37.8%) were female. The mean follow-up period was 31.28±13.22 months. The mean preoperative corrected distance visual acuity was 1.18±0.63 Logarithm of Mean angle of resolution (logMAR) which improved to 0.60±0.58 logMAR postoperatively at 6 weeks (P<0.001). The mean preoperative and 6 weeks postoperative endothelial cell density were 3,176.08±318.6 and 2,936±289.9 cells/mm2, respectively (P=0.23). In the immediate postoperative period, corneal edema (19 eyes; 16.1%), decentered IOL/tilt (3 eyes; 2.54%), vitreous hemorrhage (3 eyes; 2.54%), optic capture (4 eyes; 3.38%), and hypotony (2 eyes; 1.69%) were seen. In the late postoperative period (>6 weeks), retinal detachment was observed in two eyes that had associated Marfan syndrome. Cystoid macular edema was seen in four eyes (3.38%), and glaucoma was seen in five eyes (4.23%). CONCLUSIONS Fibrin glue-assisted intrascleral haptic fixation of a PCIOL is a safe and effective method to manage aphakia with inadequate capsular support in children.
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Affiliation(s)
- Rajesh Sinha
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Gabai A, Zeppieri M, Toneatto G, Salati C. Enhanced surgical technique for sutureless intrascleral fixation of intraocular lenses. J Cataract Refract Surg 2021; 47:e75-e79. [PMID: 34016822 DOI: 10.1097/j.jcrs.0000000000000700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023]
Abstract
A simplified intrascleral fixation technique involving implantation of the Carlevale intraocular lens (IOL) in the posterior chamber is described, which lodges the T-shaped IOL haptics in the scleral wall, not requiring scleral flaps. This surgical modification reduces operative time, limits iatrogenic damage to the sclera, and avoids friction between haptics and the conjunctiva, which may cause conjunctival erosion and infection in the long term. 13 patients with crystalline lens or IOL dislocation/subluxation had surgery to implant the Carlevale IOL in the posterior chamber. Mean corrected distance visual acuity preoperatively was 0.75 ± 0.5 logMAR (range, 0.2 to 1.5 logMAR) and improved to 0.28 ± 0.3 logMAR (range, 0 to 1.0 logMAR) postoperatively. Complications rarely occurred and were not sight-threatening. The sutureless scleral fixation of the Carlevale IOL using the modified surgical technique may represent a safe and effective procedure to restore visual function in patients with damaged zonular-capsular support.
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Affiliation(s)
- Andrea Gabai
- From the Department of Ophthalmology, University Hospital of Udine, Udine, Italy
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Sun Y, Hammer M, Yildirim TM, Khoramnia R, Auffarth GU. Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation. Sci Rep 2021; 11:21436. [PMID: 34728749 PMCID: PMC8564516 DOI: 10.1038/s41598-021-01051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
An Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.
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Affiliation(s)
- Yanxiu Sun
- Department of Ophthalmology, Peking University Third Hospital, Northgarden Road 49, Haidian District, Beijing, 100191, China.,International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Maximilian Hammer
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur M Yildirim
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Shahid SM, Flores-Sánchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, Charteris DG. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond) 2021; 35:2930-2961. [PMID: 34117388 PMCID: PMC8526814 DOI: 10.1038/s41433-021-01571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/08/2022] Open
Abstract
Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.
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Affiliation(s)
- S M Shahid
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK.
| | | | - E W Chan
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - R Anguita
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - S N Ahmed
- Ophthalmology Department, Northampton General Hospital, Cliftonville, Northampton, UK
| | - L Wickham
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - D G Charteris
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
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Adjustment of intraocular lens tilt during intrascleral fixation assisted by intraoperative OCT. J Cataract Refract Surg 2021; 47:1308-1313. [PMID: 34544086 DOI: 10.1097/j.jcrs.0000000000000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/04/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the efficacy of using intraoperative optical coherence tomography (iOCT) to adjust the tilting of an intraocular lens (IOL) during implantation with intrascleral fixation. SETTING Kyorin University Hospital, Tokyo, Japan. DESIGN Retrospective, case-control, single-center study. METHODS Thirty-seven eyes of 37 patients who had undergone pars plana vitrectomy with intrascleral fixation of an IOL by a single surgeon were retrospectively studied. The length of the externalized haptics was determined when the anterior surface of the IOL was parallel to the plane of the iris as observed by iOCT. The maximal IOL tilt relative to the visual axis and to the iris plane was measured by anterior segment OCT (CASIA2; Tomey Corp.). RESULTS Intraoperative crosssectional OCT (RESCAN 700: Carl Zeiss Meditec AG) scans were used to adjust the degree of IOL tilt in 23 eyes (iOCT group) and not used in 14 eyes (control group). The maximal angle of IOL tilt relative to the visual axis was significantly smaller in the iOCT group than that in the control group (5.45 ± 2.63 degrees vs 10.38 ± 10.48 degrees, P = .034). The maximal angle of the IOL tilt to the iris plane was also significantly smaller in the iOCT group than that in the control group (4.58 ± 1.86 degrees vs 9.60 ± 10.82 degrees; P = .040). The distance of decentration was greater in the iOCT group (0.56 ± 0.29 mm) than that of the control group (0.41 ± 0.41 mm, P = .005). CONCLUSIONS Intraoperative OCT can be used to adjust the degree of IOL tilt to reduce the lenticular astigmatism during intrascleral fixation surgery.
