1
|
Chen FF, Jiang F, Zhang WW, Liu YJ, He ZF, Xie ZG. Six-point scleral fixation of a three-looped haptics one-piece posterior chamber intraocular lens by a single suture. Indian J Ophthalmol 2024; 72:S319-S322. [PMID: 38271430 DOI: 10.4103/ijo.ijo_1093_23] [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: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 01/27/2024] Open
Abstract
To evaluate a novel technique for six-point scleral fixation of a three-looped haptics posterior chamber intraocular lens (PCIOL) by a single suture. Nine eyes of nine patients were studied from September 2021 to March 2023. All patients had undergone vitrectomy. Only a single 9-0 polypropylene suture was used for scleral fixation. The three looped haptics were fixed at 12, 4, and 8 o'clock with six-point scleral fixation. The entire procedure took about 30 min. Among the nine patients, eight (88.8%) eyes had a significant improvement in best-corrected visual acuity, whereas one (11.2%) eye showed no change. No intraoperative or postoperative complications were observed. By ultrasonic biomicroscopy examination, intraocular lenses were well positioned and stable with no tilt in the horizontal and vertical axis. The method of six-point scleral fixation of a three-looped haptics PCIOL by a single suture is safe and effective.
Collapse
Affiliation(s)
- Fei-Fei Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, Jiangsu Province, China
| | | | | | | | | | | |
Collapse
|
2
|
Lou W, Chen Z, Huang Y, Jin H. Flapless and Conjunctiva-Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support. J Ophthalmol 2023; 2023:4032011. [PMID: 37124064 PMCID: PMC10132900 DOI: 10.1155/2023/4032011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Wei Lou
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziang Chen
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Huang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiying Jin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Ye H, Zhang S, Mi W, Fei P, Zhao P. One-Year Outcomes of Modified Technique for Scleral Fixation of a Three-Piece Intraocular Lens Without Conjunctival Opening. Front Med (Lausanne) 2022; 9:856800. [PMID: 35721099 PMCID: PMC9200955 DOI: 10.3389/fmed.2022.856800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to present the 1-year follow-up of a modified technique for scleral fixation of three-piece intraocular lens (IOLs) without conjunctival incision. Materials and Methods A retrospective chart review of a consecutive series of 10 eyes of nine patients who underwent scleral IOL fixation using the modified technique was performed. Data were collected 1 year after surgery for all patients. Results The range of follow-up time was between 1 year and 31 months. At the last follow-up point, the IOL was well-positioned and the visual acuity was good (as limited by primary diseases). Short-term complications included pupillary IOL capture (n = 1) and decreased intraocular pressure (n = 1), and no long-term complications were observed. Conclusion Outcome data support this technique as a viable option for the management of secondary IOL fixation with flexible usage of more designs of IOLs.
Collapse
Affiliation(s)
- Hongfei Ye
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiguang Zhang
- Department of Ophthalmology, Zhenjiang Ruikang Hospital, Zhenjiang, China
| | - Wei Mi
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fei
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Single-string, Closed-loop Fixation Technique as a Modified Approach to Repositing a Dislocated Triple-looped Haptic Intraocular Lens: Local Experience. J Cataract Refract Surg 2022; 48:859-862. [PMID: 35546428 DOI: 10.1097/j.jcrs.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT A technique using the single-string, closed-loop fixation method to reposit dislocated triple-looped haptic IOL-capsular bag complexes is described. The long needle or curved needle with 10-0 / 8-0 polypropylene suture and 27 / 30g needle were used as the guide needle to pass through the fenestrated haptics for two times. The scleral interlaminar course was used as the fixed point. last, A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached needle.Four eyes from 4 consecutive patients were studied retrospectively; During all follow-up visits, the IOLs were well centered and stable, No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Mahler OS, Biron R, Hecht I, Pras E, Einan-Lifshitz A. Intrascleral 4-flanged technique for in-the-bag intraocular lens subluxation. J Cataract Refract Surg 2021; 47:476-481. [PMID: 33149040 DOI: 10.1097/j.jcrs.0000000000000474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a series of cases in which the 4-flanged technique was used in the management of in-the-bag intraocular lens (IOL) subluxation. SETTING Shamir Medical Center, Israel. DESIGN Retrospective cohort analysis. METHODS Included were consecutive cases with secondary IOL subluxation that underwent scleral fixation with the 4-flanged technique using 6-0 polypropylene and low temperature cautery. Surgeries were performed during September 2019 to April 2020. Postoperative IOL angle tilt was evaluated using high-resolution ocular coherence tomography. RESULTS Eleven eyes of 11 patients were included. The mean age was 82.7 ± 5.5 years, and 60% were men. Pseudoexfoliation was noted in 82% of patients, and only 1 case was related to trauma. The mean corrected distance visual acuity (CDVA) postoperatively was within 1 line of the original presubluxation CDVA (0.55 ± 0.41 vs 0.54 ± 0.6 logMAR, P = .965). The mean postoperative IOL tilt was 5.78 ± 3.85 degrees. Surgery duration decreased from 70 ± 14 minutes to 39 ± 15 minutes (first to last operations). No intraoperative complications were reported. Postoperatively, transient intraocular pressure elevation, which resolved at 1 week, was recorded in 45% of cases. Cystoid macular edema, which resolved within a few months under topical treatment, was seen in 2 patients. CONCLUSIONS Among a cohort of patients with secondary in-the-bag IOL subluxation, the 4-flanged technique was safe and resulted in satisfactory visual outcomes and a stable IOL position, with a short learning curve.
