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Barbieri F, Maglionico MN, Casini G, Guidi G, Figus M, Posarelli C. Current Evidence for a New Surgical Technique for Scleral Fixation: The Implantation of a Carlevale Lens, a Systematic Review. J Clin Med 2024; 13:3287. [PMID: 38892997 PMCID: PMC11172714 DOI: 10.3390/jcm13113287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The Carlevale lens (FIL SSF, Soleko IOL Division, Italy) is a new lens for suture-less scleral fixation. This paper aimed to systematically review articles on this lens, the surgical techniques used for its implantation, complications and outcomes. Methods: This systematic review was performed following the PRISMA guidelines. The search string used was "Carlevale" AND "scleral fixation" from inception until March 2024. For completeness, either case-control studies, case reports or case series written in English were included. The authors used the Newcastle-Ottawa scale for the case-control studies and the JBI Critical Appraisal Checklist for case reports and case series. Results: Twenty-nine articles were included. Scleral fixation with Carlevale lens can be performed by creating scleral flaps or, alternatively, by using scleral pockets. The two sclerotomies must be diametrically opposed, and are preferably created by 25-gauge trocars. A pars plana vitrectomy should be performed every time, and the design of the lens should be suitable for self-anchoring to the sclera; the most accredited strategy to achieve this is to avoid scleral sutures. There were only a few intraoperative and postoperative complications reported; vitreous hemorrhages were the most frequent intraoperative events, while the most relevant postoperative complications were vitreous hemorrhages, cystoid macular oedema and transient variations in the intraocular pressure. Excellent results have been obtained in terms of BCVA, IOL centration and stability, mean intraocular pressure, postoperative spherical equivalent, separation between anterior and posterior chamber and the distance of the IOL from anterior chamber structures. Conclusions: The foldable hydrophilic design of the Carlevale lens has shown good effectiveness, IOL stability and few intra and post-operative complications.
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Affiliation(s)
- Francesca Barbieri
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
| | - Giamberto Casini
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
| | - Gianluca Guidi
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (F.B.); (M.N.M.); (M.F.)
- Ophthalmology, Department of Medical and Surgical Specialties, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy; (G.C.); (G.G.)
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Carlà MM, Boselli F, Giannuzzi F, Caporossi T, Gambini G, Mosca L, Savastano A, Rizzo S. Sutureless scleral fixation Carlevale IOL: a review on the novel designed lens. Int Ophthalmol 2022; 43:2129-2138. [DOI: 10.1007/s10792-022-02579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
Abstract
AbstractBackground: Complicated cataract surgery is the main cause of secondary lens implantation surgery. Several approaches have been introduced to face those circumstances. As it concerns scleral-fixated IOLs for the posterior chamber, many types of IOL can be implanted. The aim of article is to review the single piece sutureless scleral fixation Carlevale lens; Methods: Narrative review; Results: Several works described as safe the IOL implantation utilizing the handshake approach, without tactile manipulation, which allows for self-centration and lens firm fixation in uncomplicated surgery. This allows to reduce high order aberration such as astigmatism and coma, with a very good postoperative BCVA Conclusions: Carlevale lens is one of the best option to manage insufficient capsular support.
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Behera UC, Thakur PS. Scleral Fixation of Intraocular Lens in Aphakic Eyes without Capsular Support: Description of a New Technique. Clin Ophthalmol 2021; 15:4689-4696. [PMID: 34949910 PMCID: PMC8689012 DOI: 10.2147/opth.s344506] [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: 10/21/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the efficacy and safety of a modified trans-scleral intraocular lens (IOL) fixation technique in aphakic eyes when performed by ophthalmologists in training. Methods The study was conducted in an institutional setting that included 43 surgeries performed by surgeons training in small incision cataract surgeries. The data were analyzed for stability and position of IOL, refractive changes, best-corrected vision, and associated complications. Results Mean age of the subjects was 53.8 ± 18.5yrs (range 6–81yrs). Surgical aphakia (58.14%) was the most common cause. The corrected distance visual acuity improved significantly at six weeks (p = 0.0003). The mean residual spectacle correction was +0.74 ± 1.2D spherical equivalent (cylinder −1.6±1.5D at 84 ± 50°) at the 6th-month follow-up (24.35 ± 6.71wks). Lens tilt on ultrasound biomicroscopy (kappa 0.762; p < 0.001) and the IOL centration (kappa 0.411; p = 0.001), assessed by two independent masked observers, were satisfactory at the 6th-month visit. Transient postoperative vitreous hemorrhage was the most common complication (46.5%). Cellular deposits on the IOL surface (18.6%), cystoid macular edema (11.6%), subconjunctival haptic exposure (4.66%), and haptic slippage (2.33%) were the other complications. Conclusion This method of trans-scleral IOL fixation is an effective rescue procedure for eyes with deficient capsular support when ophthalmologists perform in training.