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Li Z, Lian Z, Young CA, Zhao J, Jin G, Zheng D. Accuracy of intraocular lens calculation formulas for eyes with insufficient capsular support. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:324. [PMID: 33708951 PMCID: PMC7944297 DOI: 10.21037/atm-20-3290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is no consensus on which intraocular lens (IOL) power calculation formula provides the best refractive prediction in patients with inadequate capsular support whose anterior ocular anatomic structure differs from that of normal subjects. Therefore, the purpose of this study was to analyze the accuracy and performance of IOL calculation formulas (SRK/T, Holladay 1, Hoffer Q, Haigis, and Barrett Universal II) in predicting postoperative refractive prediction error (PE) for this subgroup of patients. Methods A total of 110 eyes from 110 patients with insufficient capsular support who underwent scleral fixation of an IOL at the Zhongshan Ophthalmic Center from July 1, 2016 to November 30, 2019 were enrolled in this retrospective study. Preoperative optical biometrics were measured with the IOL Master 500 (Carl Zeiss, Oberkochen, Germany). The performance of each formula in predicting PE was compared, and the effect of keratometry and axial length (AL) on PE was evaluated for each formula using univariate and multivariate linear regression analysis. Results The mean age of the included participants was 12.54±9.66 years. The Sanders, Retzlaff, and Manus/theoretical (SRK/T) (-0.25 D) and Holladay 1 (-0.28 D) formulas tended to have minimal postoperative PE compared to the Hoffer Q (-0.62 D), Haigis (-0.67 D), and Barrett Universal II (-0.62 D) formulas (P=0.005). All formulas individually resulted in <70% of eyes within ±1.00 D of the PE. Nevertheless, after constants were optimized, these formulas led to 7.3% to 13.6% of increase within ±1.00 D of the PE. Keratometry and AL were significantly associated with PE for each formula, but the relationship was weakest for SRK/T. Conclusions In eyes with insufficient capsular support, postoperative PE was minimal for the SRK/T formula, which suggested SRK/T to be the best choice, especially when the keratometry and AL of patients are extremely large or small.
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Affiliation(s)
- Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhangkai Lian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, Third Affiliated Hospital, Nanchang University, Nanchang, China
| | - Jing Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Wong HM, Kam KW, Rapuano CJ, Young AL. A Systematic Review on Three Major Types of Scleral-Fixated Intraocular Lens Implantation. Asia Pac J Ophthalmol (Phila) 2021; 10:388-396. [PMID: 33481393 DOI: 10.1097/apo.0000000000000369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. DESIGN Systematic review. METHODS We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. RESULTS Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. CONCLUSIONS Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.
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Affiliation(s)
- Ho Ming Wong
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, US
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
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Kumar DA, Agarwal A, Ali WRK. Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation. Indian J Ophthalmol 2020; 67:1610-1616. [PMID: 31546491 PMCID: PMC6786213 DOI: 10.4103/ijo.ijo_20_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the visual outcome and complication profile after glued intraocular lens (IOL) in post uveitic eyes. Methods: Patients with history of uveitis who had glued IOL with 3 months antecedent quiet anterior chamber (AC) were included in this prospective observational case series. Visual acuity, slit-lamp examination, fundus evaluation, optical coherence tomography, intraocular pressure, specular count and AC inflammation were analyzed before and after glued IOL procedure. Glued IOL eyes were also compared with their fellow normal capsular bag IOL. Results: Overall 17 eyes (50.7 ± 16.1 years) were analyzed. It included 41.8%, 23.5%, and 35.29% anterior, posterior, and pan uveitis, respectively. The etiologies were tuberculosis (23.53%), toxoplasmosis (11.77%), Fuch's heterochromic cyclitis (5.88%), HLA B27 (11.77%), psoriatic arthritis (5.88%), Rheumatoid arthritis (5.8%), sarcoidosis (11.77%), herpetic kerato-uveitis (5.88%), and idiopathic (17.65%). Cataractous subluxated lens (35.3%), aphakia (23.5%), decentered IOL (23.5%) and intraoperative capsular rupture (17.6%) were the surgical indications. A significant improvement in the mean uncorrected and best corrected visual acuity (P < 0.001) was recorded. The complications were IOL pigment dispersion (47%), macular edema (41%), and epiretinal membrane (24%). There was significant rise in AC reaction on day 1 (P < 0.001) and normal AC was attained by 88.2% eyes at 6 months. AC inflammation reactivation was noted in 11.7% of eyes. Though inflammatory reactivation was similar to the normal IOL, macular edema was higher in glued IOL. Conclusion: Glued IOL can cause inflammation in uveitis eyes which can be managed medically with minimal complications.
