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Kannan NB, Dey Sarkar A, Vallinayagam M. A retrospective analysis of surgical outcome in sutureless glueless scleral fixation of foldable intraocular lens. Indian J Ophthalmol 2024; 72:S658-S663. [PMID: 38953133 PMCID: PMC11338433 DOI: 10.4103/ijo.ijo_1698_23] [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: 06/29/2023] [Revised: 11/07/2023] [Accepted: 12/24/2023] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts. OBJECTIVE This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India. RESULTS The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon's experience in influencing outcomes has been evaluated. CONCLUSION The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.
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Affiliation(s)
- Naresh Babu Kannan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Avik Dey Sarkar
- Department of Vitreoretinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Ripa M, Angunawela R, Motta L. SCLERAL FIXATION OF CARLEVALE INTRAOCULAR LENS: A Systematic Review and Meta-Analysis. Retina 2023; 43:1750-1762. [PMID: 37399540 DOI: 10.1097/iae.0000000000003873] [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: 07/05/2023]
Abstract
PURPOSE The mean change in best-corrected visual acuity (BCVA), intraocular pressure, and endothelial cell counts after intraocular lens (IOL) implantation and the incidence rate of postoperative complications were estimated by systematic review and meta-analysis to assess the surgical and refractive outcomes of the sutureless scleral fixation Carlevale IOL. METHODS A literature search was conducted using PubMed, Embase, and Scopus. The weighted mean difference (WMD) was used to present the mean change in BCVA, intraocular pressure, and endothelial cell count after IOL implantation, whereas a proportional meta-analysis was used to estimate the pooled incidence rate of postoperative complications. RESULTS In the meta-analysis of 13 studies involving 550 eyes, the pooled WMD of the mean change in BCVA showed a significant improvement in BCVA in patients who underwent Carlevale IOL implantation (WMD = 0.38, 95% confidence interval: 0.30-0.46, P < 0.001; heterogeneity [I 2 ] = 52.02%). The subgroup analyses indicated that the mean change in BCVA was not significantly higher according to the last follow-up visit, with no statistically significant subgroup effect ( P = 0.21) (WMD up to 6 months: 0.34, 95% confidence interval: 0.23-0.45, I 2 = 58.32%, WMD up to 24 months: 0.42, 95% confidence interval: 0.34-0.51, I 2 = 38.08%). In the meta-analysis of 16 studies involving 608 eyes, the pooled incidence rate of postoperative complications was equal to 0.22 (95% confidence interval: 0.13-0.32, I 2 = 84.87, P ≤ 0.001). CONCLUSION Carlevale IOL implantation represents a reliable method of restoring vision in eyes with missing capsular or zonular support.
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Affiliation(s)
- Matteo Ripa
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom; and
| | | | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom; and
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3
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Oli A, Yadav A, Babu JG, Balakrishnan D. Scheimpflug imaging for evaluation of intraocular lens position in modified flanged scleral fixated intraocular lens. Ther Adv Ophthalmol 2023; 15:25158414221147208. [PMID: 36654884 PMCID: PMC9841840 DOI: 10.1177/25158414221147208] [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: 08/26/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023] Open
Abstract
Background Scleral fixation of intraocular lens (IOLs) is the most preferred technique for the management of aphakia and the techniques have evolved over the years. These methods have their advantages and disadvantages, however, the major concern being the position of the intraocular lens, its stability and complications. The final IOL position is the major determinant of the final visual acuity, and various imaging modalities have been used to quantify the IOL tilt. Objectives Use of Scheimpflug imaging to evaluate the IOL tilt in modified flanged scleral-fixated intraocular lens (MFSIOL). Design Retrospective chart review of 41 consecutive patients who underwent MFIOL. Methods We conducted a retrospective chart review of 41 consecutive patients who underwent MFIOL. The baseline and final best-corrected visual acuity (BCVA), refractive error, and clinical examination findings were recorded. The vertical and horizontal tilts of the IOLs were calculated using the Scheimpflug image. The IOL tilt (in degrees) in the vertical and horizontal axes was the primary outcome and the BCVA, residual refractive error, intraocular pressure, and surgical complications were secondary outcome measures. Results