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Affiliation(s)
- Umesh Chandra Behera
- Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, India
| | - Pratima Singh Thakur
- Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, India
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Dimensions of the limbus-ciliary sulcus region by OCT and correlation study in a large population. J Cataract Refract Surg 2021; 47:1573-1580. [PMID: 34653090 DOI: 10.1097/j.jcrs.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the dimensions of the limbus-ciliary sulcus region measured by swept-source optical coherence tomography (SS-OCT) and conduct a correlation study in a large healthy population. SETTING Centro Internacional de Oftalmología Avanzada, Madrid, Spain. DESIGN Cross-sectional study. METHODS The dimensions of the limbus-ciliary sulcus region were measured in the temporal and nasal quadrants using a SS-OCT. The limbus-sulcus distance (LSD), the posterior iris line-ocular surface to limbus distance (PIOLD), and the angle-to-sulcus distance (ASD) were measured. These distances were then assessed for correlations with factors such as age, sex, refractive error, anterior chamber angle (ACA), ciliary muscle thickness (CMT), conjunctival-Tenon capsule thickness (CTT), and anterior scleral thickness (AST). RESULTS The mean age of the participants was 41.0 ± 18.2 years (range 5 to 86) and the mean refractive error -0.75 ± 3.3 diopters (range -10 to 7). The LSD could be measured in 93.2% of the participants (625 eyes out of 670 eyes), with a mean of 1.35 ± 0.12 mm (range 0.96 to 1.75) and 1.33 ± 0.12 mm (range 1.05 to 1.68) in the temporal and nasal quadrants, respectively, and a correlation of R = 0.616 (P < .001) between them. PIOLD measured 2.22 ± 0.31 mm (1.42 to 2.98), and ASD was 0.21 ± 0.05 mm (0.01 to 0.40). No correlation was observed between LSD with age, spherical error, sex, or ACA (P ≥ .247). However, LSD exhibited the highest correlation with AST (R = 0.466), followed by CTT (R = 0.309) and CMT (R = 0.259). CONCLUSIONS The SS-OCT allowed for an accurate in vivo measurement of the dimensions of the limbus-ciliary sulcus region.
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Sevimli N, Karadag R, Çakıcı Ö. A review of techniques and challenges in performing sutureless intrascleral fixation of intraocular lens. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1999807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Neslihan Sevimli
- Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - Özgür Çakıcı
- Ophthalmology, Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
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Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens. J Clin Med 2021; 10:jcm10102216. [PMID: 34065508 PMCID: PMC8161112 DOI: 10.3390/jcm10102216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background. The management of patients with aphakia and/or lack of capsular support remains debated. The sutureless posterior chamber IOL (PCIOL) fixation is a very useful surgical option. The purpose of the study was to compare the early outcomes as well as post-operative best corrected visual acuity, refractive errors and complications of two different techniques of sutureless PCIOL secondary implantation. Methods. Patients who underwent secondary implantation from December 2019 to January 2021 in the Department of Ophthalmology of Creteil Hospital, and in the Granville Ophthalmology Center, were retrospectively included. Eyes implanted with the iris claw lens (Artisan Aphakia IOL model 205, Ophtec BV, Groningen, The Netherlands) were included in group 1, and eyes implanted with a newly developed sutureless trans-scleral plugs fixated lens (STSPFL, Carlevale lens, Soleko, Pontecorvo, Italy) were included in group 2. Results. Twenty-two eyes of 22 patients were enrolled in group 1, and twenty eyes of 20 patients in group 2. No difference was found in visual acuity between two groups (0.35 +/− 0.29 logmar for group 1 and 0.23 +/− 0.51 logmar for group 2) (p = 0.15) at mean post-operative follow up (6.19 +/− 3.44 months for group 1 and 6.42 +/− 3.96 months for group 2) (p = 0.13). Both the mean refractive error (MRE) and induced astigmatism (IA) were greater in group 1 compared to group 2, respectively: the MRE was 0.99 +/− 0.57 vs. 0.46 +/− 0.36 (p < 0.01), and IA was 1.72 +/− 0.96 vs. 0.72 +/− 0.52 (p < 0.01). Conclusions. No significant differences in terms of the recovery of visual acuity were found between the two groups. Group 2 (STPFL) gives better results in our sample due to less post-operative induced astigmatism and less refractive error.
