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Cameron NW, Karadaghy A, Mitchell MK, Ajlan RS. Optic inversion of scleral-fixated intraocular lens after vitrectomy with fluid-air exchange: case series and review of the literature. J Surg Case Rep 2023; 2023:rjad600. [PMID: 38026751 PMCID: PMC10640673 DOI: 10.1093/jscr/rjad600] [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: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Lens dislocation is a significant complication after cataract surgery. Scleral fixation of 3-piece intraocular lens provides favorable visual outcome and can spare patients the need for lens exchange. Two patients presented with dislocated 3-piece lenses implanted over 10 years earlier. Both patients underwent pars plana vitrectomy and dropped lens rescue with scleral fixation. Postoperatively, the lens optic was found flipped nearly 90° at the optic-haptic junctions secondary to fluid-air exchange performed during vitrectomy. Both patients underwent intraocular lens exchange with a four point sclera fixated lens. Our study found that air tamponade is better avoided during rescue of old dislocated 3-piece lens implants. Intraocular lens exchange is preferred, when possible, to avoid complications associated with old dislocated lenses. Larger studies are needed to determine the effect of time on dislocated lens implants materials.
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Affiliation(s)
- Nathaniel W Cameron
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amin Karadaghy
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Mary K Mitchell
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Radwan S Ajlan
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS, United States
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52
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Tanaka Y, Inoue T, Mohamed S, Yamaguchi T, Iwashita Y, Hirono K, Nakamura K, Asaoka R, Kobayashi S, Yamane S, Yanagi Y, Maruyama-Inoue M, Kadonosono K. IMPACT OF GAS/AIR TAMPONADE ON REFRACTIVE OUTCOMES AFTER FLANGED INTRASCLERAL INTRAOCULAR LENS FIXATION. Retina 2023; 43:1745-1749. [PMID: 37315568 DOI: 10.1097/iae.0000000000003860] [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: 06/16/2023]
Abstract
PURPOSE This study aims to investigate the postoperative refractive outcomes in eyes that underwent the flanged intrascleral intraocular lens (IOL) fixation combined with vitrectomy with or without gas/air tamponade. METHODS The eyes were divided into two groups (Group A; eyes that underwent flanged intrascleral IOL fixation with gas/air tamponade, and Group B; eyes that underwent flanged intrascleral IOL fixation without gas/air tamponade). The predicted spherical equivalent (SE) refraction values were calculated using the Sander-Retzlaff-Kraff Theoretical formula. Then, the prediction error was calculated by subtracting the predicted SE refraction from the postoperative objective SE refraction and the absolute prediction error was calculated as the absolute value of the prediction error for each eye. RESULTS A total of 68 eyes were included in the current study. There was a significant correlation between the predicted and postoperative SE refraction in both groups (Group A, r = 0.968, P < 0.0001, Group B, r = 0.943, P < 0.0001, linear regression analysis). The prediction error demonstrated a mild myopic shift after the flanged intrascleral IOL fixation in both groups (Group A, -0.40 ± 0.96 diopter, Group B, -0.59 ± 0.95 diopter). There was no significant difference in prediction error and absolute prediction error between the two groups ( P = 0.44, P = 0.70, Wilcoxon rank sum test). CONCLUSION The postoperative SE refraction after flanged intrascleral IOL fixation was not influenced by gas/air tamponade.
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Affiliation(s)
- Yui Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Shaheeda Mohamed
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan; and
| | - Yume Iwashita
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Kazushi Hirono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Kentaro Nakamura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shinobu Kobayashi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Shin Yamane
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
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Januschowski K, Boden KT, Macek AM, Szurman P, Bisorca-Gassendorf L, Hoogmartens C, Rickmann A. MODIFIED SUTURELESS INTRASCLERAL FIXATION TECHNIQUE FOR SECONDARY INTRAOCULAR LENS IMPLANTATION: A Pilot Study. Retina 2023; 43:1802-1806. [PMID: 34050099 DOI: 10.1097/iae.0000000000003220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To demonstrate possible complications of a new intraocular lens for sutureless secondary scleral implantation and modifications of the surgical technique to optimize outcomes. METHODS A retrospective study of 16 eyes (16 patients) who underwent a secondary intraocular lens implantation using the Carlevale intraocular lens (Soleko, Italy) with two anchor haptics for intrascleral implantation (mean follow-up 2.2 months). RESULTS The visual acuity did not improve statistically significantly postoperatively ( P = 0.601). Seven (44%) patients suffered from postoperative hypotonia (intraocular pressure <5 mmHg) during the first three postoperative days. CONCLUSION Owing to the early postoperative hypotony, we decided to modify the surgical technique. We present several suggestions to optimize the technique and outcome such as positioning the sclerotomies at the 2 and 8 o'clock positions, using 27 G trocars alone and suturing the frown incisions using self-resorbing sutures.
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Affiliation(s)
- Kai Januschowski
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Centre for Ophthalmology, University Eye Hospital Tuebingen, Tuebingen, Germany; and
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
| | - Karl T Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Andrej M Macek
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Peter Szurman
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
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54
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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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55
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Eom Y, Koh E, Yang SK, Kim S, Yi S, Jeon HS, Kim SJ, So J, Song JS, Cooke DL. Four-flanged polypropylene optic piercing technique for scleral fixation of multifocal intraocular lens. BMC Ophthalmol 2023; 23:392. [PMID: 37752479 PMCID: PMC10521417 DOI: 10.1186/s12886-023-03133-7] [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: 04/03/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To evaluate the feasibility of creating flanges using an optic piercing technique with a 6 - 0 polypropylene monofilament for scleral fixation of dislocated one-piece diffractive multifocal intraocular lenses (IOLs). STUDY DESIGN Experimental study and case series. SUBJECTS Optical bench test and eyes with IOL dislocation. METHODS Two separate 6 - 0 polypropylenes were penetrated twice at the opposite peripheral optic of the TECNIS Synergy IOL (Johnson & Johnson Vision). The root mean square of the modulation transfer function (MTFRMS), at between + 1.00 and - 4.00 D of defocus, was measured in the TECNIS Synergy IOL both with and without optic piercing in the optical bench study. This case series included three eyes from two patients who underwent scleral-fixation of multifocal IOLs using the four-flanged polypropylene optic piercing technique. The postoperative corrected distance visual acuity (CDVA) at 4 m, the uncorrected near visual acuity (UNVA) at 40 cm, and IOL centration were evaluated. RESULTS The optical bench test showed no differences in MTFRMS values measured in the TECNIS Synergy IOL, either with or without optic piercing at all defocuses. In all three case series, the postoperative CDVA at 4 m was 20/20 and UNVA at 40 cm was J1. Postoperative anterior segment photographs showed good centration of IOLs in all cases. CONCLUSION The four-flanged polypropylene optic piercing technique for multifocal IOL scleral fixation can provide excellent clinical outcomes and IOL stability after surgery without diminishing the performance of the multifocal IOLs.
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Grants
- grant numbers 13-2020-007 SNUBH Research Fund
- grant numbers 13-2020-007 SNUBH Research Fund
- K210790 TRC Research Grant of the Korea University Medicine and Korea Institute of Science and Technology
- K1625491, K1722121, K1811051, K1913161, and K2010921 Korea University Ansan Hospital grant
- K1625491, K1722121, K1811051, K1913161, and K2010921 Korea University grant
- Project Number: 9991007583, KMDF_PR_20200901_0296 The Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety)
- 2020002960007, NTIS-1485017544 Korea Environment Industry & Technology Institute (KEITI) through Technology Development Project for Safety Management of Household Chemical Products, funded by Korea Ministry of Environment (MOE)
- S3127902 The Technology Development Program (S3127902) funded by the Ministry of SMEs and Startups(MSS, Korea)
- NRF-2021R1F1A1062017 The National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)
- The Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety)
- Korea Environment Industry & Technology Institute (KEITI) through Technology Development Project for Safety Management of Household Chemical Products, funded by Korea Ministry of Environment (MOE)
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA USA
| | - Eunheh Koh
- Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Seul Ki Yang
- Space Optics Laboratory, Department of Astronomy, Yonsei University, Seoul, Republic of Korea
- Satellite system 2 Team, Hanwha Systems Co., Ltd, Gyeonggi-do, Republic of Korea
| | - Soo Kim
- BNeye Clinic, Seoul, Republic of Korea
| | | | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Jason So
- Great Lakes Eye Care, Saint Joseph, MI USA
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
| | - David L Cooke
- Great Lakes Eye Care, Saint Joseph, MI USA
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI USA
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Iannetta D, Febbraro S, Valsecchi N, Moramarco A, Fontana L. FIL SSF intraocular lens opacification after pars plana vitrectomy with gas tamponade for traumatic lens luxation and retinal detachment: a case report and literature review. BMC Ophthalmol 2023; 23:383. [PMID: 37743488 PMCID: PMC10519003 DOI: 10.1186/s12886-023-03126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To report a case of sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF IOL, Soleko, Italy) opacification following pars plana vitrectomy surgery using sulfur hexafluoride (SF6) for traumatic lens luxation associated with retinal detachment. CASE PRESENTATION A 77-year-old woman was referred to our emergency department after blunt trauma in her right eye. At the ophthalmic evaluation, visual acuity was hand movement, biomicroscopy showed pseudoexfoliation syndrome and a traumatic lens luxation in the vitreous chamber. The patient underwent pars plana vitrectomy, subluxated cataract explantation, and FIL SSF IOL implant. During surgery, an inferior retinal detachment was encountered, requiring 20% SF6 gas tamponade. No adverse events were encountered. One month postoperatively, visual acuity (BCVA) improved to 0,3 logMAR. At the 3-month follow-up, the patient presented with BCVA of 0,5 logMAR, and biomicroscopy showed a minimal IOL opacification. Six months postoperatively, BCVA decreased to 1.0 logMAR, and diffuse, IOL opacification was noted at slit lamp examination. The patient refused any other surgical intervention for IOL exchange. CONCLUSIONS Although hydrophilic IOL opacification gas related is known, to the best of our knowledge, this is the first case reported in the literature of FIL SSF IOL opacification after pars plana vitrectomy with gas tamponade for retinal detachment.