Collapse
Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | |
Collapse
|
7
|
Huang CW, Tsai CY, Lai TT. Short-term outcomes of a modified technique for small-incision scleral-fixated intraocular lens implantation using Gore-Tex sutures. Graefes Arch Clin Exp Ophthalmol 2021; 259:1889-1896. [PMID: 33914157 DOI: 10.1007/s00417-021-05201-4] [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: 10/28/2020] [Revised: 03/29/2021] [Accepted: 04/11/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the short-term outcomes of a modified small-incision technique for implantation of scleral-fixated intraocular lenses (IOLs) using Gore-Tex sutures. METHODS A retrospective, interventional, consecutive case series was conducted. From June 2019 to February 2020, 10 patients underwent small-incision scleral-fixated IOL implantation using Gore-Tex sutures at a tertiary referral center. Visual and anatomical outcomes and complications were recorded with a minimum follow-up period of 3 months. Surgically induced astigmatism (SIA) and IOL-induced astigmatism were measured. RESULTS The mean follow-up duration (range) was 396 (240-573) days. Best-corrected visual acuity improved significantly from logarithm of the minimal angle of resolution (logMAR) 0.88 ± 0.65 (Snellen equivalent: 20/153) preoperation to logMAR = 0.30 ± 0.51 (Snellen equivalent: 20/40) at final follow-up (P = .008). The estimated SIA and IOL-induced astigmatism were 0.61 diopters (D) ± 0.49D and 0.40D ± 0.36D, respectively. No intraoperative complications occurred. The postoperative complications, which included ocular hypertension (20%), cystoid macular edema (30%), and vitreous hemorrhage (20%), were transient and resolved with topical medication. CONCLUSIONS The modified small-incision technique for implantation of scleral-fixated IOLs using Gore-Tex sutures was well tolerated in all patients, with favorable postoperative visual outcomes and minimal SIA and IOL-induced astigmatism.
Collapse
Affiliation(s)
- Ching-Wen Huang
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Chia-Ying Tsai
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
- Department of Ophthalmology, Fu-Jen Catholic University Hospital, Fu-Jen Catholic Univerisity, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, 100, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
8
|
Rodríguez-Aramendía A, Díaz-Doutón F, Fernández-Trullàs J, Falgueras P, González L, Pujol J, Grulkowski I, Güell JL. Whole anterior segment and retinal swept source OCT for comprehensive ocular screening. BIOMEDICAL OPTICS EXPRESS 2021; 12:1263-1278. [PMID: 33796352 PMCID: PMC7984787 DOI: 10.1364/boe.414592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 05/20/2023]
Abstract
Whole eye visualization and morphometry are of high relevance in clinical practice. However, most standard ophthalmic OCT instruments are dedicated either to retinal or to anterior segment imaging. We demonstrate a swept source optical coherence tomography system (SS-OCT) that images both the whole anterior segment and the retina alternately using a single source and detector. A pilot population was imaged with the proof of concept prototype. We demonstrate the clinical potential of whole eye OCT screening for the description and early detection of relevant clinical features in the anterior segment and retina of several patients.
Collapse
Affiliation(s)
- Ana Rodríguez-Aramendía
- Instituto de Microcirugía Ocular (IMO), Josep María Lladó 3, Barcelona 08035, Spain
- Center for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Rambla Sant Nebridi 10, Terrassa 08222, Barcelona, Spain
| | - Fernando Díaz-Doutón
- Center for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Rambla Sant Nebridi 10, Terrassa 08222, Barcelona, Spain
| | - José Fernández-Trullàs
- Center for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Rambla Sant Nebridi 10, Terrassa 08222, Barcelona, Spain
| | - Pol Falgueras
- Center for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Rambla Sant Nebridi 10, Terrassa 08222, Barcelona, Spain
| | - Laura González
- Instituto de Microcirugía Ocular (IMO), Josep María Lladó 3, Barcelona 08035, Spain
| | - Jaume Pujol
- Center for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Rambla Sant Nebridi 10, Terrassa 08222, Barcelona, Spain
| | - Ireneusz Grulkowski
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, ul. Grudziądzka 5, 87-100 Toruń, Poland
| | - José Luis Güell
- Instituto de Microcirugía Ocular (IMO), Josep María Lladó 3, Barcelona 08035, Spain
| |
Collapse
|