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Wong HM, Kam KW, Rapuano CJ, Young AL. A Systematic Review on Three Major Types of Scleral-Fixated Intraocular Lens Implantation. Asia Pac J Ophthalmol (Phila) 2021; 10:388-396. [PMID: 33481393 DOI: 10.1097/apo.0000000000000369] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. DESIGN Systematic review. METHODS We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. RESULTS Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. CONCLUSIONS Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.
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Affiliation(s)
- Ho Ming Wong
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, US
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
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Janse van Rensburg E, Ryu CL, Vila N, Chen JC. Sutureless intrascleral fixation of intraocular lens through self-sealing sclerotomy wounds using haptic externalization and reinternalization technique. J Cataract Refract Surg 2020; 45:1367-1371. [PMID: 31564310 DOI: 10.1016/j.jcrs.2019.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/13/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
In eyes with absent or insufficient capsule support, three-piece posterior chamber intraocular lens (PC IOL) may be fixed to the sclera. Previous techniques involve the use of sutures, flaps, glue, needles, trocars, or intrascleral tunnels to fixate the distal tips of the haptics intrasclerally. Herein we describe a modified technique for the sutureless scleral fixation of a standard 3-piece PC IOL using self-sealing sclerotomies created with a crescent blade and a 20-gauge microvitreoretinal blade, and then reinserting the haptics to leave the tips inside the vitreous cavity. We believe the relative simplicity of this technique makes it widely applicable for the placement of an IOL with insufficient capsule support.
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Affiliation(s)
| | - Christina L Ryu
- McGill University, Montreal, Quebec, Canada; Minneapolis Veterans Affairs Health Care System, Minnesota, Minnesota, USA; University of Minnesota Department of Ophthalmology and Visual Neurosciences, Minneapolis, Minnesota, USA
| | | | - John C Chen
- McGill University, Montreal, Quebec, Canada.
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Suzuki Y, Tando T, Adachi K, Kudo T, Nakazawa M. Modified Intraocular Lens Intrascleral Fixation Technique Using Two Vitrectomy Ports as Lens Haptic Fixation Sites. Clin Ophthalmol 2020; 14:1223-1228. [PMID: 32440088 PMCID: PMC7212690 DOI: 10.2147/opth.s247920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction We developed a new technique that uses two of the vitrectomy ports as intraocular lens (IOL) haptic fixation sites and compared that with a conventional T-fixation method. Methods A total of 33 eyes were retrospectively divided into the port-fixation (n=21) and conventional (n=12) groups. For the port-fixation group, supranasal and inferotemporal trocars (25-gauge) were placed in the center of a T-shaped lamellar scleral incision 2 mm from the corneal limbus and a supratemporal trocar at 3.5 mm. Following a vitrectomy, along with lens or IOL extraction as needed, the infusion cannula was changed from an inferotemporal to supratemporal trocar. The first IOL haptic and trocar were then simultaneously withdrawn from the eye by grasping with vitreoretinal forceps, with the same performed for the second IOL haptic and trocar, after which the infusion cannula was removed. In the conventional group, 2 T-shaped scleral incisions and three trocars were separately placed. Results Postoperatively, transient ocular hypotension and hypertension were observed in a few eyes in both groups. At 6 months after surgery, astigmatism was 1.71±1.13 D in the port-fixation group and 2.21±1.78 D in the conventional group (p=0.40, t-test). Conclusion This new technique may be effective because of the lower number of scleral wounds.
