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Almulhim A, Alsarhani WK, Alanazi B, Alfaleh A, Aljindan M, Al Malawi RM, Al-Somali A. Outcomes of sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty. BMC Ophthalmol 2024; 24:337. [PMID: 39135167 PMCID: PMC11318130 DOI: 10.1186/s12886-024-03603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 07/31/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The purpose of the study was to assess visual outcomes, complications, intraocular lens (IOL) stability, and corneal status after sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty (PKP). METHODS This retrospective single-arm cohort study included patients who underwent PKP and sutured scleral-fixated intraocular lens implantation between 2013 and 2018 at the Dhahran Eye Specialty Hospital. The eyes were examined postoperatively at 1, 3, 6, 12, and 24 months. Corneal status, complications, and IOL status were also evaluated periodically, and the number of eyes with a BCVA of > 20/200 was recorded. RESULTS Twenty-two eyes from 22 patients were included. The median duration of follow-up was 3 (IQR 1.8; 4.4) years. Reasons for surgery were traumatic globe rupture (six eyes, 27.3%), bullous keratopathy (nine eyes, 40.1%), failed previous graft (five eyes, 22.7%), and corneal scarring (two eyes, 9.1%). Twelve (54.5%) eyes showed a BCVA of > 20/200 (non-blind) at 12 months after surgery and only five (22.7%) before surgery. Twelve months after surgery, 13 patients showed an improvement in BCVA in two lines (59.1%), seven remained the same (31.8%), and 2 deteriorated (9.1%). The indication for surgery (p = 0.2) and the stability of the sutured-scleral fixated IOL (p = 0.8) were not associated with an improvement in BCVA at the final follow-up. The corneal graft remained clear in nine eyes (40.9%) at a median duration of 3 years. The overall average survival period for all corneal grafts was 42.9 months. CONCLUSIONS The combination of sutured scleral-fixated intraocular lens implants and PKP is an effective intervention for preserving visual acuity in patients with complex cases. However, the risk of graft failure and then need for repeat transplantation should be taken into consideration.
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Affiliation(s)
- Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- Department of Ophthalmology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
| | - Bader Alanazi
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Abdulrahman Alfaleh
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Mohanna Aljindan
- Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rahaf M Al Malawi
- College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Somali
- Department of Ophthalmology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Agarwal R, Shakarwal C, Sharma N, Titiyal JS. Concomitant sutureless scleral fixation of intraocular lens with keratoplasty: Review of surgical techniques. Indian J Ophthalmol 2023; 71:1718-1732. [PMID: 37203023 PMCID: PMC10391482 DOI: 10.4103/ijo.ijo_1724_22] [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: 05/20/2023] Open
Abstract
Sutureless scleral fixation of intraocular lens (sSFIOL) is a commonly employed method of optical rehabilitation of aphakic patients with deficient capsular support, and corneal transplant surgeries can be simultaneously combined with sSFIOL to handle aphakic corneal opacities. A single-stage procedure circumvents the need for repeat intraocular procedures and carries lower risk of graft endothelial damage, endophthalmitis, and macular edema associated with sequential surgeries. However, it mandates surgical expertise and increases the chances of postoperative inflammation. A basket of options is available with the corneal surgeons regarding the manner of host and donor preparation as well as the approaches to scleral fixation and certain intraoperative modifications along with postoperative vigilance may enhance the surgical outcomes. Most of the studies pertaining to keratoplasty with sSFIOL categorize to case reports/series, surgical techniques, and retrospective studies with very limited prospective data available currently. The purpose of the present review is to consolidate all available literature on concomitant sSFIOLs and keratoplasty procedures.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Chetan Shakarwal
- Department of Optometry, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Jeewan S Titiyal
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
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3
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Pole to Pole Surgery in Ocular Trauma: Standardizing Surgical Steps. Ophthalmol Ther 2022; 11:1951-1959. [DOI: 10.1007/s40123-022-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022] Open
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Sevimli N, Karadag R, Çakıcı Ö. A review of techniques and challenges in performing sutureless intrascleral fixation of intraocular lens. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1999807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Neslihan Sevimli
- Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - Özgür Çakıcı
- Ophthalmology, Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
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de Angelis L, Barca F, Rizzo S, Di Leo L, Oliverio L, Caporossi T. Trans-scleral plugs scleral fixation IOL and penetrating keratoplasty to restore vision in vitrectomized eyes. Eur J Ophthalmol 2021; 32:NP67-NP70. [PMID: 33567894 DOI: 10.1177/1120672121990634] [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: 11/16/2022]
Abstract
PURPOSE To report the surgical outcomes of penetrating keratoplasty (PKP) and sutureless scleral fixation (SSF) using Carlevale Lens (Soleko) combined procedure to solve corneal failure and aphakia in vitrectomized eyes and discuss eventual advantages of this new approach. METHODS Two patients underwent primary wound repair and pars plana vitrectomy after a penetrating ocular trauma and were referred to the author's clinic. The PKP and SSF-Carlevale lens implantation were performed under retrobulbar anesthesia. Intraoperative and postoperative complications were recorded, intraocular lens positioning was evaluated using anterior segment optical coherence tomography (AS-OCT) and endothelial cell density was determined using an endothelial microscope. Both patients completed 12 months follow-up. RESULTS The surgery was performed without intraoperative complications. After 1 month, the lens was fixed well, and the graft showed no sign of rejection. At the last visit after 12 months, the corneal graft remained transparent with good endothelial cell density in both cases; conjunctival scarring or inflammation and plugs externalization did not occur during follow-ups. Best-corrected visual acuity was 4/10 Snellen in the first case, while in the second case, we witnessed a limited visual recovery of 1/20 Snellen due to retinal issues. CONCLUSION We report the feasibility of secondary IOL implantation using Carlevale with penetrating keratoplasty. The relative of ease of Carlevale lens implantation through the transscleral plugs reduces the open globe length resulting in a safer procedure, especially for vitrectomized eyes.