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Affiliation(s)
- Danilo Iannetta
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy.
| | - S Febbraro
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - N Valsecchi
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - A Moramarco
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
| | - L Fontana
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9 Bologna, Postal code, 40138, Bologna, Italy
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Ma CJ, Schallhorn CC, Stewart JM, Schallhorn JM. Modified intrascleral haptic fixation of the light adjustable lens in a case of spontaneous adult-onset bilateral lens subluxation. Am J Ophthalmol Case Rep 2023; 31:101864. [PMID: 37427094 PMCID: PMC10323170 DOI: 10.1016/j.ajoc.2023.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/02/2023] [Accepted: 05/20/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To describe the application of the light adjustable lens (LAL) using an intrascleral haptic fixation (ISHF) technique for the correction of aphakia and post-operative refractive error. Observation The LAL was placed using a modified trocar-based ISHF technique for visual rehabilitation following removal of bilateral cataracts in a patient with ectopia lentis. She ultimately obtained an excellent refractive outcome after adjustment with micro-monovision. Conclusions and Importance Secondary intraocular lens placement has a much higher risk of residual ametropia than traditional in-the-bag lens placement. The ISHF technique with the LAL presents a solution for eliminating postoperative refractive error in patients requiring scleral-fixated lenses.
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Affiliation(s)
- Chu Jian Ma
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Craig C. Schallhorn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie M. Schallhorn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
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58
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Agrawal S, Mishra DK, Shanmugam PM. Laser Photo-Cauterization for the Management of Exposed Polypropylene Scleral Fixation Sutures. Asia Pac J Ophthalmol (Phila) 2023; 12:495-496. [PMID: 36650096 DOI: 10.1097/apo.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/09/2022] [Indexed: 01/19/2023] Open
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Curran C, Adam MK. Clinical and Anatomic Outcomes of 3-Piece Poly(methyl methacrylate) Intraocular Lens Rescue and Needle-Assisted Transconjunctival Intrascleral Lens Fixation. JOURNAL OF VITREORETINAL DISEASES 2023; 7:404-411. [PMID: 37706089 PMCID: PMC10496816 DOI: 10.1177/24741264231178377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Purpose: To report the clinical and anatomic outcomes of a single-stage rescue and sutureless 30-gauge needle-assisted transconjunctival intrascleral fixation of dislocated 3-piece rigid poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs). Methods: This retrospective noncomparative single-surgeon interventional study comprised eyes that had concurrent 23- or 25-gauge pars plana vitrectomy and IOL rescue with sutureless transconjunctival needle-assisted flanged haptic intrascleral fixation. Lamellar scleral dissection for haptic fixation was performed 3 mm posterior to the surgical limbus with 30-gauge needles. Primary endpoints included visual acuity (VA), IOL tilt measured with ultrasound biomicroscopy (UBM), and postoperative complications. Results: The study evaluated 25 eyes of 24 patients. The IOL was successfully refixated in 24 of the 25 eyes. The mean preoperative logMAR VA of 1.21 ± 0.79 SD (median 1.3; Snellen equivalent 20/400) improved to 0.28 ± 0.35 (median 0.14; Snellen equivalent 20/30) postoperatively (P < .0001). The mean IOL tilt measured by UBM (n = 7) was 3.79 ± 3.60 degrees. The mean postoperative follow-up was 348 ± 284 days (range, 7-979 days). Postoperative complications included self-clearing vitreous hemorrhage (n = 9), retinal detachment (RD) (n = 1), cystoid macular edema (n = 3), and corneal edema (n = 3). Three eyes (13%) required additional surgery, 1 for RD and 2 for delayed haptic slippage and secondary IOL tilt causing irregular astigmatism. Conclusions: Intrascleral needle-assisted fixation of dislocated or mobile 3-piece PMMA IOLs is an effective, safe method to restore VA.
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Affiliation(s)
- Christian Curran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Murtaza K. Adam
- Colorado Retina Associates, Denver, CO, USA
- Rocky Vista University, Parker, CO, USA
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60
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Rao GN, Kumar S, Sinha N, Rath B, Pal A. Outcomes of three-piece rigid scleral fixated intraocular lens implantation in subjects with deficient posterior capsule following complications in manual small incision cataract surgery. Heliyon 2023; 9:e20345. [PMID: 37809659 PMCID: PMC10560066 DOI: 10.1016/j.heliyon.2023.e20345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To evaluate the surgical visual outcomes of three-piece rigid scleral fixated intraocular lens (SFIOL) implantation in subjects with deficient posterior capsule following complications of cataract extraction. Design Retrospective 4-year cohort study. Participants Data from 174 eyes that underwent SFIOL combined with pars plana vitrectomy (PPV) between January 2018 and March 2022 and follow-up exams were included. Methods Demographic characteristics including primary indications for surgery, history of trauma, laterality, baseline and best-corrected visual acuity (BCVA), refraction as spherical equivalent (SE), intraocular pressure (IOP), duration of follow-up, and complications were analyzed. Results The mean preoperative BCVA was 1.38 ± 0.46 logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.37 ± 0.22 logMAR. The baseline refractive status measured in spherical equivalent (SE) was 4.1 ± 6.2 Diopters (D), and the postoperative status was -0.4 ± 0.97 D. Early postoperative complications included hypotony (n = 1; 0.57%, vitreous hemorrhage (n = 3; 1.72%), elevated IOP (n = 8; 4.59%), mild dilated pupil (n = 1; 0.57%) and corneal edema (n = 16; 9.19%). Late complications included in this study were retinal detachment (n = 1; 0.57%), cystoid macular edema (CME) (n = 1; 0.57%), primary glaucoma (n = 1; 0.57%), secondary glaucoma (n = 13; 7.47%), zonular dehiscence (n = 3; 1.72%), retinal pigment epithelium (RPE) changes (n = 3; 1.72%), choroidal coloboma (n = 2; 1.14%), posterior dislocation of posterior chamber IOL (PCIOL) (n = 1; 0.57%), corneal decompensation (n = 1; 0.57%), retinal hemorrhage (n = 1; 0.57%), macular hole (n = 1; 0.57%), chronic uveitis (n = 1; 0.57%), mild non-proliferative diabetic retinopathy (NPDR) (n = 3; 1.72%), and mild NPDR with diabetic macular edema (DME) (n = 1; 0.57%). Conclusion Integrating IOL implantation with vitrectomy various posterior segment complications were resolved in the same setting without attempting a second surgery.
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Affiliation(s)
- G Nageswar Rao
- Department of Ophthalmology, Kalinga Institute of Medical Science, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha 751024, India
- Vision Care, Center for Retina, Bhubaneswar, Odisha 751024, India
| | - Sonu Kumar
- Department of Zoology, School of Life Sciences, Mahatma Gandhi Central University, Motihari, Bihar 845401, India
| | - Nidhi Sinha
- Vision Care, Center for Retina, Bhubaneswar, Odisha 751024, India
| | - Bhumika Rath
- Vision Care, Center for Retina, Bhubaneswar, Odisha 751024, India
| | - Arttatrana Pal
- Department of Zoology, School of Life Sciences, Mahatma Gandhi Central University, Motihari, Bihar 845401, India
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Abstract
PURPOSE To present a surgical technique that allows rescue (repositioning) of a dislocated Akreos AO model intraocular lens using scleral sutures. METHODS The surgical technique is described with supplemental video. RESULTS The technique was used in 4 eyes of 3 patients with 2 to 18 months of follow-up information. The intraocular lens was well positioned, and the visual acuity (as limited by other disease) was good, without adverse events. CONCLUSION Scleral suture techniques for repositioning of the Akreos AO intraocular lens offer a suitable alternative to intraocular lens exchange.
