Scleral fixation of foldable acrylic intraocular lenses in aphakic post-vitrectomy eyes

Six-point scleral fixation of a three-looped haptics one-piece posterior chamber intraocular lens by a single suture

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.

Corneal endothelial cell damage after scleral fixation of intraocular lens surgery

PURPOSE

To analyze corneal endothelial cell damage after scleral fixation of intraocular lens (SFIOL) surgery.

STUDY DESIGN

Retrospective study.

METHODS

Medical records of consecutive eyes undergoing SFIOL surgery performed by a single surgeon were reviewed between January 2011 and June 2019. The patients were classified into three groups according to surgical methods: Group I, re-fixating the existing intraocular lens (IOL) or fixating a new IOL in an aphakic eye; Group II, removing the existing IOL and fixating a new IOL; and Group III, phacoemulsification and fixating a new IOL simultaneously. Preoperative and postoperative specular microscopy (SM) status were compared. Changes in SM were compared among the three groups.

RESULTS

Ninety-four eyes were included. Thirty-four eyes in Group I, 39 in Group II, and 21 in Group III. The endothelial cell density (ECD) loss in Group I was 1.5%, less than the ECD loss of 14.3% (p < 0.001) in Group II and 15.4% (p = 0.005), in Group III. In no eye was there an ECD decrease to < 1000/mm² following the surgical procedure.

CONCLUSIONS

ECD loss was related to IOL removal or phacoemulsification rather than SFIOL surgery. SFIOL using the existing IOL should be considered preferential in eyes with low ECD and dislocated IOL.

Sutureless Scleral-Fixated Intraocular Lens Implantation in the Treatment of Congenital Lens Subluxation Related to Marfan Syndrome

PURPOSE

To evaluate the efficacy and safety of bimanual capsulorhexis combined with sutureless scleral-fixated intraocular lens (IOL) implantation in children diagnosed as having Marfan syndrome.

METHODS

The study included 14 eyes with subluxated lenses of 7 children who were diagnosed as having Marfan syndrome and underwent bimanual capsulorhexis combined with sutureless scleral-fixated IOL implantation by the same surgeon between 2015 and 2019 at the University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital's Eye Department.

RESULTS

The mean preoperative and postoperative uncorrected visual acuity was 1.47 ± 0.41 and 0.42 ± 0.15 logarithm of the minimum angle of resolution (logMAR), respectively (P = .001). The preoperative best corrected visual acuity (BCVA) ranged from 1.30 to 0.40 logMAR with a mean value of 0.81 ± 0.30 logMAR. Postoperatively, all patients had an increase in the BCVA with a mean value of 0.20 ± 0.11 logMAR, which was statistically significant (P = .001). The mean preoperative and postoperative spherical equivalent was -9.69 ± 4.59 and -0.27 ± 1.21 diopters, respectively.

CONCLUSIONS

Despite the small number of patients in this study, good visual results and a low complication rate were obtained in patients with ectopic lens. The long-term IOL status in patients who have undergone sutureless scleral-fixated IOL implantation will make it possible to better evaluate the safety and applicability of the technique. [J Pediatr Ophthalmol Strabismus. 2021;58(6):401-406.].

Long-term follow-up after scleral lens fixation in patients with Marfan syndrome

Background

The dislocation of the crystalline lens is a common finding in patients with Marfan syndrome (MFS). Scleral intraocular lens (IOL) fixation is an accepted treatment method of this complication. To now, no long-term data on scleral IOL fixation in MFS exist.

Methods

We present a retrospective study of 27 eyes of 17 MFS patients that underwent scleral lens fixation at our clinic between 1999 and 2012. These patients are compared to an age- and surgeon-matched group of 31 eyes of 27 patients who underwent the same procedure for reasons other than MFS.

