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Bhadra TR, Ghosh RP, Mitra A, Saurabh K, Mandal SK, Ghosh AK. Comparative study of the outcomes of newly developed polypropylene-based modified trabeculectomy and glaucoma shunt surgery in neovascular glaucoma. Indian J Ophthalmol 2024; 72:352-356. [PMID: 38421291 PMCID: PMC11001222 DOI: 10.4103/ijo.ijo_3362_22] [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: 12/26/2022] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Neovascular glaucoma (NVG) is a secondary glaucoma with a poor visual prognosis. Trabeculectomy with antifibrotic agents, glaucoma drainage devices (GDDs), and cyclo-destructive procedures are recommended in patients who are refractory to medical management. However, due to the poor success rate of conventional trabeculectomy and the higher cost of GDDs, alternative procedures need to be looked at. PURPOSE To compare the surgical outcomes and economic aspects of a newly developed polypropylene suture bed-based modified trabeculectomy to Ahmed glaucoma valve (AGV) implantation for NVG. METHODS It was a prospective interventional study conducted at a tertiary care center between 2018 and 2020. Consecutive patients with NVG with a minimum follow-up of 18 months were included. Surgical outcomes are mainly based on intraocular pressure (IOP) control and the cost of surgery. RESULTS Sixty eyes were included out of which 40 (60.6%) underwent modified trabeculectomy and 20 (33.7%) underwent AGV. At the final follow-up, no significant difference (P < 0.05) was found between the surgical outcomes of both groups. The complete success rate (IOP < 21 mm Hg without antiglaucoma medications) was 60 and 65% while the qualified success rate (IOP < 21 mm Hg with antiglaucoma medications) was 30 and 25% in modified trabeculectomy and AGV groups, respectively, at final follow-up. The cost of surgery was significantly higher in the AGV group (P < 0.0001). CONCLUSION Modified trabeculectomy as described might be a better alternative for NVG eyes.
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Affiliation(s)
- Tania Ray Bhadra
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| | - Rudra Prosad Ghosh
- Department of Ophthalmology, Rampurhat Government Medical College, Birbhum, West Bengal, India
| | - Ankita Mitra
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| | - Kumar Saurabh
- Retina Services, Dr. Agarwal's Eye Hospital, Salt Lake, Kolkata, West Bengal, India
| | - Salil Kumar Mandal
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
| | - Asim Kumar Ghosh
- Department of Glaucoma, Regional Institute of Ophthalmology, Birbhum, West Bengal, India
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Si S, Zhang J. An Electrocoagulation Fixation Technique for One-Piece Intraocular Lens Scleral Flapless Fixation With Sutures Without Knots. Retina 2023; 43:2068-2071. [PMID: 36800862 PMCID: PMC10659249 DOI: 10.1097/iae.0000000000003756] [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] [Indexed: 02/17/2023]
Abstract
PURPOSE To present an electrocoagulation fixation technique for one-piece intraocular lens (IOL) scleral flapless fixation with sutures without knots. METHODS First of all, after repeated tests and comparisons, we chose 8-0 polypropylene suture as the material for electrocoagulation fixation of one-piece IOL haptics because of its proper elasticity and size. A transscleral tunnel puncture at the pars plana was performed using an arc-shaped needle with 8-0 polypropylene suture. The suture was subsequently guided out of the corneal incision by a 1-mL syringe needle and then guided by the needle into the inferior haptics of the IOL. The suture was cut off and heated into a shape of a probe with a spherical tip using a monopolar coagulation device to prevent slippage from the haptics. RESULTS In the end, 10 eyes underwent our new surgical procedures, and the average operation time was 42.5 ± 12.4 minutes. At the 6-month follow-up, seven of 10 eyes achieved significant vision improvement and nine of 10 kept the implanted one-piece IOL stable in the ciliary sulcus. No serious intraoperative/postoperative complications were observed. CONCLUSION The electrocoagulation fixation was a safe and effective alternative technique for previously implanted one-piece IOL scleral flapless fixation with sutures without knots.