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Affiliation(s)
- Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Januschowski K, Rickmann A, Boden KT, Ehrlich-Treuenstätt GV, Wakili P, Bisorca-Gassendorf L. Clinical Experience of Two Sutureless Intrascleral Fixation Techniques for Secondary Intraocular Lens Implantation. Ophthalmologica 2023; 247:1-7. [PMID: 37647875 DOI: 10.1159/000532065] [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: 02/16/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the outcome of the modified Carlevale intraocular lens (IOL) fixation technique, using two different vitrectomy ports (23- vs. 27-gauge) as anchor fixation. METHODS Retrospective, consecutive study of 282 eyes (282 patients) who underwent a secondary IOL implantation using the Carlevale IOL (Soleko IOL Division, Italy) with two anchor haptics for intrascleral implantation with either 23- or 27-gauge (G) port. RESULTS Transient post-operative ocular hypotonia (intraocular pressure ≤5 mm Hg) was observed less in the 27-G group (13 vs. 4 patients, p = 0.057) three requiring additional tunnel sutures (2 cases for 23-G; 1 case 27-G). Post-operative vitreous haemorrhage was recorded more often in the 23-G group (8 vs. 1 patient, p = 0.034), but all cases in both groups resolved without intervention. Visual acuity did improve post-operatively in the two groups. No post-operative complications such as retinal detachment, endophthalmitis, and IOL-dislocation tilt were observed in the follow-up. CONCLUSION The 27-G modified technique for sutureless intrascleral implantation is simple and effective and causes less post-operative hypotony.
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Affiliation(s)
- Kai Januschowski
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Eye Clinic, Petrisberg, Trier, Germany
| | | | - Karl T Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | | | - Philip Wakili
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
| | - Lukas Bisorca-Gassendorf
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
- Eye Clinic, Petrisberg, Trier, Germany
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63
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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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Yoo WS, Cho YW, Park MH, Kang HJ, Kim SJ. New Surgical Approach for Secondary Intraocular Lens Implantation Using an Artificial Bag with Optic Capture in Patients with Intraocular Lens Dislocation. Retina 2023; 43:1403-1407. [PMID: 32947433 PMCID: PMC10627538 DOI: 10.1097/iae.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We present a newly developed approach to secondary intraocular lens (IOL) implantation, which uses an artificial bag with optic capture (i.e., ABC technique) in patients with IOL dislocation. METHODS This is a retrospective, noncomparative, and interventional case series that reveals the results of secondary IOL implantation using an artificial bag with optic capture in four cases of IOL dislocation. All patients underwent the abovementioned surgery and were followed up for at least 6 months. RESULTS The best-corrected visual acuity of patients ranged from 20/30 to 20/20. The IOL of all patients showed no tilting or decentration with normal intraocular pressure. CONCLUSION We believe that this method produces satisfactory results and will be especially beneficial to retinal surgeons for the management of patients with IOL dislocation.
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Affiliation(s)
- Woong-Sun Yoo
- Department of Ophthalmology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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Sotani Y, Imai H, Iwane Y, Yamada H, Matsumiya W, Miki A, Kusuhara S, Nakamura M. Usefulness of intraoperative optical coherence tomography to minimize the intraocular lens tilt during the intrascleral fixation: a clinical and experimental evaluation. Sci Rep 2023; 13:12065. [PMID: 37495651 PMCID: PMC10372065 DOI: 10.1038/s41598-023-39294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
To report the usefulness of intraoperative real-time adjustment of intraocular lens (IOL) tilt during the intrascleral fixation with intraoperative optical coherence tomography (iOCT) as a clinical evaluation and investigate the factors contributing to IOL tilt using iOCT as an experimental evaluation. Retrospective cohort study and experimental research. As a clinical evaluation, the medical records of 43 eyes of 41 patients who underwent intrascleral IOL fixation combined with real-time iOCT observation were retrospectively reviewed. As an experimental evaluation, in order to investigate the factors contributing to IOL tilt, the four experiments were performed using iOCT. The mean IOL tilt angle (°) at the end of surgery and 3 months after surgery were 1.81 ± 1.15 and 2.10 ± 1.66, respectively (p = 0.46). No apparent intra- or postoperative complications occurred during the follow-up period. The experimental evaluation indicated that the IOL tilt was influenced by the insertion angle of the haptic in the vertical direction. The mean IOL tilt angle (°) was 1.94 ± 0.09, 4.67 ± 0.11, 8.90 ± 0.11, and 15.78 ± 0.85 when the insertion angle of the haptic was 0°, 10°, 27.5°, and 45° in the vertical direction, respectively (p < 0.01). Clinical and experimental IOL tilt assessment using iOCT is interactively useful for better quality surgery and better postoperative outcome.
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Affiliation(s)
- Yasuyuki Sotani
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Hisanori Imai
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
| | - Yukako Iwane
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Hiroko Yamada
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Wataru Matsumiya
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Huang JJ, Waldner D, Huang JJ, Huang JM, Huang P, Teichman JC, Darvish-Zargar M, Gooi P. Face and Content Validity of an Artificial Eye Model for Secondary Intraocular Lens Fixation via Yamane Technique. Clin Ophthalmol 2023; 17:2063-2069. [PMID: 37496849 PMCID: PMC10368112 DOI: 10.2147/opth.s419464] [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: 05/01/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose To assess the face and content validity of an artificial eye model for secondary intraocular lens (IOL) fixation via the Yamane technique. Methods Ophthalmologists and residents participated in a 90-minute simulation session on secondary IOL fixation via the Yamane technique. Hands-on practice of this technique was performed on an artificial eye, the Bioniko Okulo BR8. After, all ophthalmologists answered an 18-question survey assessing the face and content validity of the model. Survey responses were recorded on a 5-point double-headed Likert scale, ranging from strongly agree (1)-to-strongly disagree (5) (Figure 1). Results Twenty-three surveys were completed. Respondents rated the survey with a median response of 1 (strongly agree)-to-3 (neutral). Highest ratings for the model were received for "usefulness for training residents", and "easier to set up and clean-up compared to a cadaver". Lowest ratings were received for realism of the model compared to cadaveric eyes. Statistical analysis revealed no significant difference among identified groups. Ratings for face and content validity were viewed favorably, both with an overall median response of 2.00 (agree). Conclusion The Bioniko Okulo BR8 shows promise as a valid tool for practicing secondary IOL fixation via the Yamane technique. Considering recent guidelines in competency-based ophthalmology education programs, this model may be a valuable tool over traditional techniques for teaching and improving surgical skill amongst trainees.
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Affiliation(s)
- Jordan J Huang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek Waldner
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Jaxon J Huang
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Joshua M Huang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Huang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Joshua C Teichman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Ophthalmology, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Patrick Gooi
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
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Lewin GA, Dixon CJ. Scleral fixation of a novel modified, injected canine intraocular lens by haptic capture, in 17 dogs. Vet Ophthalmol 2023. [PMID: 37410806 DOI: 10.1111/vop.13129] [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: 01/12/2023] [Revised: 05/14/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The aims of lens removal surgery are to re-establish or preserve both a clear visual axis and emmetropic vision. Trans-scleral intraocular lens (IOL) fixation has been described in cases where lens capsule instability precludes the insertion of a prosthetic intraocular lens into the lens capsule. Previous techniques have necessitated enlargement of the corneal incision to accommodate either a rigid polymethylmethacrylate IOL or an acrylic foldable IOL inserted using forceps. This paper reports the modification of an endocapsular IOL to be used as an injectable suture-fixated IOL introduced through a 2.8 mm corneal incision. MATERIALS AND METHODS All cases underwent lens extraction by phacoemulsification followed by removal of the unstable lens capsule. A PFI X4 IOL (Medicontur) was modified to create four open-loop haptics. The IOL was injected into the anterior chamber, each haptic was captured in a loop of suture introduced ab externo, and the lens was sutured with four-point fixation. RESULTS The results from 20 eyes in 17 dogs are reported. Over an average follow-up time of 14.5 months, vision was retained in 16/20 eyes. Vision was lost in four eyes due to corneal ulceration and ocular hypertension (1/20), retinal detachment (2/20), and Progressive Retinal Atrophy (1/20). CONCLUSIONS The modified PFI X4 proved suitable for injection and scleral fixation through a 2.8 mm corneal incision, with a success rate comparable to previously published techniques.
