Long-Term Suture Breakage After Scleral Fixation of a Modified Capsular Tension Ring with Polypropylene 10-0 Suture

4-Point scleral fixation technique using Gore-tex® sutures for cut-out plated haptic intraocular lenses

Purpose

To report a 4-point scleral fixation technique utilizing Gore-tex® CV8 sutures and cut-out plated haptic intraocular lenses (IOLs) lacking a 4-eyelet haptic design for aphakic patients.

Observations

This scleral fixation technique utilizes Gore-tex CV8® sutures paired with a foldable, monofocal, cut-out plated haptic IOLs wherein the sutures are passed through the holes of the plate haptics. Initially, sectoral conjunctival peritomies are performed on the temporal and medial conjunctiva. This is followed by the creation of 4 sclerotomy sites 5mm from each other and 2mm from the limbus at the exposed medial and temporal sclera. A Gore-Tex® (CV8) suture is threaded under the plate haptic. The leading suture is then inserted intraocularly through the corneal incision and externalized through the inferior sclerotomy. The trailing end of the suture which is over the haptic plate is passed intraocularly and externalized through the same port. The externalized suture is brought back intraocularly through the superior sclerotomy and then re-externalized through the corneal incision. This suture end is then threaded through the superior portion of the plate haptic in an over-under fashion. The suture which has passed under the haptic plate, is then brought back intraocularly through the corneal incision and externalized through the superior sclerotomy creating a loop. The same steps are then performed on the contralateral side. The IOL is then inserted. Centration of the IOL is then achieved by adjusting the tension on the 4 externalized suture ends. The Gore-Tex® sutures are then tied and subsequently buried into the sclerotomy. Conjunctival peritomies are then repaired.

Conclusions and importance

Four-point fixation of cut-out plate haptic IOLs is achievable with predictable outcomes showing good centration, stability, visual and refractive outcomes providing surgeons additional options for fixation of available lenses as a secondary or primary implantation or by fixation of subluxed or dropped plate IOLs.

Double-flanged polypropylene technique: 5-year results

PURPOSE

To assess the long-term (5-year) results and complications of the double-flanged polypropylene technique in patients with capsular tension segment fixation, nonfoldable intraocular lens (IOL) scleral fixation, and foldable IOL scleral fixation.

SETTING

Santa Casa de Belo Horizonte and Centro Oftalmológico de Minas Gerais.

DESIGN

Prospective case series.

METHODS

Eyes that underwent treatment using the double-flanged polypropylene technique between September 2016 to September 2021 were included. LogMAR visual acuity was recorded, as well as complications such as long-term polypropylene resistance, conjunctival erosion, conjunctival inflammation, flange exposure, internalization, endophthalmitis, retinal detachment, and cystoid macular edema.

RESULTS

71 eyes of 61 patients were evaluated. The mean follow-up period for these eyes was 28.2 ± 14.3 (min: 4; max: 60; median: 26) months. 173 flanges were performed. 13 cases with sub-Tenon flanges (7.5%) were observed. 5 exposed flanges (2.89%), presented after a mean of 1.8 weeks postoperatively, were observed. 1 patient with large flanges presented with conjunctival inflammation and hyperemia. 2 late internalized flanges (1.1%) and 2 recently internalized flanges (1.1%) were observed. 3 eyes (4.22%) had retinal detachment. Moreover, cystoid macular edema was detected in 3 eyes (4.22%). No cases of endophthalmitis were observed.

CONCLUSIONS

The double-flanged technique was proven to be stable when the correct technical procedure was followed. However, complications can be observed, especially with short scleral tunnels and in eyes where the flanges were not buried inside the sclera.

Treatment of long-term endophthalmitis developing after intraocular lens implantation in children: a retrospective study

Background

To discussed the risk factor and the management of vitrectomy for long-term endophthalmitis developing after intraocular lens (IOL) implantation in children.

Methods

We retrospectively investigated the clinical characteristics and surgical outcomes of long-term endophthalmitis developing after IOL implantation in children.

Results

Four eyes of four children were included in the study. The mean time to endophthalmitis development after IOL implantation was 3.0 ± 0.8 years. The corneal or scleral sutures may have been caused the infection. All 4 patients underwent vitrectomy and received intravitreal antibiotics with or without IOL removal. At the last follow-up, the outcomes were satisfactory; the fundus was clear, the retina remained attached, the visual acuity improved, and there were no severe complications.

Conclusions

The use of scleral sutures and the exposure of conceal sutures may induce the onset of long-term endophthalmitis after IOL implantation. Complete vitrectomy and appropriate use of antibiotics are effective in the treatment of long-term endophthalmitis developing after IOL implantation in children.