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Affiliation(s)
- Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Toshio Tando
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Kobu Adachi
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Takashi Kudo
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Mitsuru Nakazawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
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Czajka MP, Frajdenberg A, Stopa M, Pabin T, Johansson B, Jakobsson G. Sutureless intrascleral fixation using different three-piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study. Acta Ophthalmol 2020; 98:224-236. [PMID: 31788964 DOI: 10.1111/aos.14307] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023]
Abstract
We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral (SIS) fixation of a standard three-piece PCIOL. Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL: transient/permanent corneal oedema (9-66.6%), uveitis (1.1-39.3%); iris-fixated IOL: pupil ovalization (16-47.7%); and sutured scleral-fixated IOL: suture breakage/exposure (6.1-11%), vitreous haemorrhage: (5.5-16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony (n = 20; 19.4%), corneal decompensation (n = 7; 6.7%), IOL dislocation (n = 6; 5.8%), cystoid macular oedema (n = 5; 4.8%), vitreous haemorrhage (n = 4; 3.8%) and retinal detachment (n = 4; 3.8%). Mean best corrected visual acuity improved from logMAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.
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Affiliation(s)
- Marcin Piotr Czajka
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Agata Frajdenberg
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Marcin Stopa
- Department of Ophthalmology Chair of Ophthalmology and Optometry Heliodor Swiecicki University Hospital Poznan University of Medical Sciences Poznan Poland
| | - Tomasz Pabin
- Department of Ophthalmology Chair of Ophthalmology and Optometry Heliodor Swiecicki University Hospital Poznan University of Medical Sciences Poznan Poland
| | - Björn Johansson
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology Sahlgrenska University Hospital Gothenburg Sweden
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Karadag R, Kilic G, Ardagil A, Demirok A. Trocar-assisted, flanged sutureless scleral-fixated intraocular lens implantation combined with silicone oil injection after penetrating keratoplasty surgery. GMS OPHTHALMOLOGY CASES 2020; 10:Doc03. [PMID: 32158638 PMCID: PMC7047885 DOI: 10.3205/oc000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a combined technique of trocar-assisted sutureless scleral-fixated intraocular lens implantation and silicone oil injection at the same session. Two 3 mm scleral tunnels were created 2 mm away from and parallel to the limbus with the 23-gauge vitrectomy trocars entering the sclera transconjunctivally at an angle of approximately 10° at the 3 o'clock and 9 o'clock meridians. After the 3-piece foldable IOL was delivered to the anterior chamber through the corneal incision, the tip of one of the IOL haptics was grasped with a 23-gauge serrated retinal forceps entered through the trocar located at the 3 o'clock meridian. Then the haptic was removed from the scleral tunnel together with the trocar out of the globe. The same procedure was applied to the other haptic. A transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. The ends of the haptics were cauterized to make a flange. The resultant flanges of the haptics were pushed back and fixed into the scleral tunnels. Perfluorooctane was taken out of the eye with vitreoretinal surgery and the silicone was injected into the eye to prevent hypotonia. No complications were seen intraoperatively or postoperatively. After 1-month follow-up period, IOL was seen stabilized.
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Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey
| | - Guler Kilic
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
| | - Aylin Ardagil
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
| | - Ahmet Demirok
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Goztepe, Istanbul, Turkey
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Flapless and sutureless intrascleral fixation of posterior chamber intraocular lens for correction of aphakia. J Cataract Refract Surg 2019; 44:929-931. [PMID: 30115294 DOI: 10.1016/j.jcrs.2018.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/07/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022]
Abstract
A new intrascleral fixation technique for a standard 3-piece posterior chamber intraocular lens (PC IOL) using a simple guide is described. To secure the haptics, 27-gauge scleral tunnels are created. Both haptics are secured extraocularly. The leading haptic of the PC IOL placed in the cartridge is released partly and introduced into the lumen of the guide. The PC IOL is inserted into the eye, and the leading haptic is externalized by pulling the guide gently through the 27-gauge sclerotomy site. The trailing haptic is externalized using the same procedure. This technique facilitates achieving minimally invasive sutureless intrascleral PC IOL fixation.
