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Baur ID, Winkelmann I, Albrecht M, Botros Y, Auffarth GU, Khoramnia R. [Correction of aphakia in cases of insufficient capsular bag stability]. DIE OPHTHALMOLOGIE 2024; 121:872-885. [PMID: 39172164 DOI: 10.1007/s00347-024-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024]
Abstract
A variety of situations can lead to the need for an alternative method of intraocular lens (IOL) fixation if implantation in the capsular bag is not possible. Depending on the situation, sulcus-fixated IOLs, iris-fixated IOLs (IFIOLs) and scleral-fixated IOLs (SFIOLs) are available. With SFIOLs, a distinction is made between suture-fixated and sutureless-fixated techniques. This paper summarizes the advantages and disadvantages of the different approaches, including the newer methods of sutureless SFIOLs. The decision on a specific approach in the individual case depends on both the individual circumstances of the patient and the experience of the surgeon.
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Affiliation(s)
- Isabella D Baur
- Augenklinik des Universitätsklinikums Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Isabel Winkelmann
- Augenklinik des Universitätsklinikums Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Michael Albrecht
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Youssef Botros
- Augenklinik des Universitätsklinikums Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Gerd U Auffarth
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Ramin Khoramnia
- Augenklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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Toptan M, Yilmaz OF, Oguz H. Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes. Int Ophthalmol 2024; 44:269. [PMID: 38914871 PMCID: PMC11196301 DOI: 10.1007/s10792-024-03187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/15/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. METHODS A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior-posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). RESULTS There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). CONCLUSION In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.
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Affiliation(s)
- Müslüm Toptan
- Department of Ophthalmology, School of Medicine, Harran University, Sanlıurfa, Turkey.
| | - Omer Faruk Yilmaz
- Department of Ophthalmology, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Halit Oguz
- Department of Ophthalmology, Medeniyet University Göztepe Prof. Dr. Süleyman Yalçin City Hospital, Istanbul, Turkey
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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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Chang YM, Weng TH, Tai MC, Chen YH, Lee CH, Chang WC, Hsieh MW, Chien KH. A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia. Sci Rep 2024; 14:2044. [PMID: 38267491 PMCID: PMC10808084 DOI: 10.1038/s41598-023-49084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
This study compared the visual outcomes and complications between sutureless scleral-fixated intraocular lens and iris claw intraocular lens implantation in aphakia without adequate capsule and/or zonule support. Studies comparing the clinical outcomes of scleral-fixated intraocular lens and iris claw intraocular lens implantation published until April 2022 were retrieved from the PubMed, EMBASE, Cochrane Library, and Google Scholar databases. The outcomes included postoperative final visual acuity, surgical time, surgery-induced astigmatism, and complications. The weighted mean difference and odds ratio were calculated. Two randomized controlled trials and five cohort studies, including 244 and 290 eyes in the scleral-fixated intraocular lens group and iris claw group, respectively, were included. Scleral-fixated intraocular lens implantation results in a better postoperative final corrected distance visual acuity compared with iris claw intraocular lens implantation; however, it is more time-consuming. Scleral-fixated intraocular lens implantation seems to have lesser incidences of surgery-induced astigmatism. Furthermore, both procedures have a similar complication rate. Therefore, based on current best evidence, these two procedures should be considered according to patient's conditions.
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Affiliation(s)
- Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Cheng Chang
- Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China.