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Angsana NC, Wardhana FS, Supanji, Prayogo ME, Sasongko MB. Modified Four-Point Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation Using 2 Eyelets Polymethyl Methacrylate Lens and 8-0 Polypropylene Suture. Clin Ophthalmol 2023; 17:3657-3662. [PMID: 38050556 PMCID: PMC10693757 DOI: 10.2147/opth.s426443] [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: 06/17/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose To present a modified technique of 4-point scleral fixation using polymethyl methacrylate (PMMA) 2 eyelets intraocular lens (IOL) with 8-0 polypropylene sutures. Methods A 270-degree conjunctival peritomy is done, and 4 sclerotomies (2 nasal and 2 temporal) are created. Lamellar scleral or clear corneal incision is made at superior site (6 mm wide for sclera or 5.5-6 mm for corneal). A short segment of 8-0 polypropylene is inserted into each eyelet, each thread of the suture is externalized through the sclerotomy site, and the lens is inserted. The suture is tightened evenly, and the knot is rotated and internalized. Scleral incision and conjunctival peritomy are sutured with 8-0 vicryl. Results We have performed this technique in 6 patients with excellent visual outcomes and no reported complications over 1 year of follow-up. This technique has practical advantages including rigid and stable PMMA IOL, high tensile, and slim 8-0 polypropylene suture which is easily internalized and less irritated, and affordable and widely available overall consumables. Conclusion We present a modified 4-point scleral fixation technique for posterior chamber IOL placement using PMMA IOL with 2 eyelets and 8-0 polypropylene as compared to previous studies that used foldable IOL with 4 eyelets and 10-0 polypropylene or Gore-Tex sutures. This procedure has moderate technical complexity, comparable to previously reported techniques with good overall clinical outcomes and several practical advantages, particularly related to the affordability and availability of the consumables.
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Affiliation(s)
- Natalia Christina Angsana
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Firman Setya Wardhana
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Supanji
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mohammad Eko Prayogo
- Department of Ophthalmology, Universitas Gadjah Mada Academic Hospital, Yogyakarta, Indonesia
| | - Muhammad Bayu Sasongko
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Chen L, Wang Z, Sun L, Tang Y, Sui W, Bian A, Zhang X, Zhong Y, Zhang S. Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique. BMC Ophthalmol 2023; 23:481. [PMID: 37996816 PMCID: PMC10668428 DOI: 10.1186/s12886-023-03235-2] [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: 09/23/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND IOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags. METHODS A bent 30-gauge needle threaded with 8 - 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 - 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment. RESULTS UCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks. CONCLUSIONS We presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.
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Affiliation(s)
- Lulu Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Zaowen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China.
| | - Lu Sun
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Yongxiang Tang
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, 563000, Zunyi, Guizhou, China
| | - Wenda Sui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
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Modified Technique for Scleral-Sutured Fixation with the Double Knots Technique for Posterior Chamber Intraocular Lens: Short-Term Observation. J Ophthalmol 2021; 2021:6697230. [PMID: 33728058 PMCID: PMC7937454 DOI: 10.1155/2021/6697230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the short-term safety and efficacy of a novel approach of utilizing the 9-0 looped polypropylene suture with double knots buried into the scleral groove and the scleral tunnel to minimize the risk of the suture erosion and suture knot exposure. Design Clinical-based retrospective study. Methods Records of consecutive patients who had anterior vitrectomy and scleral-fixated posterior chamber intraocular lens (IOL) implantation between July 2018 and April 2020 with a minimum follow-up of 3 months were reviewed. Results This study enrolled a total of 21 eyes from 20 patients (15 male). These patients had a mean age of 58.52 ± 8.55 years and were followed for an average of 1.08 ± 0.58 years postoperatively. Best-corrected visual acuity (BCVA) improved from a preoperative mean of 0.43 ± 0.41 logMAR to a significantly higher mean 3-month postoperative value of 0.09 ± 0.21 logMAR (Z = -3.35, p < 0.01). There were no statistical differences between the preoperative and postoperative corneal endothelial cell density (p=0.71). The postoperative complications included transient increased intraocular pressure in 5 eyes (24%). No other complications were detected during the follow-up. Conclusions The modified technique proposed is a safe, effective, and reliable approach resulting in good visual outcomes. Our procedure might have the potential benefit to avoid suture-related complications in scleral-fixated IOL implantation. Trial registration. Retrospective case series study, not applicable.
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