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Guerin PL, Guerin GM, Pastore MR, Gouigoux S, Tognetto D. Long-term functional outcome between Yamane technique and retropupillary iris-claw technique in a large study cohort. J Cataract Refract Surg 2024; 50:605-610. [PMID: 38350232 PMCID: PMC11146187 DOI: 10.1097/j.jcrs.0000000000001421] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To evaluate which secondary intraocular lens (IOL) implantation technique was more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw IOL (ICIOL) and flanged intrascleral IOL (FIIOL) fixation with the Yamane technique. SETTING Eye Clinic of the University of Trieste, Trieste, Italy. DESIGN Retrospective observational study. METHODS 116 eyes of 110 patients who underwent ICIOL or FIIOL were analyzed. Patients with follow-up shorter than 6 months or with incomplete clinical data were excluded. Collected data included demographics, ocular comorbidity, indication of surgery, intraocular pressure, early (≤1 month) and late (>1 month) postoperative complications, corrected distance visual acuity (CDVA), and manifest refraction at the last follow-up visit. RESULTS 50% (n = 58) of eyes underwent FIIOL and 50% (n = 58) ICIOL implantation for aphakia (n = 44, 38%) and IOL dislocation (n = 72, 62%). No statistically significant differences in demographics, comorbidity, follow-up duration, postoperative complications, and surgical indications were found. The refractive prediction error (RPE) was 0.69 ± 0.94 diopter (D) in the FIIOL group and 0.21 ± 0.75 D in the ICIOL group ( P = .03), indicating residual hyperopia after both techniques. RPE, mean absolute error, and median absolute error were higher in the FIIOL group ( P = .003). ICIOL implantation was more successful in obtaining a RPE between -0.50 D and +0.50 D (52% of ICIOL, n = 30, and 31% of FIIOL, n = 18). CONCLUSIONS Both techniques were effective in increasing preoperative CDVA with no statistical difference between them. Although complication rates did not significantly differ, the FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-piece IOL, as performed in ciliary sulcus implantation, to prevent myopic shift, is not recommended.
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Affiliation(s)
- Pier Luigi Guerin
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Gian Marco Guerin
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Marco Rocco Pastore
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Stefano Gouigoux
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
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Magyar M, Szentmáry N, Ujváry L, Sándor GL, Schirra F, Nagy ZZ, Tóth G. Indications and Outcomes of Intraocular Lens Explantation in a Tertiary Eyecare Center in Hungary between 2006 and 2020. J Ophthalmol 2024; 2024:6653621. [PMID: 38827421 PMCID: PMC11142860 DOI: 10.1155/2024/6653621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose Our study aimed to evaluate the indications and outcomes of intraocular lens (IOL) explantation surgeries in a tertiary eyecare center in Hungary. Materials and Methods This retrospective study included all IOL explantation surgeries performed between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary. There were no exclusion criteria for this study. For each patient, the demographics, clinical history, preoperative status, indications for IOL explantation, and operative and postoperative details were reviewed. Primary outcomes included explantation indications and the type of secondary implanted IOL. Results A total of 161 eyes from 153 patients were included (96 males; 62.7%); age at the time of the IOL explantation was 65.0 ± 17.4 years. The mean time between primary cataract surgery and IOL explantation was 8.5 ± 7.7 years. In total, 139 (86.3%) PCIOLs and 22 (13.7%) ACIOLs were explanted. The main indications for IOL explantation were dislocation (n = 133; 95.7%) and refractive cause (n = 2; 1.4%) in the PCIOL group. Among ACIOL explantations, the main reasons were pseudophakic bullous keratopathy (n = 14; 63.6%), dislocation (n = 4; 18.2%), and refractive cause (n = 2; 9.1%). In the PCIOL group, 115 (82.7%) primary IOLs were implanted in the capsular bag, 16 (11.5%) were sulcus fixated, and 8 (5.8%) were scleral fixated. The most frequent ocular comorbidities were previous vitrectomy (n = 50, 31.1%), previous ocular trauma (n = 45, 28.0%), glaucoma (n = 16, 9.9%), pseudoexfoliation syndrome (n = 15, 9.3%), and high axial myopia (n = 14, 8.7%). The most commonly used secondary IOL implant was the prepupillary iris-claw IOL (n = 115, 73.7%), followed by the retropupillary iris-claw IOL (n = 32, 20.5%). Uncorrected visual acuity (UCVA) was significantly better following IOL exchange in the entire sample (1.57 ± 0.61 (range: 2.40-0.05) vs. 0.77 ± 0.56 (range: 2.40-0.00); p < 0.001). Best-corrected visual acuity (BCVA) was maintained or improved in 80.7% of cases after IOL explantation. Conclusions The most common indication for IOL explantation at a tertiary eyecare center in Hungary is IOL dislocation, followed by pseudophakic bullous keratopathy. Prepupillary and retropupillary iris-claw IOL are the most frequently used secondary implants and their use resulted in a significant UCVA improvement following IOL exchange.