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68
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Vivekanandan VR, Nachiappan S, Benzy M, Odayappan A, Venkatesh R. 4-Flanged intrascleral fixation of an intraocular lens through the dialing hole. Indian J Ophthalmol 2023; 71:2897-2900. [PMID: 37417142 PMCID: PMC10491061 DOI: 10.4103/ijo.ijo_2906_22] [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: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
The high prevalence of mature, hypermature, and traumatic cataracts in developing countries, combined with the limited availability of surgical resources and skill by anterior segment surgeons to manage the resultant aphakia, leaves the patient needlessly blind. Relying on posterior segment surgeons, expensive surgical setup, and appropriate lenses for aphakia management limits the number of patients receiving a secondary intraocular lens (IOL). Utilizing the well-acknowledged flanging technique and the readily available polymethyl methacrylate (PMMA) lenses with dialing holes in their optic, a hammock can be created through the dialing holes using a 7-0 polypropylene suture on a straight needle. This 4-flanged scleral fixation through the dialing hole of an IOL makes scleral fixation of PMMA lens possible by even anterior segment surgeons without requiring any specialized equipment or scleral fixated lens with eyelet. This technique was successfully performed in a series of 103 cases with no incidence of IOL decentration.
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Affiliation(s)
| | - Sivagami Nachiappan
- General Ophthalmology, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | - Merlin Benzy
- Cataract and IOL Services, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | | | - Rengaraj Venkatesh
- Chief Medical Officer, Glaucoma Services, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
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Zhang Y, Zong Y, Zhu X, Lu Y, Jiang C. Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment of dislocated intraocular lenses. BMC Ophthalmol 2023; 23:271. [PMID: 37312094 DOI: 10.1186/s12886-023-03020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND To compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL). METHODS Thirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed. RESULTS The major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was - 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01). CONCLUSION All three IOL repositioning techniques resulted in favorable ocular prognosis.
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Affiliation(s)
- Yinglei Zhang
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yuan Zong
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Xiangjia Zhu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yi Lu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
| | - Chunhui Jiang
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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Schranz M, Reumüller A, Kostolna K, Novotny C, Schartmüller D, Abela-Formanek C. Refractive outcome and lens power calculation after intrascleral intraocular lens fixation: a comparison of three-piece and one-piece intrascleral fixation technique. EYE AND VISION (LONDON, ENGLAND) 2023; 10:29. [PMID: 37291668 DOI: 10.1186/s40662-023-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/30/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques. METHODS This is a prospective, randomized, longitudinal, single-site, single-surgeon study. Patients who underwent intrascleral IOL implantation using the Yamane or the Carlevale technique were followed up for a period of six months postoperatively. Refraction was measured using the best-corrected visual acuity at 4 m (EDTRS chart). Lens decentration, tilt and effective lens position (ELP) were assessed using an anterior segment optical coherence tomography (AS-OCT). The prediction error (PE) and the absolute error (AE) were evaluated for the SRK/T, Hollayday1 and Hoffer Q formula. Subsequently, correlations between the PE and axial length, keratometry, white to white and ELP were assessed. RESULTS In total, 53 eyes of 53 patients were included in the study. Twenty-four eyes of 24 patients were in the Yamane group (YG) and 29 eyes of 29 patients were in the Carlevale group (CG). In the YG, the Holladay 1 and Hoffer Q formulae resulted in a hyperopic PE (0.02 ± 0.56 D, and 0.13 ± 0.64 D, respectively) while in the SRK/T formula the PE was slightly myopic (- 0.16 ± 0.56 D). In the CG, SRK/T and Holladay 1 formulae led to a myopic PE (- 0.1 ± 0.80 D and - 0.04 ± 0.74 D, respectively), Hoffer Q to a hyperopic PE (0.04 ± 0.75 D). There was no difference between the PE of the same formulae across both groups (P > 0.05). In both groups the AE differed significantly from zero in each evaluated formula. The AE error was within ± 0.50 D in 45%-71% and was within ± 1.00 D in 72%-92% of eyes depending on the formula and surgical method used. No significant differences were found between formulae within and across groups (P > 0.05). Intraocular lens tilt was lower in the CG (6.45 ± 2.03°) compared to the YG (7.67 ± 3.70°) (P < 0.001). Lens decentration was higher in the YG (0.57 ± 0.37 mm) than in the CG (0.38 ± 0.21 mm), though the difference was not statistically significant (P = 0.9996). CONCLUSIONS Refractive predictability was similar in both groups. IOL tilt was better in the CG, however this did not influence the refractive predictability. Though not significant, Holladay 1 formula seemed to be more probable than the SRK/T and Hoffer Q formulae. However, significant outliers were observed in all three different formulae and therefore remain a challenging task in secondary fixated IOLs.
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Affiliation(s)
- Markus Schranz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Adrian Reumüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Klaudia Kostolna
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Caroline Novotny
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Claudette Abela-Formanek
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Minamoto A, Harada Y, Hiyama T, Ohara H, Kiuchi Y. Two Cases of Atopic Dermatitis Patients With Scleral Perforation After Recurrent Scleritis Induced by Scleral-Sutured Posterior Chamber Intraocular Lens Implantation. Cureus 2023; 15:e40153. [PMID: 37431339 PMCID: PMC10329562 DOI: 10.7759/cureus.40153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
This report describes two cases of atopic dermatitis patients with scleral perforation after recurrent scleritis induced by suture exposure after scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. The first patient was a 41-year-old man (case 1), and the second was a 46-year-old man (case 2). Both had a history of atopic dermatitis and scleral-sutured intraocular lens (IOL) implantation. Scleritis recurred at the suture site after scleral-sutured IOL implantation in both patients. Although the scleritis was controlled by topical and/or systemic anti-inflammatory drugs, the sclera was perforated in both cases because of exposure of the suture knots (after seven years in case 1 and after 11 years in case 2). In case 1, the superotemporal IOL haptic was also exposed over the conjunctiva, and in case 2, the ciliary body was incarcerated in the scleral hole with deformation of the pupil superonasally. Considering that there were no signs of severe intraocular inflammation, surgical intervention was performed in both cases. In case 1, IOL repositioning was performed with oral prednisolone cover at a dosage of 15 mg/day, starting two weeks prior to the surgery. The steroid dosage was gradually tapered off until two months after the surgery. In case 2, the scleral patch underwent without IOL extraction, and no steroid or immunosuppression cover was administered. There was no recurrence of scleritis after surgery in either case, and visual acuity was preserved in both cases. The scleral perforation that occurred after scleral-sutured IOL implantation in these patients was thought to be the result of recurrent scleritis caused by suture exposure and chronic mechanical irritation by a suture knot. The scleritis subsided without removal of the IOL by moving the suture site of the IOL haptic and covering the suture with a scleral flap or patch graft.
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Affiliation(s)
- Akira Minamoto
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Yosuke Harada
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Tomona Hiyama
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Hiromi Ohara
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Yoshiaki Kiuchi
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
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Walsh MK, Williams MT. Flanged Sutureless Intrascleral Fixation of Dislocated Hard 1-Piece Polymethyl Methacrylate Intraocular Lenses. Retina 2023; 43:1035-1038. [PMID: 38235975 DOI: 10.1097/iae.0000000000002899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the vitreoretinal surgical technique and report the outcomes of our method of sutureless flanged intrascleral haptic fixation of dislocated 1-piece polymethyl methacrylate intraocular lenses with rigid haptics. METHODS Ciliary sulcus-based scleral tunnels were created by placing valved 27-gauge (g) trocar cannulas limbus parallel with conjunctival displacement. After complete vitrectomy, the rigid haptics were then externalized using 27g forceps. Cautery was then used to form flanges at the haptic tips. The haptics were then pushed back into the mouths of the scleral tunnels. RESULTS Flanged intrascleral fixation was successfully achieved in eight eyes of seven patients. The average age at the time of surgery was 75 ± 13.7 years, with a mean follow-up of 17.9 ± 16.3 months (range 3-42 months). Intraocular lens dislocation/subluxation was the most common indication for surgery. All patients fully recovered to their potential acuity by their third postoperative visit. The most significant complication was erosion of one haptic in one patient, which was successfully managed without requiring intraocular lens exchange. There were no complications of subsequent dislocation, endophthalmitis, retinal detachment, or uveitis-glaucoma-hyphema syndrome. CONCLUSION Flanged sutureless intrascleral fixation of dislocated 1-piece polymethyl methacrylate intraocular lenses with rigid haptics can be safely and successfully performed, avoiding the large wound creation accompanying intraocular lens exchange and the disadvantages of suture-based techniques.
