Sutureless Intrascleral Posterior Chamber Intraocular Lens Fixation: Analysis of Clinical Outcomes and Postoperative Complications

Two Cases of Atopic Dermatitis Patients With Scleral Perforation After Recurrent Scleritis Induced by Scleral-Sutured Posterior Chamber Intraocular Lens Implantation

This report describes two cases of atopic dermatitis patients with scleral perforation after recurrent scleritis induced by suture exposure after scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. The first patient was a 41-year-old man (case 1), and the second was a 46-year-old man (case 2). Both had a history of atopic dermatitis and scleral-sutured intraocular lens (IOL) implantation. Scleritis recurred at the suture site after scleral-sutured IOL implantation in both patients. Although the scleritis was controlled by topical and/or systemic anti-inflammatory drugs, the sclera was perforated in both cases because of exposure of the suture knots (after seven years in case 1 and after 11 years in case 2). In case 1, the superotemporal IOL haptic was also exposed over the conjunctiva, and in case 2, the ciliary body was incarcerated in the scleral hole with deformation of the pupil superonasally. Considering that there were no signs of severe intraocular inflammation, surgical intervention was performed in both cases. In case 1, IOL repositioning was performed with oral prednisolone cover at a dosage of 15 mg/day, starting two weeks prior to the surgery. The steroid dosage was gradually tapered off until two months after the surgery. In case 2, the scleral patch underwent without IOL extraction, and no steroid or immunosuppression cover was administered. There was no recurrence of scleritis after surgery in either case, and visual acuity was preserved in both cases. The scleral perforation that occurred after scleral-sutured IOL implantation in these patients was thought to be the result of recurrent scleritis caused by suture exposure and chronic mechanical irritation by a suture knot. The scleritis subsided without removal of the IOL by moving the suture site of the IOL haptic and covering the suture with a scleral flap or patch graft.

Flapless and Conjunctiva-Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support

Purpose

To evaluate refractive outcomes, intraocular lens (IOL) power calculation, and IOL position following a novel conjunctiva-sparing transscleral fixation technique.

Methods

Forty-one eyes of 40 patients managed with a flapless transscleral-sutured technique were included. Preoperative and postoperative refractive errors (spherical equivalents, SE) were compared. IOL position was assessed on the Scheimpflug images. IOL power was calculated by SRK/T, Holladay 1, and Hoffer Q formulas.

Results

The mean age was 57.39 ± 14.83 years (range: 26 to 79 years), and the mean follow-up was 7.46 ± 6.42 months (range: 1 to 24 months). Surgical indications were aphakia (n = 14), subluxated lenses (n = 3), and IOL dislocation (n = 24). The SE was 4.50 ± 6.38 diopter (D) (range: -3.75 to 13.75 D) preoperatively and -1.68 ± 1.57 D (range: -5.50 to 1.13 D) postoperatively (P < 0.001). The mean tilt angle and decentration were 2.90° ± 1.93° (range: 0.39° to 9.10°) and 0.23 ± 0.19 mm (range: 0.02 to 0.94 mm) vertically, and 1.75° ± 1.41° (range: 0.24° to 7.65°) and 0.18 ± 0.19 mm (range: 0.02 to 1.06 mm) horizontally, which were clinically insignificant. All three IOL formulas produced myopic errors (range: -0.29 to -0.50 D). The SRK/T had the lowest median absolute error (0.55 D), followed by the Holladay 1 (0.70 D) and the Hoffer Q (0.74 D). The three formulas had the same percentage of prediction errors (PEs) within ±0.5 D (43.48%), while the Hoffer Q had the highest percentage of PEs within ±1.0 D (82.61%).

Conclusion

The present technique can serve as an alternative approach for transscleral IOL fixation and refractive correction in eyes with compromised capsular support, ensuring the stability of IOLs and reasonable IOL power calculation accuracy.

Ultrasound Biomicroscopy Diagnosis Analysis and Fine Care of Anterior Segment Injury of Traumatic Anterior Chamber Based on Intelligent Virtual Reality Technology

The front part of the eye is exposed to the surface of the body, making it susceptible to injury. Blunt eye injuries often destroy the tissue structure in the anterior part of the eye. Often there is detachment of the iris root, separation of the ciliary body, the angle of retraction of the chamber, and complete dislocation or subluxation of the lens. Ordinary ocular ultrasound can penetrate into opaque tissue, but because of its low resolution, it can only show its outline, which is still very small for doctors in assisting diagnosis. Ultrasonic biomicroscopy is a very real-time analysis, will not be affected by the refraction space, and has great application value for ocular trauma. Based on this, this article proposes the ultrasound biomicroscope diagnosis analysis and fine nursing research of traumatic anterior chamber injury based on intelligent virtual reality technology. This article describes literature methods, experimental analysis methods, and other methods, in-depth study of the causes of traumatic anterior injuries, ultrasound biomicroscopy, and other theoretical knowledge, ultrasound biomicroscopy and microcontrol experiments for traumatic anterior injury design, and finally the causes of eye damage. This study compares the pairing results of ultrasound biomicroscopy biological measurements, analyzes the relationship between anterior bleeding level and anterior ocular injury, and analyzes the outcome and extent of service ophthalmology. The angle retreat accounted for 52.17% in grade I, 72.22% in grade II, and 60% in grade III. Anterior bleeding can cause single or complex iris root detachment, iris root detachment, ciliary body detachment, and angular leakage. The more the bleeding, the more serious the eye damage.