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Bedda AM, ElGoweini HF, Abdelhadi AM, Elhady AM. Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation. Int J Ophthalmol 2019; 12:1283-1289. [PMID: 31456918 DOI: 10.18240/ijo.2019.08.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens (PCIOL) implantation in aphakic eyes with insufficient or no capsular support. METHODS A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure (IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy (UBM) was done for 10 cases to evaluate optic tilt. RESULTS The study evaluated 42 eyes of 42 patients. The follow-up period was 6mo. Improvement of best corrected visual acuity (BCVA) one line occurred in 10 cases (23.8%) and loss of one line in 3 cases (7.1%). Intraoperative complications included: haptic kink in 4 cases (9.5%), haptic breakage in 1 case (2.4%), haptic dislocation in 1 case (2.4%), haptic slippage in 3 cases (7.1%), IOL dislocation in 1 case (2.4%) and sclerotomy related bleeding in 1 case (2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases (7.1%), choroidal detachment in 1 case (2.4%), cystoid macular edema (CME) in 1 case (2.4%), optic capture in 1 case (2.4%), subconjunctival haptic in 2 cases (4.8%), ocular hypotony in 4 cases (9.5%) and ocular hypertension in 1 case (2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases (30%). CONCLUSION Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus-provided axial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6mo.
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Affiliation(s)
- Ahmed M Bedda
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Hesham F ElGoweini
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Ahmed M Abdelhadi
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Amr M Elhady
- Department of Ophthalmology, the General Ophthalmology Hospital, Alexandria 21515, Egypt
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Karadag R, Gunes B, Aykut V, Oguz H, Demirok A. Scleral suture fixation technique for dislocated plate haptic toric IOL. Int Ophthalmol 2017; 38:2183-2186. [PMID: 28801741 DOI: 10.1007/s10792-017-0680-6] [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: 04/17/2017] [Accepted: 08/01/2017] [Indexed: 11/25/2022]
Abstract
Purpose We describe a scleral suture fixation technique for dislocated plate haptic toric intraocular lens (IOL) implantation. Materials and methods A double-armed 10-0 straight polypropylene suture was passed into the eye from the sclera (2 mm away from the limbus). A suture needle was passed through the hole on the corner of the IOL and pulled out from the paracentesis with a 27-gauge needle. Afterward, the suture needle was reinserted from the same paracentesis and then removed from the eye with the help of a 27-gauge needle entering the eye from a nearby point to the first scleral entrance. The needle was passed through the end of the loop and pulled slightly to initiate the formation of a cow-hitch knot. The same procedure was applied to the other hole on the plate haptic. Both sutures were adjusted and fixed to the sclera with a Z suture. Results No complications were observed and at the follow-up visits, uncorrected visual acuity was 0.8 with decimal. Conclusion Axial, sagittal, and rotational stability rules are taken into consideration, scleral fixation surgery for a dislocated plate haptic foldable toric IOL is an alternative method to eliminate astigmatic refractive error.
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Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey.