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Affiliation(s)
- Mark K Walsh
- Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson, Arizona; and
- Retina Associates Southwest, Tucson, Arizona
| | - Mark T Williams
- Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson, Arizona; and
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Do JR, Park SJ, Kim JY, Shin JP, Park DH. RISK FACTORS FOR PUPILLARY OPTIC CAPTURE FOLLOWING SUTURELESS FLANGED INTRAOCULAR LENS FIXATION FOR INTRAOCULAR LENS DISLOCATION. Retina 2023; 43:964-971. [PMID: 38235974 DOI: 10.1097/iae.0000000000003743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE To identify risk factors for pupillary optic capture after sutureless flanged intraocular lens (IOL) fixation for IOL dislocation. METHODS This retrospective comparative study enrolled consecutive patients who underwent flanged IOL fixation using 25-gauge pars plana vitrectomy. One hundred twenty-six eyes (126 patients) were divided into two groups according to the presence or absence of pupillary optic capture. A swept-source anterior segment optical coherence tomography and a rotating Scheimpflug camera were used to analyze and compare surgical parameters, including axial length, anterior chamber depth, differences in scleral tunnel angle and length, and IOL tilt and decentration, between the two groups. RESULTS Compared with the nonpupillary optic capture group (106 eyes, 84.1%), the pupillary optic capture group (20 eyes, 15.9%) had larger differences in the nasal and temporal scleral tunnel angles and larger horizontal tilt (P < 0.05). Multivariate regression analysis demonstrated that these factors correlated with the occurrence of pupillary optic capture (P < 0.05). CONCLUSION To prevent pupillary optic capture after flanged IOL fixation, surgeons should avoid asymmetry in the angles of the nasal and temporal scleral tunnels, which causes horizontal IOL tilt and subsequent pupillary capture.
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Affiliation(s)
- Jae Rock Do
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Republic of Korea
| | | | - Jin Young Kim
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Republic of Korea
| | - Jae Pil Shin
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Republic of Korea
| | - Dong Ho Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Republic of Korea
- Kyungpook National University, Cell and Matrix Research Institute, Republic of Korea
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74
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Canabrava S, Carvalho MS. Double-flanged polypropylene technique: 5-year results. J Cataract Refract Surg 2023; 49:565-570. [PMID: 36745851 DOI: 10.1097/j.jcrs.0000000000001154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the long-term (5-year) results and complications of the double-flanged polypropylene technique in patients with capsular tension segment fixation, nonfoldable intraocular lens (IOL) scleral fixation, and foldable IOL scleral fixation. SETTING Santa Casa de Belo Horizonte and Centro Oftalmológico de Minas Gerais. DESIGN Prospective case series. METHODS Eyes that underwent treatment using the double-flanged polypropylene technique between September 2016 to September 2021 were included. LogMAR visual acuity was recorded, as well as complications such as long-term polypropylene resistance, conjunctival erosion, conjunctival inflammation, flange exposure, internalization, endophthalmitis, retinal detachment, and cystoid macular edema. RESULTS 71 eyes of 61 patients were evaluated. The mean follow-up period for these eyes was 28.2 ± 14.3 (min: 4; max: 60; median: 26) months. 173 flanges were performed. 13 cases with sub-Tenon flanges (7.5%) were observed. 5 exposed flanges (2.89%), presented after a mean of 1.8 weeks postoperatively, were observed. 1 patient with large flanges presented with conjunctival inflammation and hyperemia. 2 late internalized flanges (1.1%) and 2 recently internalized flanges (1.1%) were observed. 3 eyes (4.22%) had retinal detachment. Moreover, cystoid macular edema was detected in 3 eyes (4.22%). No cases of endophthalmitis were observed. CONCLUSIONS The double-flanged technique was proven to be stable when the correct technical procedure was followed. However, complications can be observed, especially with short scleral tunnels and in eyes where the flanges were not buried inside the sclera.
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75
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Tellioğlu A, Beşek NK, Kırgız A, Yılmaz FÖ, Şimşek M, Ahmet S, Atik BK. Changes in Corneal High Order Aberrations and Anterior Chamber Parameters Following Scleral Fixated Intraocular Lens Implantation. Photodiagnosis Photodyn Ther 2023:103595. [PMID: 37146894 DOI: 10.1016/j.pdpdt.2023.103595] [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: 01/01/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND To evaluate the change in corneal high order aberrations (HOAs) and anterior chamber parameters following scleral fixation in aphakic patients using the Scheimpflug camera system. METHODS This retrospective study included patients who were aphakic after phacoemulsification surgery and underwent scleral-fixed intraocular lens (SF-IOL) implantation with Z suture technique between 2010 and 2022. Preoperative and postoperative best corrected visual acuity (BCVA), anterior segment parameters and corneal aberrations were evaluated with a combined Scheimpflug-Placido disc corneal topography device (Sirius Costruzione Strumenti Oftalmici, Florence, Italy). The following values were recorded: Simulated keratometry (SimK), flat meridian (K1), steep meridian (K2), iridocorneal angle (ICA), temporal anterior chamber angle (T-ACA), nasal anterior chamber angle (N-ACA), horizontal anterior chamber diameter (HACD), anterior chamber volume (ACV), corneal volume (CV), total Root Mean Square (RMS), high order aberrations (HOAs), spherical aberration, coma, trefoil, quadrifoil, and secondary astigmatism. RESULTS The study included 31 eyes of 31 patients (mean age: 63.00±19.41 years, 17 males/14 females). Postoperative BCVA was better than preoperative BCVA (p=0.012). Postoperatively, there was a statistically significant increase in ACV and CV values and a statistically significant decrease in K2 (p=0.009, p=0.032, p=0.015). Preoperative T-ACA and preoperative and postoperative ACV were negatively correlated with postoperative intraocular pressure (r=-0.427 p=0.033, r=-0.406 p=0.032 and r=-0.561 p=0.001). There were statistically significant postoperative increases in corneal RMS, trefoil and HOAs for 3 mm pupil diameter (p=0.0177, p=0.001, p=0.031) and in corneal RMS, trefoil and quadrifoil aberrations for 6 mm pupil diameter (p=0.033, p=0.001, p=0.001). CONCLUSIONS In conclusion, SF-IOL implantation with Z-suture technique used for visual rehabilitation of aphakic patients may affect visual quality by increasing corneal HOAs while improving visual acuity.
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Affiliation(s)
- Adem Tellioğlu
- Department of Ophtalmology, Soma State Hospital, Manisa, Turkiye.
| | - Nilay Kandemir Beşek
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Ahmet Kırgız
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Fevziye Öndeş Yılmaz
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Metehan Şimşek
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Sibel Ahmet
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Burcu Kemer Atik
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
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76
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Agarwal R, Shakarwal C, Sharma N, Titiyal JS. Concomitant sutureless scleral fixation of intraocular lens with keratoplasty: Review of surgical techniques. Indian J Ophthalmol 2023; 71:1718-1732. [PMID: 37203023 PMCID: PMC10391482 DOI: 10.4103/ijo.ijo_1724_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Sutureless scleral fixation of intraocular lens (sSFIOL) is a commonly employed method of optical rehabilitation of aphakic patients with deficient capsular support, and corneal transplant surgeries can be simultaneously combined with sSFIOL to handle aphakic corneal opacities. A single-stage procedure circumvents the need for repeat intraocular procedures and carries lower risk of graft endothelial damage, endophthalmitis, and macular edema associated with sequential surgeries. However, it mandates surgical expertise and increases the chances of postoperative inflammation. A basket of options is available with the corneal surgeons regarding the manner of host and donor preparation as well as the approaches to scleral fixation and certain intraoperative modifications along with postoperative vigilance may enhance the surgical outcomes. Most of the studies pertaining to keratoplasty with sSFIOL categorize to case reports/series, surgical techniques, and retrospective studies with very limited prospective data available currently. The purpose of the present review is to consolidate all available literature on concomitant sSFIOLs and keratoplasty procedures.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Chetan Shakarwal
- Department of Optometry, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Jeewan S Titiyal
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
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77
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Limon U, Akçay BIS. A novel Yamane technique modification: Reverse intraocular lens implantation for simplifying trailing haptic insertion. Indian J Ophthalmol 2023; 71:2244-2246. [PMID: 37202960 PMCID: PMC10391425 DOI: 10.4103/ijo.ijo_3158_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
We described a modified Yamane technique for simplifying trailing haptic insertion in aphakia correction. In Yamane intrascleral intraocular lens (IOL) implantation technique, trailing haptic implantation is challenging for many surgeons. This modification provides an easier and safer way of trailing haptic insertion into the needle tip and decreases the possibility of bending or breaking the trailing haptic.