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Affiliation(s)
- Dhivya Ashok Kumar
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Amar Agarwal
- Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
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Suzuki Y, Tando T, Adachi K, Kudo T, Nakazawa M. Modified Intraocular Lens Intrascleral Fixation Technique Using Two Vitrectomy Ports as Lens Haptic Fixation Sites. Clin Ophthalmol 2020; 14:1223-1228. [PMID: 32440088 PMCID: PMC7212690 DOI: 10.2147/opth.s247920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction We developed a new technique that uses two of the vitrectomy ports as intraocular lens (IOL) haptic fixation sites and compared that with a conventional T-fixation method. Methods A total of 33 eyes were retrospectively divided into the port-fixation (n=21) and conventional (n=12) groups. For the port-fixation group, supranasal and inferotemporal trocars (25-gauge) were placed in the center of a T-shaped lamellar scleral incision 2 mm from the corneal limbus and a supratemporal trocar at 3.5 mm. Following a vitrectomy, along with lens or IOL extraction as needed, the infusion cannula was changed from an inferotemporal to supratemporal trocar. The first IOL haptic and trocar were then simultaneously withdrawn from the eye by grasping with vitreoretinal forceps, with the same performed for the second IOL haptic and trocar, after which the infusion cannula was removed. In the conventional group, 2 T-shaped scleral incisions and three trocars were separately placed. Results Postoperatively, transient ocular hypotension and hypertension were observed in a few eyes in both groups. At 6 months after surgery, astigmatism was 1.71±1.13 D in the port-fixation group and 2.21±1.78 D in the conventional group (p=0.40, t-test). Conclusion This new technique may be effective because of the lower number of scleral wounds.
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Affiliation(s)
- Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Toshio Tando
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Kobu Adachi
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Takashi Kudo
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Mitsuru Nakazawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
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Somani SN, Moshirfar M, Shmunes KM, Ronquillo YC. Comparison and application of commercially available fibrin sealants in ophthalmology. Ocul Surf 2020; 18:418-426. [PMID: 32361085 DOI: 10.1016/j.jtos.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/03/2020] [Accepted: 04/16/2020] [Indexed: 01/07/2023]
Abstract
Fibrin glues carry many advantages over traditional suture as a tissue adhesive and have been increasingly used in a variety of ophthalmic procedures over the past 15 years. Several fibrin sealants are commercially available worldwide, each of which differs slightly in its composition and mechanism of delivery. The focus of our review is to briefly discuss the reported uses of fibrin in ophthalmic surgery and provide a broad overview of the properties associated with each commercially available fibrin sealant.
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Affiliation(s)
- Shaan N Somani
- Northwestern Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; Utah Lions Eye Bank, Murray, UT, USA; HDR Research Center, Hoopes Vision, Draper, UT, USA.
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Rastogi A, Kumar P, Dhiman S, Mishra M, Anand K, Bhardwaj A. Evaluation of functional outcome and stability of sutureless scleral tunnel fixated IOLs in children with ectopia lentis. Int J Ophthalmol 2020; 13:66-70. [PMID: 31956572 DOI: 10.18240/ijo.2020.01.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate functional outcome of sutureless scleral tunnel intraocular lens (SSTIOL) in children with crystalline lens subluxation of more than 7 clock hours. METHODS A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18y having >7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation. Primary outcome was improvement in best corrected visual acuity (BCVA) and secondary outcomes were assessment of intraocular lens (IOL) tilt using ultrasound biomicroscopy (UBM), mean change in astigmatism at last follow-up of 1y and associated complications. RESULTS The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45 (logMAR) respectively (P=0.001) at last follow-up. The mean astigmatism preoperatively and postoperatively was -4.17±2.69 D and -1.86±1.25 D respectively (P=0.011). Significant IOL tilt (>5 degrees) was present in 5 cases. The mean percentage endothelial loss was 3.65%±1.92%. The most serious complication encountered was retinal detachment seen in 2 cases. CONCLUSION SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection. We recommend caution in children having white-to-white distance >12 mm and presence of peripheral retinal degenerations.