| | - Bahar Gunes
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey
| | - Veysel Aykut
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey
| | - Halit Oguz
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey
| | - Ahmet Demirok
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey
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PREVENTING PUPILLARY CAPTURE AFTER VITRECTOMY AND TRANSSCLERAL FIXATION OF AN INTRAOCULAR LENS: Iridotomy Using a Vitrectomy Probe. Retina 2017; 37:2112-2117. [PMID: 28098733 DOI: 10.1097/iae.0000000000001461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effects of concurrent iridotomy using a vitreous cutter probe on the prevention of pupillary capture in patients undergoing transscleral fixation of intraocular lens implantation. METHODS A total of 79 eyes from 79 patients, who underwent transscleral fixation of intraocular lens without preexisting vitreoretinal disorders and who were followed up for 6 months were included. Subjects were divided into a noniridotomy group (51 eyes) and an iridotomy group (28 eyes). After conventional 23-gauge vitrectomy and transscleral fixation of intraocular lens implantation in all patients, 28 patients underwent concurrent iridotomy intraoperatively. The patients were followed up to evaluate the incidence of surgery-related complications, including pupillary capture. RESULTS There were no statistically significant differences in the preoperative demographic findings between the two groups (all P > 0.05). There was a significant difference in pupillary capture in 15 eyes (29.4%) of the noniridotomy group, compared with 1 eye (3.6%) of the iridotomy group (P = 0.007). There were no differences in postoperative best-corrected visual acuity between the two groups, and no iridotomy-related complications were observed. CONCLUSION Concurrent iridotomy using a vitreous cutter probe is an easy, rapid, and effective procedure to prevent possible pupillary capture after combined vitrectomy and transscleral fixation of intraocular lens implantation.
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Karadag R, Celik HU, Bayramlar H, Rapuano CJ. Sutureless Intrascleral Fixated Intraocular Lens Implantation. J Refract Surg 2016; 32:586-97. [DOI: 10.3928/1081597x-20160601-03] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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Trocar-Assisted, Sutureless, Scleral-Fixated Intraocular Lens Implantation Combined With Penetrating Keratoplasty. Cornea 2016; 35:1261-5. [DOI: 10.1097/ico.0000000000000944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety Barricade Suture for Preventing Pupillary Capture of Intraocular Lens With Scleral Fixation. Retina 2016; 36:206-10. [DOI: 10.1097/iae.0000000000000821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karadag R, Bayramlar H, Cakici O. Sutureless scleral fixation of intraocular lenses. Graefes Arch Clin Exp Ophthalmol 2015; 253:1817-8. [PMID: 25726755 DOI: 10.1007/s00417-015-2973-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/18/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Remzi Karadag
- School of Medicine, Department of Ophthalmology, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey.
| | - Hüseyin Bayramlar
- School of Medicine, Department of Ophthalmology, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey
| | - Ozgur Cakici
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
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Totan Y, Karadag R. New approach: removal of silicone oil and trocar assisted sutureless scleral fixated intraocular lens implantation at the same session. Int J Ophthalmol 2014; 7:734-6. [PMID: 25161953 DOI: 10.3980/j.issn.2222-3959.2014.04.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/26/2013] [Indexed: 11/02/2022] Open
Affiliation(s)
- Yuksel Totan
- Department of Ophthalmology, Fatih University School of Medicine, Emek, Ankara 06500, Turkey
| | - Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Istanbul 34730, Turkey
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Karadag R, Bayramlar H, Cakici O. Is this really sutureless intrascleral pocket technique of transscleral fixation? KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:352-3. [PMID: 25120346 PMCID: PMC4130497 DOI: 10.3341/kjo.2014.28.4.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Huseyin Bayramlar
- Department of Ophthalmology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ozgur Cakici
- Department of Ophthalmology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
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Karadag R, Bayramlar H, Sari U. Is this really sutureless scleral intraocular lens fixation? J Cataract Refract Surg 2014; 40:851. [DOI: 10.1016/j.jcrs.2014.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Indexed: 10/25/2022]
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Karadag R, Bayramlar H, Sari U. Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 2014; 40:853-4. [DOI: 10.1016/j.jcrs.2014.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Indexed: 11/27/2022]
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Karadag R, Bayramlar H. Re: Yamane et al.: Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection (Ophthalmology 2014;121:61-6). Ophthalmology 2014; 121:e42. [PMID: 24780406 DOI: 10.1016/j.ophtha.2014.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/14/2014] [Indexed: 11/15/2022] Open
Affiliation(s)
- Remzi Karadag
- Department of Ophthalmology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Huseyin Bayramlar
- Department of Ophthalmology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
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Modified method of sutureless intrascleral posterior chamber intraocular lens fixation without capsular support. Eur J Ophthalmol 2014; 24:976. [PMID: 24474380 DOI: 10.5301/ejo.5000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 11/20/2022]
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