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Affiliation(s)
- Utku Limon
- Department of Retina, University of Health Sciences Umraniye Training and Research Hospital Eye Clinic, Istanbul, Turkey
| | - Betül I S Akçay
- Department of Retina, University of Health Sciences Umraniye Training and Research Hospital Eye Clinic, Istanbul, Turkey
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78
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Mastrogiuseppe E, Pirraglia MP, Sampalmieri L, Iannetti L, Beccia A, Gharbiya M. Management of Spontaneous Crystalline Lens Luxation in a Patient Diagnosed with Takayasu's Disease. Diagnostics (Basel) 2023; 13:diagnostics13081400. [PMID: 37189502 DOI: 10.3390/diagnostics13081400] [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: 03/14/2023] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Takayasu's disease is a chronic granulomatous arteriopathy that affects large vessels and their major branches. Nonspecific symptoms characterize the early phase, whereas findings of arterial occlusion and aneurysmal formation become manifest later. Ocular signs typically refer to retinal vascular involvement, as Takayasu arteritis or hypertensive retinopathy. We report a case of a 63-year-old woman suffering from Takayasu arteritis that complained of sudden onset of blurred vision in her left eye due to crystalline lens luxation in the vitreous cavity. The patient's past medical history was unremarkable for trauma, personal or familiar collagenopathies. Prompt surgical management was performed and the patient reached 0 LogMAR seven days after surgery. Our case illustrates the concomitant occurrence, never reported before, of two rare conditions in the same patient, namely, Takayasu arteritis and spontaneous lens dislocation. Further research and future knowledge are needed to explain whether Takayasu arteritis could obliquely injure zonular or fibrillar structures and whether these features may be possibly related.
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Affiliation(s)
- Elvia Mastrogiuseppe
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Department of Sense Organs, Sapienza University of Rome, 00185 Roma, Italy
| | - Maria Pia Pirraglia
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Department of Sense Organs, Sapienza University of Rome, 00185 Roma, Italy
| | - Lorenzo Sampalmieri
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Department of Sense Organs, Sapienza University of Rome, 00185 Roma, Italy
| | - Ludovico Iannetti
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Department of Sense Organs, Sapienza University of Rome, 00185 Roma, Italy
| | - Alessandro Beccia
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Department of Sense Organs, Sapienza University of Rome, 00185 Roma, Italy
| | - Magda Gharbiya
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Department of Sense Organs, Sapienza University of Rome, 00185 Roma, Italy
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Lalwani S, Kekunnaya R. Secondary Intraocular Lens Implantation (IOL) in Children- What, Why, When, and How? Semin Ophthalmol 2023; 38:255-264. [PMID: 36016513 DOI: 10.1080/08820538.2022.2116288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE To provide a comprehensive review on secondary IOL implantation in children who have undergone primary surgery at an early age and are aphakic aiming at answering common dilemmas among pediatric ophthalmologists. METHOD OF LITERATURE REVIEW A systematic literature search was done using keywords like secondary intraocular implantation, congenital cataractand surgical aphakia. Various novel case reports, retrospective case studies and review articles covering different aspects of secondary IOL implantation were searched and reviewed using PubMed and Google scholar journal search engines. RESULTS This article highlights various aspects of secondary IOL implantation like the appropriate timing should be when the child is entering preschool, with the proper technique being in bag fixation is the most preferred method with least associated complications and the IOL type should be decided based on the fixation site. CONCLUSION Secondary IOL implantation can accomplish good and stable long-term outcomes in children. It is the most accepted mode of optical correction once the appropriate age is achieved.
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Affiliation(s)
- Sakshi Lalwani
- Head, Pediatric Ophthalmology, Strabismus, and Neuro-ophthalmology Services, Child Sight Eye Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Head, Pediatric Ophthalmology, Strabismus, and Neuro-ophthalmology Services, Child Sight Eye Institute, L V Prasad Eye Institute, Hyderabad, India
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80
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Pakravan P, Patel V, Chau V, Rohowetz L, Lai J, Fan KC, Al-Khersan H, Melo IM, Muni RH, Tsao SW, Kaplan R, Jung JJ, Hoyek S, Patel NA, Kuriyan AE, Laura DM, Mantopoulos D, Syed ZA, Yannuzzi NA. Haptic Erosion Following Sutureless Scleral-fixated Intraocular Lens Placement. Ophthalmol Retina 2023; 7:333-337. [PMID: 36441084 DOI: 10.1016/j.oret.2022.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To describe the clinical features and visual outcomes of eyes with conjunctival haptic erosion after sutureless intrascleral (SIS) fixated intraocular lens (IOL) placement. DESIGN Retrospective case series. SUBJECTS Patients experiencing haptic erosion after SIS fixation between January 1, 2013, and March 1, 2022. METHODS A multicenter, multisurgeon, retrospective review. MAIN OUTCOME MEASURES Clinical features, visual outcomes, and treatment options following haptic erosions after SIS fixation. RESULTS Nineteen eyes with haptic erosion were identified. The mean age at initial SIS fixation was 64 ± 12 years (range, 38-81 years). There were 5 (26%) eyes with a history of conjunctiva involving ocular surgery, including scleral buckle surgery and tube shunt surgery. Trocar-assisted fixation was performed in 15 (79%) eyes, whereas needle fixation was used in 4 (21%) eyes. Eighteen (95%) sets of haptics were flanged with a low temperature cautery. Seventeen (90%) sets of haptics were externalized superiorly and inferiorly, and 2 (10%) sets of haptics were externalized nasally and temporally. Haptics were covered by conjunctiva in 14 (74%) eyes and by scleral flap in 5 (26%) eyes. All patients experienced a single haptic erosion, of which 8 (43%) were located superiorly, 9 (47%) inferiorly, and 2 (10%) temporally. The mean interval between the initial SIS fixation and haptic erosion was 278 ± 437 days. After correction of the erosion, 18 (95%) eyes had a stable IOL at the last follow-up, with no recurrence of haptic erosion. In this series, there were no cases of endophthalmitis. CONCLUSIONS Haptic erosion is a notable complication after SIS fixated IOL surgery but may be repaired with favorable visual outcomes. Careful evaluation of the conjunctiva should be considered before the surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Parastou Pakravan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Veshesh Patel
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Viet Chau
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Landon Rohowetz
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - James Lai
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Sean W Tsao
- Department of Ophthalmology, Southern California Permanente Medical Group, Santa Ana, California
| | | | - Jesse J Jung
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; East Bay Retina Consultants, Inc., Oakland, California
| | - Sandra Hoyek
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Nimesh A Patel
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Ajay E Kuriyan
- Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Diana M Laura
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Zeba A Syed
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
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81
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Ahn J. The clinical outcomes of 33 canine eyes following the novel sulcus fixation technique of an injectable acrylic lens through a 3-mm corneal incision. Vet Ophthalmol 2023. [PMID: 36872846 DOI: 10.1111/vop.13073] [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: 12/04/2021] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE This retrospective study introduces and evaluates transscleral fixation using a horizontal mattress suture of a conventional injectable acrylic intraocular lens (IOL) inserted through a 3-mm corneal incision in dogs. MATERIALS AND METHODS This technique was applied to four groups: lens subluxation (group SL, n = 15), anterior or posterior lens luxation (group APLL, n = 9), lens capsule tear or rupture (group LCTR, n = 7), and dislocation of the lens capsule containing an IOL (group IOLD, n = 4). RESULTS Patients were followed up for an average of 366.7 days (range: 94-830 days) after the surgery. Each IOL was well-centered and the overall visual success rate was 74.3% (26/35). Retinal detachment (4/35) was the most common cause of blindness, followed by glaucoma (3/35), hyphema of unknown etiology (1/35), and severe uveitis accompanied by deep corneal ulcer (1/35). CONCLUSION This technique enables sulcus fixation of an IOL, inserted through a 3-mm corneal incision, which is less traumatic than conventional techniques, without the need for specifically designed IOL for sulcus fixation. In this series, this technique enabled to contribute to restore emmetropic vision in dogs.
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Affiliation(s)
- Jaesang Ahn
- Dr. Ahn's Animal Eye Clinic, Seoul, South Korea
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82
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Trans-Scleral Plugs Fixated FIL SSF IOL: A Review of the Literature and Comparison with Other Secondary IOL Implants. J Clin Med 2023; 12:jcm12051994. [PMID: 36902780 PMCID: PMC10004107 DOI: 10.3390/jcm12051994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications.
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83
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Silpa-Archa S. SIMPLE REFIXATION OF A DISLOCATED HAPTIC OF FLANGED INTRAOCULAR LENS USING A 25-GAUGE NEEDLE. Retin Cases Brief Rep 2023; 17:173-175. [PMID: 36821471 DOI: 10.1097/icb.0000000000001135] [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: 11/25/2022]
Abstract
PURPOSE To report the development of a novel, simple-to-use technique for the salvage of a haptic of dislocated flanged intraocular lens during a retinal detachment surgery. METHODS A 25-gauge regular-wall needle was prepared and threaded by the dislocated flanged haptic before the flanged haptic was heated and enlarged by low-temperature cautery. RESULTS The dislocated flanged haptic was probably the result of too small of a diameter of the previously flanged haptic and was triggered by scleral indentation. The rescue technique required only a 25-gauge regular-wall needle to conduct the conventional procedure of flanged haptic intraocular lens fixation before being enlarged by low-temperature cautery. The intraocular lens remained centered and stable at a 3-month postoperative follow-up examination. CONCLUSION The application of a 25-gauge needle in the salvage of a haptic of dislocated flanged intraocular lens is simple and effective without the need for trimming the flanged tip.