The mean baseline BCVA was logMAR 0.49, which improved to logMAR 0.356 (p < .005) after the surgery. The mean IOL tilt in the vertical axis was 3.40° (range of 0.0°-8.5°, interquartile range: 1.21-5.66) and in the horizontal axis was 1.35° (range of 0.60°-4.620°, interquartile range: 0.44-1.86), respectively. There was no correlation between angle of IOL tilt and UCVA (r = 0.089, p = 0.580), BCVA (r = 0.109, p = 0.498), final spherical error (r = 0.081, p = 0.615), cylindrical error (r = 0.207, p = 0.195), axial length (r = 0.105, p = 0.514), and IOL power (r = -0.139, p = 0.388). Conclusion Modified flanged IOL (MFIOL) is an alternative technique for intrascleral fixation of IOL resulting in good lens stability. The IOL tilt achieved by this technique is minimal and did not influence the final visual outcome or spectacle correction. Scheimpflug imaging is simple and non-invasive method to measure the IOL tilt. Plain Language Summary Scheimpflug imaging for modified flanged scleral fixated lens position This study on 41 eyes was aimed to analyze the lens tilt using Scheimpflug imaging in cases of modified flanged scleral fixation of intraocular lens (MFSFIOL), which is a novel technique to minimize the complications and simplify the procedure. The intraocular lens (IOL) remained stable with an acceptable range of vertical and horizontal tilt. There was no significant effect of IOL tilt on the final best-corrected visual acuity (BCVA) or spectacle correction. Scheimpflug imaging is an accurate and non-invasive technique for assessment of lens position in the patients with intrascleral fixation of IOL.
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Affiliation(s)
| | - Anil Yadav
- L V Prasad Eye Institute, Hyderabad, India
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4
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Gajula S, Manayath GJ, Verghese S, Saravanan VR, Narendran K, Narendran V. Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation. Eye (Lond) 2022; 36:2334-2340. [PMID: 34980895 PMCID: PMC9674570 DOI: 10.1038/s41433-021-01880-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/02/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance. RESULTS A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.
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Affiliation(s)
- Shruthi Gajula
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - George J Manayath
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Shishir Verghese
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India.
| | - V R Saravanan
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Kalpana Narendran
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Venkatapathy Narendran
- Department of Retina and Vitreous services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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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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6
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Mohanty A, Mahapatra SK, Mannem N. Multipiece posterior chamber intraocular lens as sutureless, glueless scleral fixated intraocular lens. Oman J Ophthalmol 2022; 15:69-72. [PMID: 35388260 PMCID: PMC8979377 DOI: 10.4103/ojo.ojo_115_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/26/2021] [Accepted: 12/18/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of the study is to report the outcomes of sutureless, glueless multipiece posterior chamber intraocular lens (PCIOL) as scleral fixated intraocular lens (SFIOL) implantation in patients with poor or no posterior capsular support. METHODS Medical records of 45 eyes of 42 patients who underwent SFIOL implantation where no suture or glue was used to fixate intraocular lens (IOL) to the sclera from November 2016 to October 2017, with minimum 18 months of follow-up were retrospectively analyzed. The best-corrected visual acuity, indication of surgery, other significant eye examination findings, and complications were analyzed. RESULTS Out of 42 patients, 62% were males and 38% were females. Mean age of subjects was 48.5 ± 16.5 years (range 13-79 years). Mean preoperative and postoperative visual acuity was 1.48 ± 0.6 Logarithm of the Minimum Angle of Resolution (logMAR) units and 0.6 ± 0.3 logMAR units, respectively. Most common complication was vitreous hemorrhage six eyes (13.3%) followed by postoperative hypotony in five eyes (11.11%). Other complications such as transient postoperative intraocular pressure rise, hyphema, tilted IOL, cystoid macular edema, retinal detachment were also noted. CONCLUSION Multipiece PCIOL used as SFIOL without any sutures and glue is a viable, cost-effective method of IOL implantation in eyes with aphakia following surgical complication or trauma, with comparable outcome to other techniques of SFIOL implantation.
