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Amado SF, Amado NM, Hermosa L. Flange depth for scleral pocket vs no pocket techniques for intrascleral intraocular lens fixation. J Cataract Refract Surg 2024; 50:505-510. [PMID: 38651698 PMCID: PMC11045402 DOI: 10.1097/j.jcrs.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/29/2023] [Accepted: 12/09/2023] [Indexed: 04/25/2024]
Abstract
PURPOSE To compare flange depth for a modified scleral pocket (SP) vs no scleral pocket (NSP) technique (Yamane technique) for intrascleral intraocular lens (IOL) fixation. SETTING Instituto de Oftalmología Santa Fe, Santa Fe, Argentina. DESIGN Prospective, randomized, single-surgeon, observational study. METHODS Eyes with aphakia and no capsular support were included. They were divided into 2 groups: one was programmed for a double-needle flanged intrascleral IOL fixation as originally described by Shin Yamane with NSP and the second group had a modified SP technique. Flange depth was measured with anterior-segment optical coherence tomography (AS-OCT) at 1 month, 3 months, 6 months, and 12 months postoperatively, and the results were compared. RESULTS Each group comprised 18 eyes of 18 patients, giving a total of 36 flanges per group. The groups were comparable preoperatively. At 12 months, uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were not statistically different for both groups (P = .333; P = .448). Spherical equivalent (SEQ) was not significantly different between groups at 12 months postoperatively (P = .078). AS-OCT revealed a significantly deeper flange position for the SP group at 1 month, 3 months, 6 months, and 12 months postoperatively (P < .05). CONCLUSIONS When performing a double-needle intrascleral IOL fixation in aphakic eyes with no capsular support, a modified scleral pocket technique provides a significantly deeper flange position with no difference in CDVA or SEQ 12 months postoperatively.
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Affiliation(s)
| | | | - Luciano Hermosa
- From the Instituto de Oftalmología Santa Fe, Santa Fe, Argentina
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2
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Pakravan P, Patel V, Chau V, Rohowetz L, Lai J, Fan KC, Al-Khersan H, Melo IM, Muni RH, Tsao SW, Kaplan R, Jung JJ, Hoyek S, Patel NA, Kuriyan AE, Laura DM, Mantopoulos D, Syed ZA, Yannuzzi NA. Haptic Erosion Following Sutureless Scleral-fixated Intraocular Lens Placement. Ophthalmol Retina 2023; 7:333-337. [PMID: 36441084 DOI: 10.1016/j.oret.2022.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To describe the clinical features and visual outcomes of eyes with conjunctival haptic erosion after sutureless intrascleral (SIS) fixated intraocular lens (IOL) placement. DESIGN Retrospective case series. SUBJECTS Patients experiencing haptic erosion after SIS fixation between January 1, 2013, and March 1, 2022. METHODS A multicenter, multisurgeon, retrospective review. MAIN OUTCOME MEASURES Clinical features, visual outcomes, and treatment options following haptic erosions after SIS fixation. RESULTS Nineteen eyes with haptic erosion were identified. The mean age at initial SIS fixation was 64 ± 12 years (range, 38-81 years). There were 5 (26%) eyes with a history of conjunctiva involving ocular surgery, including scleral buckle surgery and tube shunt surgery. Trocar-assisted fixation was performed in 15 (79%) eyes, whereas needle fixation was used in 4 (21%) eyes. Eighteen (95%) sets of haptics were flanged with a low temperature cautery. Seventeen (90%) sets of haptics were externalized superiorly and inferiorly, and 2 (10%) sets of haptics were externalized nasally and temporally. Haptics were covered by conjunctiva in 14 (74%) eyes and by scleral flap in 5 (26%) eyes. All patients experienced a single haptic erosion, of which 8 (43%) were located superiorly, 9 (47%) inferiorly, and 2 (10%) temporally. The mean interval between the initial SIS fixation and haptic erosion was 278 ± 437 days. After correction of the erosion, 18 (95%) eyes had a stable IOL at the last follow-up, with no recurrence of haptic erosion. In this series, there were no cases of endophthalmitis. CONCLUSIONS Haptic erosion is a notable complication after SIS fixated IOL surgery but may be repaired with favorable visual outcomes. Careful evaluation of the conjunctiva should be considered before the surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Parastou Pakravan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Veshesh Patel
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Viet Chau
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Landon Rohowetz
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - James Lai
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Sean W Tsao
- Department of Ophthalmology, Southern California Permanente Medical Group, Santa Ana, California
| | | | - Jesse J Jung
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; East Bay Retina Consultants, Inc., Oakland, California
| | - Sandra Hoyek
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Nimesh A Patel
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Ajay E Kuriyan
- Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Diana M Laura
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Zeba A Syed
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
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3
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Asif MI, Bafna RK, Kapoor A, Sharma N. Intrascleral haptic fixation for haptic exposure after Yamane technique. BMJ Case Rep 2021; 14:e243627. [PMID: 34404655 PMCID: PMC8375743 DOI: 10.1136/bcr-2021-243627] [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] [Accepted: 06/28/2021] [Indexed: 11/03/2022] Open
Abstract
A 55-year-old patient presented with exposure of both the haptics beyond the conjunctiva of the scleral fixated multipiece intraocular lens (IOL). Two diagonally opposite scleral pockets were created, and the exposed haptics was redirected and repositioned aseptically into these pockets to facilitate intrascleral fixation. Herein, we report a simple rescue method for management of exposed haptic after Yamane technique of scleral fixated IOL.