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Affiliation(s)
- Sukhum Silpa-Archa
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
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84
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Shiraki A, Sakaguchi H, Nishida K. NEW, SIMPLE, AND SAFE SURGICAL TECHNIQUE FOR THE REMOVAL OF A DISLOCATED CAPSULAR TENSION RING-INTRAOCULAR LENS-CAPSULAR BAG COMPLEX. Retin Cases Brief Rep 2023; 17:134-136. [PMID: 35170297 DOI: 10.1097/icb.0000000000001119] [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: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To report a safe and simple surgical technique for the removal of a dislocated capsular tension ring (CTR)-intraocular lens (IOL)-capsular bag (CB) complex. METHODS We present an extraocular surgical removal technique for a dislocated CTR-IOL-CB complex. Although the entire complex is typically removed with a large incision, this approach applies a CTR injector and anterior capsule forceps in a less invasive manner. RESULTS After vitrectomy, the complex was moved to the anterior chamber, where the tip of the CTR was separated from the IOL-CB using anterior capsule forceps and hooked onto the tip of the CTR injector. Subsequently, the CTR, as well as part of the CB, was gradually separated from the IOL-CB and stored in the CTR injector. This was completed while also supporting the IOL-CB complex using the forceps. Once the whole CTR and the part of CB were removed from the anterior chamber, the residual IOL and CB were then removed. CONCLUSION Our methodology, using the CTR injector and anterior capsule forceps, enables the procedure to be completed with only a small corneal incision, thereby allowing for the safe and simple removal of a CTR-IOL-CB complex.
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Affiliation(s)
| | - Hirokazu Sakaguchi
- Departments of Ophthalmology, and
- Advanced Device Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; and
| | - Kohji Nishida
- Departments of Ophthalmology, and
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
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85
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Noguchi S, Nakakura S, Noguchi A, Tabuchi H. Relationship between Postoperative Anterior Chamber Depth and Refraction Based on the Haptic Fix Position in Intraocular Lens Intrascleral Fixation. J Clin Med 2023; 12:jcm12051815. [PMID: 36902602 PMCID: PMC10003268 DOI: 10.3390/jcm12051815] [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: 12/23/2022] [Revised: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
The aim of this study was to analyze the refraction and iris capture tendency regarding the fixation position with respect to the intrascleral fixation (ISF) of intraocular lenses. Consecutive patients who underwent ISF 1.5 mm (ISF 1.5, 45 eyes) and 2.0 mm (ISF 2.0, 55 eyes) from the corneal limbus with NX60, as well as those who underwent normal phacoemulsification with in-the-bag ZCB00V (ZCB, 50 eyes), were enrolled. The anterior chamber depth (post-op ACD), the estimated ACD when using the SRK/T (post-op ACD-predicted ACD), and the refractive error (post-op MRSE, and the predicted MRSE) were all calculated. In addition, the postoperative iris capture was also investigated. The post-op MRSE-predicted MRSE values were: -0.59, 0.02, and 0.00 D (ISF 1.5, ISF 2.0, and ZCB) (p < 0.05, between ISF 1.5 vs. ISF 2.0 and ZCB); the post-op ACD values were: 4.00, 4.17, and 4.29 mm (p < 0.05, ISF 1.5 vs. ZCB); and the post-op ACD-predicted ACD values were: -2.03, -1.98, and -1.60 mm (p < 0.05, between ZCB vs. ISF 1.5 and ISF 2.0). The iris capture occurred in four eyes with regard to ISF 1.5 and three eyes with ISF 2.0 (p = 0.52). Moreover, ISF 2.0 possessed 0.6D hyperopia and 0.17 mm deeper anterior chamber depth. The refractive error of ISF 2.0 was less than that of ISF 1.5. Lastly, no significant iris capture onset was noted between ISF 1.5 mm and 2.0 mm.
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86
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Surgical decisions in the setting of zonulopathy. J Cataract Refract Surg 2023; 49:221-222. [PMID: 36700891 DOI: 10.1097/j.jcrs.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An 85-year-old man with a history of type 2 diabetes, pseudoexfoliation (PXF) in both eyes, and tamsulosin use was referred for the evaluation of a dense cataract in the right eye and a subluxated intraocular lens (IOL) in the left eye. Unfortunately, his surgery in the left eye was complicated by diffuse zonulopathy. The referring surgeon placed a 3-piece IOL in the sulcus. However, the passively fixated 3-piece IOL moved inferiorly causing monocular diplopia for over a year. Because the patient was pleased with the IOL immediately postoperatively, a refixation procedure was performed in the form of sulcus placement with iris suture fixation in the left eye. Fortunately, the iris-fixated IOL in the left eye has remained well centered and stable without cystoid macular edema (CME) or chronic inflammation for over 8 months. The patient is on no ocular medications and has no family history of glaucoma. He now needs cataract surgery in the right eye and is extremely apprehensive because of his difficult course in the left eye. The corrected distance visual acuity is 20/70 in the right eye and 20/25 in the left eye. Intraocular pressures (IOPs) measure 20 mm Hg in the right eye and 14 mm Hg in the left eye by Goldmann tonometry. Pachymetry is 536 µm in the right eye and 543 µm in the left eye. Pupils are round with minimal reactivity and without a relative afferent pupillary defect. Extraocular motility is normal in both eyes, and confrontation visual fields is full in both eyes. Gonioscopy reveals an angle open to the pigmented trabecular meshwork (PTM) in the right eye and the ciliary body in the left eye with 1+ PTM and without peripheral anterior synechia in both eyes. The retinal nerve fiber layer and macular optical coherence tomography are normal in both eyes. On slitlamp examination, pertinent findings include pseudoexfoliative changes at the pupillary margin with poor dilation of 3.5 mm in both eyes; the anterior chamber (AC) is shallow but adequate in the right eye and deep and quiet with rare pigmented cells in the left eye. There is a 5+ nuclear sclerotic cataract with pseudoexfoliative changes on the anterior capsule and no obvious phacodonesis in the right eye and a 3-piece posterior chamber IOL in the sulcus fixated to the iris with 10-0 polypropylene sutures at 6 and 12 o'clock without pseudophacodonesis in the left eye. Dilated fundus examination reveals a cup-to-disc ratio of 0.4 with healthy neuroretinal rims in both eyes, posterior vitreous detachments in both eyes, and no evidence of diabetic retinopathy in both eyes. All other findings are unremarkable. How would you counsel this patient regarding his risk factors for surgery in the right eye? What surgical maneuvers would you use to remove the cataract safely? How would you stabilize the IOL if the capsule bag becomes compromised due to zonulopathy?
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87
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Evaluations of bridging sutures in preventing iris capture in eyes with intrascleral fixation of implanted intraocular lens. Graefes Arch Clin Exp Ophthalmol 2023; 261:427-434. [PMID: 36042055 DOI: 10.1007/s00417-022-05816-1] [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: 06/06/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The study aims to determine the effectiveness of bridging sutures in preventing iris capture and a subsequent reverse pupillary block after an intrascleral fixation of an implanted intraocular lens (IOL). METHODS We studied 6 eyes that had an iris capture with reverse pupillary block due to a dislocated IOL after an intrascleral fixation. After the dislocated IOL was repositioned, 10-0 polypropylene sutures were inserted 1.5 mm posterior to the limbus and directed to run between the iris and the IOL. The sutures were placed orthogonal to the haptics of the IOL. Anterior segment optical coherence tomography (AS-OCT) was used in 4 eyes to evaluate the degree of iridodonesis before and after the bridging sutures. The heights of the temporal and nasal sectors of the middle iris from the iris plane (the line between anterior chamber angles) were compared for each 0.2-s AS-OCT image taken immediately after the eye moved from a lateral to a primary position. RESULTS None of the eyes had a recurrence of the iris capture after the bridging sutures. The refractive error, anterior chamber depth, and vision were not significantly altered after the bridging sutures were placed. The AS-OCT images showed that the height of the nasal iris was decreased more at 0 s postoperatively blocking the excessive downward movement of the nasal iris but not the iridodonesis. CONCLUSION Bridging sutures were effective in preventing iris capture and subsequent reverse pupillary block after an intrascleral fixation of an IOL.