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Affiliation(s)
- Anuja Mohanty
- Department of Vitreoretina, JPM Rotary Eye Hospital and Research Institute, Cuttack, Odisha, India
| | - Santosh K. Mahapatra
- Department of Vitreoretina, JPM Rotary Eye Hospital and Research Institute, Cuttack, Odisha, India,Address for correspondence: Dr. Santosh K. Mahapatra, Department of Vitreo-Retina, JPM Rotary Eye Hospital and Research Institute, Sector-6, CDA, Cuttack - 753 014, Odisha, India. E-mail:
| | - Navya Mannem
- Department of Retina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
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7
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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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8
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Sül S, Kaderli A, Karalezli A, Kaya C. Comparison of decentration, tilt and lenticular astigmatism of ıntraocular lens between sutured and sutureless scleral fixation techniques. J Fr Ophtalmol 2021; 44:1174-1179. [PMID: 34226085 DOI: 10.1016/j.jfo.2020.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. METHODS We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. RESULTS The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001). CONCLUSION In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.
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Affiliation(s)
- S Sül
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey
| | - A Kaderli
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey.
| | - A Karalezli
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey
| | - C Kaya
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey
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9
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Colantuono D, Seknazi D, Miere A, Amoroso F, Glacet-Bernard A, Souied EH. Sutureless intrascleral fixation using a uniquely designed intraocular lens. J Fr Ophtalmol 2021; 44:957-961. [PMID: 34154871 DOI: 10.1016/j.jfo.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
We report our experience in the surgical technique of sutureless intrascleral posterior chamber intraocular lens (PC IOL) fixation in patients with insufficient capsular support using a uniquely designed, foldable, acrylic Carlevale IOL. It is specifically designed for sutureless scleral fixation and is equipped with a small plug attached to each of two haptics to anchor the lens to the sclera with a self-retaining mechanism. This surgery does not require creation of a scleral tunnel or transscleral exposure or excessive manipulation of the haptics. The harpoon-like plugs provide great stability to this implant, which can be injected through a 2.2mm incision. The characteristics of this IOL and the relative simplicity of this implantation technique makes it widely applicable in aphakic patients after previous complicated cataract surgery.
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Affiliation(s)
- D Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France.
| | - D Seknazi
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - A Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - F Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - A Glacet-Bernard
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - E H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
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Agarwal R, Todi V, Bafna RK, Asif MI, Sharma N. Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature. Indian J Ophthalmol 2021; 69:758-761. [PMID: 33595520 PMCID: PMC7942097 DOI: 10.4103/ijo.ijo_2149_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned with an angled 20-guage microvitreoretinal blade 1.5 mm away from the limbus in line with pre-existing defective scleral flap underneath which the exposed haptic is tucked securely. Following this, conjunctival autograft (CAG) with fibrin glue application is undertaken to combat conjunctival fibrosis. In three patients, where this technique was performed, had well-tucked haptic and maintained visual acuity with no complications at 3-months follow-up. This technique is a useful method of tucking extruded haptic after SFIOL in eyes subjected to multiple previous surgeries.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnu Todi
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Md Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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COMPARISON OF 25- AND 27-GAUGE SUTURELESS CANNULA-BASED INTRAOCULAR LENS SCLERAL FIXATION VISUAL ACUITY OUTCOMES AND COMPLICATION RATES. Retina 2021; 41:940-946. [PMID: 33009221 DOI: 10.1097/iae.0000000000002991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the visual outcomes and complication rates of sutureless cannula-based intraocular lens scleral (SCILS) fixation performed with 25-gauge (25 G) versus 27-gauge (27 G) instrumentation. METHODS A retrospective chart review of consecutive cases of eyes without capsular support that underwent SCILS fixation of a three-piece intraocular lens. Sutureless cannula-based intraocular lens scleral fixation was performed by transconjunctival use of either 25-G or 27-G trocar cannulas. During postoperative follow-up evaluations, visual acuity and intraocular pressure were measured, and slit-lamp and indirect ophthalmoscopy examinations were performed to assess for development of known complications. RESULTS A total of 69 eyes underwent 25 G (27 eyes) or 27 G (42 eyes) SCILS fixation. The mean preoperative logarithm of the minimum angle of resolution visual acuity trended toward improvement from 0.95 ± 0.68 (20/178 Snellen equivalent) to 0.67 ± 0.64 (20/94 Snellen equivalent) for 25 G group at 1 year. Similar trend toward visual acuity improvement was seen in 27 G group with a mean preoperative logarithm of the minimum angle of resolution visual acuity of 1.43 ± 0.94 (20/538 Snellen equivalent) improving to 0.86 ± 1.00 (20/145 Snellen equivalent) at 1 year. Statistically significant improvement was seen as early as postoperative week one for 27 G group (P < 0.01), whereas statistically significant worsening was noted at the same time in 25 G group (P = 0.01). There was a statistically significant reduction in intraocular lens displacement (P = 0.01) and need for reoperation (P = 0.01) in 27 G group. CONCLUSION Compared with 25 G SCILS fixation, eyes managed with 27 G SCILS fixation experienced more rapid visual acuity improvement. In addition, there was a lower rate of complications including intraocular lens displacement and need for reoperation.