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Affiliation(s)
- Anju Rastogi
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Prateek Kumar
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Shweta Dhiman
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Manisha Mishra
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Kamlesh Anand
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Ankita Bhardwaj
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
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Yusef YN, Yusef SN, Ivanov MN, Fokina ND, Alkharki L. [Methods of out-of-the-bag intraocular lens implantation]. Vestn Oftalmol 2019; 135:104-108. [PMID: 31393453 DOI: 10.17116/oftalma2019135031104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article reviews the main modern methods of out-of-the-bag IOL implantation. Literature data shows that the most pressing question to date is comparative assessment of retropupillary iris-claw lens implantation and trans-scleral posterior chamber IOL fixation.
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Affiliation(s)
- Yu N Yusef
- Research Institute of Eye Disease, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - S N Yusef
- Research Institute of Eye Disease, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - M N Ivanov
- Research Institute of Eye Disease, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N D Fokina
- I.M. Sechenov First Moscow State Medical University, Department of Ophthalmology, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - L Alkharki
- Research Institute of Eye Disease, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Li X, Ni S, Li S, Zheng Q, Wu J, Liang G, Xu W. Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis. Am J Ophthalmol 2018; 192:10-19. [PMID: 29750951 DOI: 10.1016/j.ajo.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). DESIGN Systematic review and network meta-analysis. METHODS The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. RESULTS A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. CONCLUSIONS Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.
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Affiliation(s)
- Xi Li
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Shuang Ni
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Shuyi Li
- Department of Ophthalmology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Qianyin Zheng
- Department of Ophthalmology, Taizhou Hospital, Taizhou, Zhejiang, China
| | - Jing Wu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Guanlu Liang
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Wen Xu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
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Mizuno Y, Sugimoto Y. A comparative study of transscleral suture-fixated and scleral-fixated intraocular lens implantation. Int Ophthalmol 2018; 39:839-845. [PMID: 29502212 DOI: 10.1007/s10792-018-0883-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare short-term clinical outcomes between scleral-fixated and transscleral suture-fixated intraocular lens (IOL) implantation. SEETING Hiroshima Prefectural Hospital, Japan. DESIGN A retrospective, nonrandomized, comparative case series. METHODS Eighty-nine eyes of 87 patients were included in this study; 45 eyes underwent transscleral suture-fixated IOL implantation (group 1), and 44 eyes underwent scleral-fixated IOL implantation (group 2) between February 2009 and June 2017 in the department of Ophthalmology, Hiroshima Prefectural Hospital, Japan. The postoperative best corrected visual acuity (BCVA), degree of astigmatism, IOL astigmatism (total astigmatism-corneal astigmatism), and refractive error were all measured at 1-week and 1-month intervals. RESULTS The mean preoperative BCVA in logarithm of minimum angle of resolution (log MAR) was 0.39 ± 0.56 and 0.46 ± 0.51 in groups 1 and 2, respectively, and the mean postoperative BCVA was 0.25 ± 0.41 and 0.34 ± 0.49 at 1 month. The postoperative degree of astigmatism in group 2 was significantly less than that in group 1 at 1 week and 1 month (p = 0.0046 and p = 0.021, respectively). The postoperative IOL astigmatism in group 2 was significantly less than that in group 1 at 1 week (p = 0.021), while the refractive error between the two groups was not significantly different at 1 week or 1 month. CONCLUSIONS Scleral-fixated IOL implantation has equivalent BCVA and refractive error outcomes as transscleral suture-fixated IOL implantation during the early postoperative period without serious complications. Scleral-fixated IOL implantation appears to provide more stable fixation than suture-fixated IOL implantation.
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Affiliation(s)
- Yu Mizuno
- Department of Ophthalmology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minamiku, Hiroshima, 734-8530, Japan.
| | - Yosuke Sugimoto
- Department of Ophthalmology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minamiku, Hiroshima, 734-8530, Japan
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Yoshida N, Kojima T, Yokoyama S, Horai R, Ichikawa K. New surgical approach for intrascleral fixation using an intraocular lens with hook-shaped haptics. J Cataract Refract Surg 2018; 44:129-133. [PMID: 29502861 DOI: 10.1016/j.jcrs.2017.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 11/27/2022]
Abstract
We report a new surgical technique of intrascleral posterior chamber intraocular lens (PC IOL) fixation using a newly developed hook-shaped haptic IOL (NX-70CH) and a 25-gauge loop-shaped haptic manipulator. Previous techniques of intrascleral PC IOL fixation had 2 major technical challenges; that is, externalization of the haptic and fixation of the haptic into the scleral tunnel. The new IOL and manipulator can facilitate externalization and secure fixation of the IOL haptic and can be used for suture fixation or implantation in the capsular bag in cases with presumed subluxated lens.