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Affiliation(s)
| | - Rahul Kumar Bafna
- Ophthalmology, R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India
| | - Anirudh Kapoor
- Ophthalmology, R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India
| | - Namrata Sharma
- Ophthalmology, R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India
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4
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Agarwal R, Todi V, Bafna RK, Asif MI, Sharma N. Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature. Indian J Ophthalmol 2021; 69:758-761. [PMID: 33595520 PMCID: PMC7942097 DOI: 10.4103/ijo.ijo_2149_20] [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] [Indexed: 11/04/2022] Open
Abstract
Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned with an angled 20-guage microvitreoretinal blade 1.5 mm away from the limbus in line with pre-existing defective scleral flap underneath which the exposed haptic is tucked securely. Following this, conjunctival autograft (CAG) with fibrin glue application is undertaken to combat conjunctival fibrosis. In three patients, where this technique was performed, had well-tucked haptic and maintained visual acuity with no complications at 3-months follow-up. This technique is a useful method of tucking extruded haptic after SFIOL in eyes subjected to multiple previous surgeries.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnu Todi
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Md Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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5
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Kannan NB, Sen S, Mishra C, Lalitha P, Rameshkumar G, Kumar K, Rajan RP, Ramasamy K. Ten-year trends in the incidence, clinical profile and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and sutureless, glueless and flapless scleral fixation of intraocular lenses. Int Ophthalmol 2021; 41:1651-1658. [PMID: 33511515 DOI: 10.1007/s10792-021-01715-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the frequency and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and scleral fixation of intraocular lens. METHODS We evaluated patients undergoing a sutureless, glueless, flapless technique of scleral fixation of intraocular lenses (SFIOL) implantation for various causes of aphakia and documented the clinico-demographic data, microbiological profile and final outcome after acute endophthalmitis in this cohort of eyes. RESULTS The frequency of suspected acute endophthalmitis diagnosed post-surgery was 0.112% (4/3541 eyes), with culture-positive endophthalmitis frequency being 0.028% (1 eye), showing growth of Pseudomonas aeruginosa. Mean age of patients with endophthalmitis was 51.75 ± 9.28 years, and mean interval between surgery and acute endophthalmitis presentation was 10.25 ± 9.6 days. Patients were managed with intravitreal antibiotics with or without core vitrectomy. Visual acuity of patients increased from baseline 1.43 ± 0.32 logMAR (Snellen equivalent = 6/150) to 0.79 ± 0.16 logMAR (Snellen equivalent = 6/36) after an average follow-up of 11 ± 2 weeks. CONCLUSION Endophthalmitis is a rare complication following SFIOL surgery, and all ophthalmic surgeons must be aware of this inadvertent possibility, since SFIOLs are gaining wider acceptability recently. Moreover, these cases of endophthalmitis may show a different pattern of microorganisms than post-cataract surgery endophthalmitis; however, with prompt diagnosis and effective timely management, favorable outcomes can be achieved.
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Affiliation(s)
| | - Sagnik Sen
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India.
| | | | - Prajna Lalitha
- Department of Microbiology, Aravind Eye Hospital, Madurai, India
| | | | - Karthik Kumar
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India
| | - Renu P Rajan
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India
| | - Kim Ramasamy
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India
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6
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Janse van Rensburg E, Ryu CL, Vila N, Chen JC. Sutureless intrascleral fixation of intraocular lens through self-sealing sclerotomy wounds using haptic externalization and reinternalization technique. J Cataract Refract Surg 2020; 45:1367-1371. [PMID: 31564310 DOI: 10.1016/j.jcrs.2019.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/13/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
In eyes with absent or insufficient capsule support, three-piece posterior chamber intraocular lens (PC IOL) may be fixed to the sclera. Previous techniques involve the use of sutures, flaps, glue, needles, trocars, or intrascleral tunnels to fixate the distal tips of the haptics intrasclerally. Herein we describe a modified technique for the sutureless scleral fixation of a standard 3-piece PC IOL using self-sealing sclerotomies created with a crescent blade and a 20-gauge microvitreoretinal blade, and then reinserting the haptics to leave the tips inside the vitreous cavity. We believe the relative simplicity of this technique makes it widely applicable for the placement of an IOL with insufficient capsule support.
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Affiliation(s)
| | - Christina L Ryu
- McGill University, Montreal, Quebec, Canada; Minneapolis Veterans Affairs Health Care System, Minnesota, Minnesota, USA; University of Minnesota Department of Ophthalmology and Visual Neurosciences, Minneapolis, Minnesota, USA
| | | | - John C Chen
- McGill University, Montreal, Quebec, Canada.
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