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Ucar F, Cetinkaya S, Kahraman H, Yener HI. Changes in Intraocular Lens Explantation Indications and Comparison of Various Explantation Techniques. Am J Ophthalmol 2024; 257:84-90. [PMID: 37422203 DOI: 10.1016/j.ajo.2023.06.025] [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: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To examine the current causes of intraocular lens (IOL) explantation, compare various IOL explantation techniques, and assess the visual outcomes and complications. DESIGN Retrospective comparative case series. PARTICIPANTS A total of 175 eyes of 160 patients who underwent IOL exchange for a one-piece foldable acrylic IOL between January 2010 and March 2022 were covered by the research. Group 1 included 74 eyes from 69 patients in which the IOL was removed after being grasped, pulled, and refolded inside the main incision. Group 2 consisted of 66 eyes from 60 patients in which the IOL was removed by bisecting it, whereas group 3 included 35 eyes from 31 patients in which the IOL was removed by enlarging the main incision. MAIN OUTCOMES Surgical indications, interventions, visual outcomes and refraction, and complications. RESULTS The mean patient age was 66.1 ± 10.5 years. The mean time between primary surgery and IOL explantation was 57.0 ± 38.9 months. IOL dislocation (in 85 eyes, 49.5%) was the most common reason for IOL explantation. When the patients were examined in terms of both surgical indication groups and IOL removal techniques, corrected-distance visual acuity increased significantly in all subgroups (P < .001). The increase in astigmatism after surgery was 0.08 ± 0.13 diopters (D) in group 1, 0.09 ± 0.17 D in group 2, and 0.83 ± 0.29 D in group 3 (P < .001). CONCLUSIONS The grasp, pull, and refold technique for IOL explantation provides a simpler surgery, less complication, and good visual outcomes.
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Affiliation(s)
- Fikret Ucar
- From the Department of Ophthalmology, Konyagoz Eye Hospital (F.U., S.C., H.I.Y.).
| | - Servet Cetinkaya
- From the Department of Ophthalmology, Konyagoz Eye Hospital (F.U., S.C., H.I.Y.)
| | - Hilal Kahraman
- Department of Ophthalmology, Beyhekim Training and Research Hospital (H.K.), Konya, Turkey
| | - Halil Ibrahim Yener
- From the Department of Ophthalmology, Konyagoz Eye Hospital (F.U., S.C., H.I.Y.)
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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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[Secondary implantation of retropupillary fixated iris-claw intraocular lenses]. DIE OPHTHALMOLOGIE 2023; 120:184-190. [PMID: 36028580 DOI: 10.1007/s00347-022-01714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no standard for the treatment of functional aphakia in cases with a compromised capsular system. Retropupillary fixation of an Artisan iris-claw IOL ("Intraokularlinse") is one of the established procedures. OBJECTIVE Aim of this study was the evaluation of indications, visual and refractive long-term results and complication rates after retropupillary implantation of an iris-claw lens. MATERIAL AND METHODS This retrospective study comprised 366 eyes that received a retropupillary Artisan intraocular lens (IOL) in a single center between January 2009 and December 2019. The mean follow-up period was 249 days (8 months) ±516 days. RESULTS IOL dislocation (68%) was the most common reason for a retropupillary iris-claw implantation. Previous vitrectomy was a significant preoperative risk factor for IOL dislocation (p = 0.0001). Best corrected visual acuity improved from 0.65 ± 0.64 (logMAR) preoperatively to 0.57 ± 0.51 (logMAR) 4-6 weeks after the surgery. The mean deviation from the planned refraction was +0.40 ± 1.37 dpt and 73% of the patients had a deviation within ±1 dpt of the planned refraction. Relevant postoperative complications during the first 4 weeks were pupillary distortion (42%), ocular hypotony (15%) and transient hyphema (14%). Late complications (≥4 weeks after the surgery) included persistent pupillary distortion (20%), cystoid macular edema (13%) and iris-claw disenclavation (6%). CONCLUSION The retropupillary Artisan implantation is an efficient method for treating aphakia without capsular support and provides good visual and refractive results with an acceptable surgical risk profile.
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Fernández Berdasco K, Castro Navarro J, González Castaño CN, Rodríguez Villa S, García Fernández M. Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:317-322. [PMID: 35676024 DOI: 10.1016/j.oftale.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.
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Affiliation(s)
- K Fernández Berdasco
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - J Castro Navarro
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - C N González Castaño
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - S Rodríguez Villa
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - M García Fernández
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Shahid SM, Flores-Sánchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, Charteris DG. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond) 2021; 35:2930-2961. [PMID: 34117388 PMCID: PMC8526814 DOI: 10.1038/s41433-021-01571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/08/2022] Open
Abstract
Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.