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Affiliation(s)
- Norihiko Yoshida
- From the Departments of Ophthalmology, Japanese Red Cross Gifu Hospital (Yoshida), Gifu, Keio University School of Medicine (Kojima), Tokyo, and Japan Community Healthcare Organization Chukyo Hospital (Yokoyama), and Chukyo Medical Co. Inc. (Horai), and Chukyo Eye Clinic (Ichikawa), Nagoya, Japan
| | - Takashi Kojima
- From the Departments of Ophthalmology, Japanese Red Cross Gifu Hospital (Yoshida), Gifu, Keio University School of Medicine (Kojima), Tokyo, and Japan Community Healthcare Organization Chukyo Hospital (Yokoyama), and Chukyo Medical Co. Inc. (Horai), and Chukyo Eye Clinic (Ichikawa), Nagoya, Japan.
| | - Sho Yokoyama
- From the Departments of Ophthalmology, Japanese Red Cross Gifu Hospital (Yoshida), Gifu, Keio University School of Medicine (Kojima), Tokyo, and Japan Community Healthcare Organization Chukyo Hospital (Yokoyama), and Chukyo Medical Co. Inc. (Horai), and Chukyo Eye Clinic (Ichikawa), Nagoya, Japan
| | - Rie Horai
- From the Departments of Ophthalmology, Japanese Red Cross Gifu Hospital (Yoshida), Gifu, Keio University School of Medicine (Kojima), Tokyo, and Japan Community Healthcare Organization Chukyo Hospital (Yokoyama), and Chukyo Medical Co. Inc. (Horai), and Chukyo Eye Clinic (Ichikawa), Nagoya, Japan
| | - Kazuo Ichikawa
- From the Departments of Ophthalmology, Japanese Red Cross Gifu Hospital (Yoshida), Gifu, Keio University School of Medicine (Kojima), Tokyo, and Japan Community Healthcare Organization Chukyo Hospital (Yokoyama), and Chukyo Medical Co. Inc. (Horai), and Chukyo Eye Clinic (Ichikawa), Nagoya, Japan
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Lee MS, Chae SH, Bang CW, Jeon HM, Yoon HS. Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.7.657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yamane S, Sato S, Maruyama-Inoue M, Kadonosono K. Flanged Intrascleral Intraocular Lens Fixation with Double-Needle Technique. Ophthalmology 2017; 124:1136-1142. [PMID: 28457613 DOI: 10.1016/j.ophtha.2017.03.036] [Citation(s) in RCA: 329] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/20/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL). DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS One hundred eyes of 97 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied. METHODS Two angled incisions parallel to the limbus were made by 30-gauge thin-wall needles. Haptics of an IOL were externalized with the needles and cauterized to make a flange of the haptics. The flange of the haptics were pushed back and fixed into the scleral tunnels. MAIN OUTCOME MEASURES Best-corrected visual acuity (VA), corneal endothelial cell density, IOL tilt, and complications were determined. RESULTS The IOLs were fixed with exact centration and axial stability. The mean preoperative best-corrected VA was 0.25 logarithm of the minimum angle of resolution (logMAR) units; after surgery, it improved significantly to 0.11 logMAR, 0.09 logMAR, 0.12 logMAR, and 0.04 logMAR at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P = 0.03, and P = 0.10, respectively). The mean corneal endothelial cell density decreased from 2341 cells/mm2 before surgery to 2313 cells/mm2, 2240 cells/mm2, 2189 cells/mm2, and 2244 cells/mm2 at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P < 0.01, and P = 0.17, respectively). The mean IOL tilt was 3.4°±2.5°. The postoperative complications included iris capture by the IOL in 8 eyes (8%), vitreous hemorrhage in 5 eyes (5%), and cystoid macular edema in 1 eye (1%). There were no incidents of postoperative retinal detachment, endophthalmitis, or IOL dislocation. CONCLUSIONS We have developed a new technique for intrascleral IOL fixation. The flanged IOL fixation technique is a simple and minimally invasive method for achieving good IOL fixation with firm haptic fixation.
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Affiliation(s)
- Shin Yamane
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Shimpei Sato
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
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