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Recurrent Intraocular Lens Dislocation in a Patient with Familial Ectopia Lentis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094545. [PMID: 33922930 PMCID: PMC8123295 DOI: 10.3390/ijerph18094545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
A 36-year-old patient presented to the hospital with recurrent dislocation of the intraocular lens (IOL). The patient with the diagnosis of familial ectopia lentis was first operated on for crystalline lens subluxation in the left eye in 2007 and in the right eye in 2009. In both eyes, lens extraction with anterior vitrectomy and transscleral fixation of a rigid IOL was performed. In 2011, the IOL in the right eye luxated into the vitreous cavity due to ocular trauma. The patient underwent a pars plana vitrectomy with the IOL resuturation to the sclera. Seven years later, a spontaneous vision loss in the right eye was caused by a retinal detachment. The pars plana vitrectomy with silicone oil tamponade and a consequential oil removal three months later were performed in 2018. The follow-up examination revealed recurrent IOL dislocation in the same eye. Due to a history of previous suture-related complications a decision was made to remove the subluxated rigid polymethyl-methacrylate (PMMA) IOL and fixate to sclera a sutureless SOLEKO FIL SSF Carlevale lens. The purpose of this report is to present a single case of a 36-year-old patient who was presented to the hospital with recurrent dislocation of the intraocular lens. In a three-month follow-up period, a good anatomical and functional outcome was finally obtained with transscleral sutureless intraocular lens. This lens is an option worth considering especially in a young patient with a long life expectancy and physically active.
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Deb AK, Sarkar S, Natarajan K, Elamurgan V, Jayaseelan J, Gokhale T, Jacob N. Complications and visual outcome of sutureless, scleral fixated intraocular lens in cases with traumatic aphakia. Ther Adv Ophthalmol 2021; 13:25158414211009095. [PMID: 33959701 PMCID: PMC8060742 DOI: 10.1177/25158414211009095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study is to describe the complications and outcome of
sutureless scleral fixated intraocular lens (SFIOL) implantation in
traumatic aphakia. Setting: The study was conducted in a tertiary eye care centre in South India. Design: The study involved a retrospective data analysis. Methods: Medical records of cases with traumatic aphakia who had undergone sutureless
SFIOL implantation in the last 2 years were included in the study. Data on
intraoperative and postoperative complications and visual outcome were
collected and analysed. Results: In total, 45 cases were recruited. Mean logarithm of the minimum angle of
resolution (logMAR) best-corrected visual acuity (BCVA) improved from
preoperative 1.64 ± 0.45 to 0.63 ± 0.36 at last follow-up visit, and the
difference was statistically significant (p < 0.0001).