Results

The median age in the MFS group was 35.4 years versus 35.6 years in the non-MFS group. The median follow-up was 4 years for MFS and 3 years for non-MFS. In the MFS group, significantly more IOL-dislocations occurred than compared to the non-MFS group (30% vs. 6.5%, p = 0.02). Retinal detachment occurred in four MFS-eyes compared to three eyes in the non-MFS group. Biometry prediction error was 1.11 diopters (D) for MFS and 1.33 D for non-MFS (p = 0.11). Median BCVA (best-corrected visual acuity, logMAR) was 0.1 in the MFS group versus 0.3 in non-MFS patients.

Conclusion

Scleral lens fixation in MFS patients achieves satisfying visual and refractive outcomes. Our data shows a significantly higher rate of IOL dislocations in patients with MFS. We therefore recommend addressing this complication preoperatively.

Electronic supplementary material

The online version of this article (10.1186/s12886-017-0625-x) contains supplementary material, which is available to authorized users.

Scleral fixation of one piece intraocular lens by injector implantation

Aim of Study:

With an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fixation through small clear corneal incision.

Materials and Methods:

Case report and literature review.

Results:

This procedure has been performed in eight aphakic eyes with four different types of IOLs. Good centration was achieved with minimal technical effort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up.

Conclusion:

We managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fluid leakage and consecutive hypotony can be minimized.

Sulcus Fixation of Foldable Intraocular Lenses Guided by Ultrasound Biomicroscopy

Background. To evaluate the clinical efficacy of suture fixation of foldable intraocular lens (IOL) in ciliary sulcus guided by ultrasound biomicroscopy (UBM). Methods. Thirty-five eyes of 32 cases needing suture fixation of foldable IOL in ciliary sulcus in our hospital were collected and divided into two groups: group A and group B. In group A, UBM was performed on 19 eyes of 17 cases before surgery to locate the projection position of ciliary sulcus in iris surface. In group B, the traditional sulcus fixation of IOL was performed on 16 eyes of 15 cases. The inserting position of needles, the haptics position of IOL and the IOL tilt, and decentration were observed by UBM examination 3 months after the surgery. Meanwhile, the vision and contrast sensitivity were analysed. Results. The differences in inserting position of the needle, the IOL tilt and decentration, the ratio of IOL haptics in sulcus, and uncorrected visual acuity were statistically significant (P < 0.05). The differences in best corrected visual acuity (BCVA) and contrast sensitivity were not statistically significant (P > 0.05). Conclusions. Sulcus fixation of foldable IOL aided by UBM can increase the accuracy of IOL haptics implanted into ciliary sulcus and reduce the IOL tilt and decentration.

Use of pars plana vitrectomy with phacoemulsification in vitreous cavity to treat complete posterior dislocation of lens

Background

The purpose of this study was to evaluate pars plana vitrectomy (PPV) with phacoemulsification in the vitreous cavity for treatment of complete posterior dislocation of the lens without any damage to the lens capsule.

Methods

We evaluated factors such as cause of dislocation, scleral fixation of an intraocular lens (IOL), preoperative and postoperative visual acuity, corneal endothelial cell density, and intraoperative and postoperative complications.

Results

Displacement in the eleven eyes studied was mostly caused by ocular trauma and was idiopathic (four eyes each). Scleral fixation of the IOL was performed in seven of the eyes during first-time PPV. Visual acuity was improved in two eyes, unchanged in eight eyes, and worse in one eye. Mean corneal endothelial cell density was 2485 cells/mm² preoperatively and 2301 cells/mm² postoperatively. No significant differences were seen before and after the surgeries (P = 0.15, paired t-test). Intraoperative complications included retinal detachment and suprachoroidal hemorrhage in one eye each. The most common postoperative complication was transient ocular hypertension, which occurred in three eyes. IOL dislocation and vitreous incarceration of the anterior chamber in one eye required a second operation, while retinal detachment in one eye required a third operation.

Conclusion

When treating a completely dislocated lens, prevention of retinal detachment which subsequently can affect the visual prognosis is the most important factor to be addressed after PPV with intravitreal phacoemulsification.