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Affiliation(s)
- Márton Magyar
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Nóra Szentmáry
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Kirrberger Str. 100 66424, Homburg, Saar, Germany
| | - László Ujváry
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Gábor László Sándor
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Frank Schirra
- Argos Augenzentrum, Faktoreistraße 4 66111, Saarbrücken, Germany
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Gábor Tóth
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Kirrberger Str. 100 66424, Homburg, Saar, Germany
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Almeida J, Costa TR, Vivas M, Monteiro C, Vaz FT, Silva DS, Prieto I. A new approach for single-haptic retropupillary iris-claw lens subluxation - The "fencing" technique. Eur J Ophthalmol 2024; 34:884-887. [PMID: 38115710 DOI: 10.1177/11206721231222792] [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: 12/21/2023]
Abstract
INTRODUCTION Single-haptic iris-claw intraocular lens (IOL) dislocation is not an uncommon complication. A few different surgical techniques are available for its refixation but usually involve a more invasive approach. We aim to demonstrate an original and simple approach for refixation of single haptic retropupillary iris-claw IOL subluxations. METHODS We present a case of an 80-year-old male with a single haptic retropupillary iris-claw IOL subluxation in a previously vitrectomized eye. We used a new surgical approach to refix this type of subluxation. RESULTS This new technique uses only two 30-gauge needles (one of them connected to a viscosurgical device) to re-enclavate the subluxated haptic of the retropupillary iris-claw IOL. By minimising surgical manipulation, the patient's postoperative period was uneventful. CONCLUSIONS We highlight a new, quick, safe, and unusual surgical approach to single-haptic retropupillary iris-claw IOL dislocation in vitrectomized eyes. Because of its characteristics, we named it the "fencing" IOL repositioning technique.
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Affiliation(s)
- Júlio Almeida
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
| | - Tomás R Costa
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
| | - Maria Vivas
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
| | - Catarina Monteiro
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
| | - Fernando T Vaz
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
| | - Diana S Silva
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
| | - Isabel Prieto
- Ophthalmology department, Prof. Doutor Fernando Fonseca Hospital, Lisbon, Portugal
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Khoramnia R, Baur ID, Auffarth GU. Aetiology and Management of IOL Dislocations. Klin Monbl Augenheilkd 2023; 240:971-980. [PMID: 37494272 DOI: 10.1055/a-2074-9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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João MD, Costa JV, Sousa K, Monteiro T, Lopes N, Calvão-Santos G, Cruz C, Vaz F. Visual and refractive outcomes following secondary intraocular lens implantation. Semin Ophthalmol 2022; 37:619-625. [PMID: 35245158 DOI: 10.1080/08820538.2022.2046805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the visual and refractive results after secondary IOL implantation using different surgical techniques - iris-claw aphakic IOL through a corneal incision or scleral tunnel, and 3-piece IOL into the ciliary sulcus. PATIENTS AND METHODS Retrospective study including patients that were submitted to secondary IOL implantation from January 2017 to December 2019 at the Department of Ophthalmology of Hospital de Braga, Portugal. We collected demographic data (age, surgical indication, comorbidities, surgical technique, IOL implanted, and intra and postoperative complications) and visual and refractive data [preoperative and 3-month, 6-month, and 12-month postoperative corrected-distance visual acuity (CDVA), spherical equivalent (SE), manifest cylinder, and intraocular pressure]. RESULTS 128 eyes from 123 patients were included. The most frequent surgical indications were IOL subluxation/luxation (62.5%) and intraoperative posterior capsular rupture (23.4%). CDVA improved from 1.26 ± 0.51 to 0.47 ± 0.49 logMar (p < .001). CDVA was significantly better in the 3-piece into the ciliary sulcus IOL group than both other groups. The final SE was -0.68 ± 0.94 diopters. The mean manifest refractive cylinder remained stable until the 6th month after the surgery (p = .454) and improved in the last 6 months of follow-up (p = .015). In the postoperative period, the cylinder was higher in the corneal incision iris-claw aphakic IOL group and lower in the 3-piece IOL into the ciliary sulcus group (p < 0,05). The corneal incision iris-claw aphakic IOL group presented the most postoperative complications. CONCLUSION All techniques showed satisfying results. The 3-piece IOL into the ciliary sulcus group showed the best visual and refractive performance, followed by the scleral tunnel iris-claw IOL group and the corneal incision iris-claw IOL group.
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Affiliation(s)
| | | | - Keissy Sousa
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Tiago Monteiro
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Nuno Lopes
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | | | - Carlos Cruz
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Fernando Vaz
- Ophthalmology Department, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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Sun Y, Hammer M, Yildirim TM, Khoramnia R, Auffarth GU. Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation. Sci Rep 2021; 11:21436. [PMID: 34728749 PMCID: PMC8564516 DOI: 10.1038/s41598-021-01051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
An Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.
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Affiliation(s)
- Yanxiu Sun
- Department of Ophthalmology, Peking University Third Hospital, Northgarden Road 49, Haidian District, Beijing, 100191, China.,International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Maximilian Hammer
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur M Yildirim
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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