Final logMAR BCVA was worse than one in three patients who had associated
posterior segment pathology. There was no incidence of intraoperative haptic
rebound into the vitreous cavity or intraocular lens (IOL) drop. Four cases
had hypotony, two cases had choroidal detachment, four cases had raised
intraocular pressure (IOP), eight cases had transient corneal oedema and six
patients had mild dispersed vitreous haemorrhage during immediate
postoperative period. Six patients had postoperative cystoid macular oedema
(CME). Two cases developed glaucoma. None of the patients had postoperative
haptic exposure, retinal detachment (RD), iris capture of IOL or SFIOL
dislocation till the last follow-up. Conclusion: Final visual outcome of sutureless SFIOL implantation in traumatic aphakia
may be affected by concomitant posterior segment pathology. The immediate
and late postoperative complications noted in our study were comparable with
other similar studies. However, longer follow-up is needed to detect RD and
angle recession glaucoma at the earliest and initiate therapy.
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Affiliation(s)
- Amit Kumar Deb
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu, India
| | - Sandip Sarkar
- Senior Resident, Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu 605006, Puducherry, India
| | - Kaviyapriya Natarajan
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu, India
| | - Vignesh Elamurgan
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu, India
| | - Jagadeeswari Jayaseelan
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu, India
| | - Ninan Jacob
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education & Research, Gorimedu, India
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14
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Mo B, Li SF. Novel use of an adjustable single 8-0 polypropylene suture of scleral fixation without conjunctival dissection. BMC Ophthalmol 2020; 20:304. [PMID: 32711502 PMCID: PMC7382057 DOI: 10.1186/s12886-020-01558-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background This report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach. Methods In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8–0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8–0 polypropylene sutures were inserted into the eye guided by 10–0 polypropylene sutures of a long straight needle. The 8–0 suture was then used to fix the haptic IOs. Finally, these 8–0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence. Results For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up. Conclusions An adjustable single 8–0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation. Trial registration Retrospective case series study, not applicable. NCT04476264.
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Affiliation(s)
- Bin Mo
- Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China
| | - Song-Feng Li
- Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, No. 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China.
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15
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Ishikawa H, Fukuyama H, Komuku Y, Araki T, Gomi F. Flanged intraocular lens fixation via 27-gauge trocars using a double-needle technique decreases surgical wounds without losing its therapeutic effect. Acta Ophthalmol 2020; 98:e499-e503. [PMID: 31736267 PMCID: PMC7317769 DOI: 10.1111/aos.14313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/31/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Intraocular lens (IOL) fixation using a sutureless 27-gauge needle intrascleral IOL implantation technique requires six surgical wounds. We developed a modified technique using two 27-gauge trocars for vitrectomy and indwelling flanged IOL haptics to reduce the number of surgical wounds. SETTING Department of Ophthalmology, Hyogo College of Medicine. DESIGN This retrospective study enrolled 54 patients who had undergone IOL scleral fixation between January 2016 and April 2019. METHODS Patients who underwent IOL scleral fixation and were observed for >12 weeks were analysed using medical record data. Before October 2017, patients underwent normal flanged IOL scleral fixation. Between November 2017 and April 2019, patients underwent the modified method (flanged IOL via 27-gauge trocars with double-needle technique). Primary end-point was superiority or non-inferiority of modified IOL scleral fixation compared with normal IOL scleral fixation for visual acuity (VA). Changes in corneal endothelium cell number, refractivity, astigmatisms and surgery-related complications, were secondary end-points. RESULTS There were no significant differences in baseline characteristics between groups. Raw VA and best collected VA (BCVA) were significantly improved in all eyes (p-). There were no statistical significances in raw VA, BCVA and surgery-related complications between groups. CONCLUSIONS Results of the modified technique were not inferior compared with the original technique although it was less invasive. Therefore, flanged IOL fixation via trocars using a double-needle technique is a useful technique for IOL implantation.
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Affiliation(s)
- Hiroto Ishikawa
- Department of OphthalmologyHyogo College of MedicineNishinomiyaHyogoJapan
| | - Hisashi Fukuyama
- Department of OphthalmologyHyogo College of MedicineNishinomiyaHyogoJapan
| | - Yuki Komuku
- Department of OphthalmologyHyogo College of MedicineNishinomiyaHyogoJapan
| | - Takashi Araki
- Department of OphthalmologyHyogo College of MedicineNishinomiyaHyogoJapan
| | - Fumi Gomi
- Department of OphthalmologyHyogo College of MedicineNishinomiyaHyogoJapan
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16
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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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