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Affiliation(s)
- S M Shahid
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK.
| | | | - E W Chan
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - R Anguita
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - S N Ahmed
- Ophthalmology Department, Northampton General Hospital, Cliftonville, Northampton, UK
| | - L Wickham
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - D G Charteris
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
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Thulasidas M. Retropupillary Iris-Claw Intraocular Lenses: A Literature Review. Clin Ophthalmol 2021; 15:2727-2739. [PMID: 34211261 PMCID: PMC8240859 DOI: 10.2147/opth.s321344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 01/02/2023] Open
Abstract
Retropupillary iris-claw intraocular lenses (ICIOLs) have been increasingly chosen by surgeons nowadays as a primary or secondary procedure of IOL implantation in eyes with insufficient capsular or zonular support. They have gained popularity due to their simple fast technique, favourable functional outcomes, and safety. The transition in the ICIOL fixation from prepupillary to a more biologically appropriate retropupillary position and change in the optic design from biconvex to convex-concave have provided better visual outcomes and improved safety. A peer-reviewed literature search was conducted in Medline (PubMed), Embase, and Cochrane Library using the keywords "retropupillary iris claw" and "iris claw". The search yielded 310 articles that were screened. Forty-three articles on retropupillary ICIOLs were finally found to be relevant and reviewed in full-text versions. The functional outcomes following retropupillary implantation of ICIOLs have been acceptable in eyes with no ocular co-morbidities otherwise. However, the indications for surgery may affect the outcomes. The major postoperative complications directly associated with ICIOLs include pupil ovalization and redislocation. Nevertheless, the rate of disenclavation depends on the experience and skill of the surgeon. This review is based on a literature review, and it focuses on the preoperative evaluation, surgical technique, postoperative outcomes, and associated complications. Prospective randomized trials with a larger sample size and longer follow-up are needed for comparison with other techniques of IOL fixation and confirmation of long-term safety profile.
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Affiliation(s)
- Mithun Thulasidas
- Cataract and Glaucoma services, Sankara Eye Hospital, Coimbatore, Tamil Nadu, 641035, India
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Forlini M, Bedi R. Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses. J Cataract Refract Surg 2021; 47:792-801. [PMID: 33278236 DOI: 10.1097/j.jcrs.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Cataract surgery via phacoemulsification with intraocular lens (IOL) placement in the capsular bag is the gold standard in the presence of adequate capsular support. However, when capsule and/or zonular fibers are weak or absent, alternate fixation strategies are required. Common alternative options include retropupillary iris-claw IOLs (RP-IC IOLs) and scleral-fixated IOLs (SF IOLs). In the present review of 87 articles with 2174 eyes implanted with RP-IC IOLs and 2980 eyes with SF IOLs, we discuss the published literature with respect to safety and efficacy. Although the studies reporting outcomes of these IOLs have been performed in patients with different concomitant conditions, visual and refractive outcomes were found to be comparable between RP-IC IOLs and SF IOLs. RP-IC IOL implantation seemed to provide equivalent or a potentially lower rate of complications than SF IOL implantation. Data from the literature also suggest that the surgical technique of RP-IC IOL implantation is relatively simpler with correspondingly shorter surgical times.
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Affiliation(s)
- Matteo Forlini
- From the Domus Nova Hospital, Ravenna, Italy (Forlini); Iris Advanced Eye Center, Chandigarh, India (Bedi)
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Muth DR, Wolf A, Kreutzer T, Shajari M, Vounotrypidis E, Priglinger S, Mayer WJ. Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview. Klin Monbl Augenheilkd 2021; 238:868-874. [PMID: 33853190 DOI: 10.1055/a-1333-3199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique. MATERIAL AND METHODS Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z). RESULTS Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up. CONCLUSION The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.
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Affiliation(s)
- Daniel Rudolf Muth
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Armin Wolf
- Augenklinik des Universitätsklinikums Ulm, Deutschland
| | - Thomas Kreutzer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Mehdi Shajari
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | | | - Siegfried Priglinger
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Wolfgang J Mayer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
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