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Affiliation(s)
- Lorenzo de Angelis
- Department of Translational Surgery and Medicine, Ophthalmology, Department of NEUROFARBA, University of Florence, Careggi, Florence, Italy
| | - Francesco Barca
- Department of Translational Surgery and Medicine, Ophthalmology, Department of NEUROFARBA, University of Florence, Careggi, Florence, Italy
| | - Stanislao Rizzo
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
| | - Laura Di Leo
- Department of Translational Surgery and Medicine, Ophthalmology, Department of NEUROFARBA, University of Florence, Careggi, Florence, Italy
| | - Leandro Oliverio
- Department of Translational Surgery and Medicine, Ophthalmology, Department of NEUROFARBA, University of Florence, Careggi, Florence, Italy
| | - Tomaso Caporossi
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Hayashi T, Yasutsugu I, Shimizu T, Kuroki T, Kobashigawa Y, Iijima Y, Yuda K. Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series. BMC Ophthalmol 2020; 20:369. [PMID: 32928189 PMCID: PMC7491070 DOI: 10.1186/s12886-020-01639-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/09/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes. METHODS In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. RESULTS This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively. CONCLUSION The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.
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Affiliation(s)
- Takahiko Hayashi
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuura Higashi, Yokohama, Kanagawa, 236-0037, Japan. .,Department of Ophthalmology, University of Cologne, Cologne, Germany. .,Department of Ophthalmology, Jichi Medical University, Tochigi, Shimotsuke, Japan. .,Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan. .,Department of Technology and Design Thinking for Medicine (DT2M), Hiroshima University, Hiroshima, Japan.
| | - Ida Yasutsugu
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuura Higashi, Yokohama, Kanagawa, 236-0037, Japan.,Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Toshiki Shimizu
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Tsubasa Kuroki
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuura Higashi, Yokohama, Kanagawa, 236-0037, Japan
| | | | | | - Kentaro Yuda
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.,Angiogenesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.,Kikuna Yuda Eye Clinic, Yokohama, Kanagawa, Japan
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Simultaneous Penetrating Keratoplasty and Implantation of a New Scleral-Fixated, Sutureless, Posterior Chamber Intraocular Lens (Soleko, Carlevale): A Novel Technique. Cornea 2020; 39:1450-1452. [DOI: 10.1097/ico.0000000000002378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karadag R, Kilic G, Ardagil A, Demirok A. Trocar-assisted, flanged sutureless scleral-fixated intraocular lens implantation combined with silicone oil injection after penetrating keratoplasty surgery. GMS OPHTHALMOLOGY CASES 2020; 10:Doc03. [PMID: 32158638 PMCID: PMC7047885 DOI: 10.3205/oc000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a combined technique of trocar-assisted sutureless scleral-fixated intraocular lens implantation and silicone oil injection at the same session. Two 3 mm scleral tunnels were created 2 mm away from and parallel to the limbus with the 23-gauge vitrectomy trocars entering the sclera transconjunctivally at an angle of approximately 10° at the 3 o'clock and 9 o'clock meridians. After the 3-piece foldable IOL was delivered to the anterior chamber through the corneal incision, the tip of one of the IOL haptics was grasped with a 23-gauge serrated retinal forceps entered through the trocar located at the 3 o'clock meridian. Then the haptic was removed from the scleral tunnel together with the trocar out of the globe. The same procedure was applied to the other haptic. A transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. The ends of the haptics were cauterized to make a flange. The resultant flanges of the haptics were pushed back and fixed into the scleral tunnels. Perfluorooctane was taken out of the eye with vitreoretinal surgery and the silicone was injected into the eye to prevent hypotonia. No complications were seen intraoperatively or postoperatively. After 1-month follow-up period, IOL was seen stabilized.
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Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey
| | - Guler Kilic
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
| | - Aylin Ardagil
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
| | - Ahmet Demirok
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey
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