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Cui Y, Li Q, Shi X, Zhou D. A comparative study of transscleral sutured intraocular lens fixation and sutureless flanged intraocular lens fixation. BMC Ophthalmol 2023; 23:23. [PMID: 36650453 PMCID: PMC9843930 DOI: 10.1186/s12886-023-02782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To compare the intraocular lens (IOL) tilt and decentration and visual outcomes of transscleral sutured IOL fixation and sutureless flanged IOL fixation. To investigate the influence of IOL tilt and decentration on internal higher-order aberrations (HOAs) in these two techniques. METHODS Patients who received transscleral sutured or sutureless flanged IOL fixation procedures were included in this prospective, non-randomized, comparative study. Corrected distance visual acuity (CDVA) was measured at baseline and at every postoperative visit for 12 months. IOL tilt and decentration were measured using a second-generation anterior segment optical coherence tomography (Casia2) and internal HOAs were measured using iTrace Visual Function Analyzer at 3 months postoperatively. RESULTS The study included 27 eyes from the transscleral sutured IOL fixation group and 26 eyes from the sutureless flanged IOL fixation group. There was no significant difference in CDVA between the two groups at all time points. The two groups did not differ in refractive difference from the predicted value, corneal endothelial cell loss, IOL tilt, IOL decentration, internal astigmatism or internal HOAs. Vertical IOL decentration significantly correlated with total internal optical aberration (r = 0.288, P = 0.036), total internal HOA (r = 0.440, P = 0.001), internal coma (r = 0.348, P = 0.001), vertical internal coma (r = 0.388, P = 0.004), average height of modulation transfer function (r = - 0.364, P = 0.007) and Strehl ratio (r = - 0.297, P = 0.031). Horizontal IOL decentration significantly correlated with horizontal internal coma (r = 0.312, P = 0.023). CONCLUSIONS Transscleral sutured IOL fixation and sutureless flanged IOL fixation had similar IOL positions and visual outcomes. IOL decentrations correlated with internal HOAs and thus should be avoided.
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Affiliation(s)
- Ying Cui
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Qiyan Li
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Xiangyu Shi
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Dan Zhou
- grid.24696.3f0000 0004 0369 153XBeijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
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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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90
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Peng T, Guo H, Wang Y, Zhou L, Bao X. Case report: Double-armed flanged polypropylene suture for repairing wide iridodialysis. Front Med (Lausanne) 2023; 9:1084538. [PMID: 36714099 PMCID: PMC9877622 DOI: 10.3389/fmed.2022.1084538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose To describe a new technique for repairing wide iridodialysis (>180°) with a double-armed flanged polypropylene suture. Setting Private practice, Wuhan, China. Design Case report. Methods Adjacent to the iridodialysis side, the sclera was punctured 2 mm exterior to the corneal limbus into the anterior chamber with a 30-G needle, then the root of the de-inserted iris was punctured. A 7-0 polypropylene thread was placed into the anterior chamber through a corneal incision on the opposite side and inserted into the needle. The needle was withdrawn, leaving one side of the suture out of the eye. Then, the sclera was punctured by a new needle 2 mm from the first puncture site and passed through the iris root 2 mm from the original iris puncture point. The other end of the thread was inserted into the needle and taken out of the eye. The suture was tightened to make the iris root adhere to the corneal limbus. Finally, the suture is was cut, and the ends were cauterized and left inside the sclera. This procedure can be repeated until the iridodialysis is solved. Results The abovementioned technique was applied in four cases. At the end of the operations, the pupils of all patients were nearly round, with a diameter of about 3 mm. No patient suffered from intraoperative and postoperative complications. Conclusions The double-armed flanged polypropylene suture is a simple and safe operation method that can be applied to repair wide iridodialysis.
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91
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Ramakrishnan MS, Wald KJ. Current Concepts of the Uveitis-Glaucoma-Hyphema (UGH) Syndrome. Curr Eye Res 2023; 48:529-535. [PMID: 36476057 DOI: 10.1080/02713683.2022.2156547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To discuss the pathophysiology, etiology, and current management strategies of uveitis-glaucoma-hyphema (UGH) syndrome. METHODS Literature review. RESULTS The classic UGH syndrome associated with anterior chamber intraocular lenses (ACIOL) have decreased in incidence with the modernization of IOL design and surgical techniques. The current UGH syndrome is increasing in prevalence largely related to a parallel increase in late onset dislocations of intraocular lenses (IOLs) and the developing techniques to remedy that condition. The modern features of UGH can present as cystoid macular edema, intraocular pressure elevation typically not attributed to UGH, and recurrent vitreous hemorrhage, unlike the original description as described by Ellingson in 1978. Medical management to control inflammation, reduce intraocular pressure, and reduced the bleeding diathesis are mainstays of therapy. However, surgery with IOL repositioning or exchange should be reserved for cases that are refractory to or progressing despite medical treatment. CONCLUSIONS UGH syndrome is an increasingly common, poorly understood, and often subtle, manifestation of an anatomic disturbance post intraocular surgery that persists with continued evolution of intraocular surgical techniques and new imaging modalities to aid in its diagnosis.
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Affiliation(s)
| | - Kenneth J Wald
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
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Pardini D, Lucatto LF, Junior OM, Maia A, Hammamji K, Dirani A, Rezende FA, Maia BT, Rodrigues EB, Roizenblatt M, Maia M. Outcomes of Pars Plana Vitrectomy and 4-Point Sutured Scleral Fixation of Akreos AO60 Intraocular Lens in Clinical Settings: A Case Series. Ophthalmol Retina 2023; 7:59-66. [PMID: 35850442 DOI: 10.1016/j.oret.2022.07.006] [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: 02/09/2022] [Revised: 06/26/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine the long-term anatomic outcomes and surgical complications of pars plana vitrectomy (PPV) and 4-point Gore-Tex-sutured Akreos AO60 intraocular lens (IOL) scleral fixation. DESIGN Retrospective, multicenter, multisurgeon case series. PARTICIPANTS Ninety-seven patients in tertiary eye care centers. METHODS The patients underwent PPV and intraocular fixation of the Akreos AO60 IOL using Gore-Tex CV-8 sutures between January 2015 and April 2020. The inclusion criteria were aphakia, no capsular support, and a minimal 1 year of follow-up. MAIN OUTCOME MEASURES Uncorrected visual acuity (VA), complication rates or types, and refraction. RESULTS Data from 101 eyes of the 97 patients were analyzed (mean follow-up duration, 33.4 months; range, 12-62 months). The mean ± standard deviation uncorrected logarithm of the minimum angle of resolution VA improved from 1.04 ± 0.73 (20/200 Snellen equivalent) before surgery to 0.66 ± 0.65 (20/80) at 6 months after surgery (P < 0.001). The most prevalent complications included hypotony (12.9%), ocular hypertension (12.9%), corneal edema (8.9%), cystoid macular edema (6.9%), and vitreous hemorrhage (5.9%). Refraction was measured between 3 and 6 months after surgery, and 61.8% of the patients had spherical equivalent of ± 2.0 diopters. Most complications occurred in the first postoperative month and resolved spontaneously or with medical treatment. CONCLUSIONS The results demonstrated that this surgical technique is well tolerated by the eyes, with a low complication rate in the long term. The rates of IOL opacification were infrequent for up to 62 months of follow-up.
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Affiliation(s)
- Denise Pardini
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, Brazil.
| | - Luiz Filipe Lucatto
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; COLP Eye Hospital, Salvador, Brazil
| | - Octaviano Magalhães Junior
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; OFT Ophthalmic Clinic, São Paulo, Brazil
| | - André Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Retina Clinic, São Paulo, Brazil
| | - Karim Hammamji
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Ali Dirani
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Flavio A Rezende
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Bruna Trench Maia
- Brazilian Institute of Fight Against Blindness (INBRACE), Assis and Presidente Prudente, São Paulo, Brazil
| | | | - Marina Roizenblatt
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Maurício Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Brazilian Institute of Fight Against Blindness (INBRACE), Assis and Presidente Prudente, São Paulo, Brazil
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93
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Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis. Int Ophthalmol 2023; 43:131-140. [PMID: 35794404 DOI: 10.1007/s10792-022-02395-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis. METHODS Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180° were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated. RESULTS The mean age of the patients was 57.4 ± 15.1 years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 ± 6.5 months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 ± 0.16 logMAR and 0.13 ± 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 ± 1.4 D and 1.0 ± 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7° ± 5.2°. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%). CONCLUSION The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.
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Erakgun T. INTRAVITREAL NEEDLE TECHNIQUE FOR INTRASCLERAL HAPTIC FIXATION OF POSTERIORLY DISLOCATED THREE-PIECE INTRAOCULAR LENSES. Retin Cases Brief Rep 2023; 17:50-53. [PMID: 33323895 PMCID: PMC9750094 DOI: 10.1097/icb.0000000000001102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Double-needle intrascleral haptic fixation (Yamane) technique is a minimally invasive method for posterior chamber intraocular lens (IOL) fixation in the setting of absent or inadequate capsule support. A modified intravitreal needle technique is herein described for the management of three piece IOLs which are dislocated into the vitreous cavity. METHODS In this technique, after completing pars plana vitrectomy, under the noncontact ophthalmomicroscope, the haptic of the dislocated IOL is docked directly in the vitreous cavity into a 27-G needle which is inserted through a transconjunctival tunneled scleral incision 2 mm. from the corneal limbus, and externalized from the conjunctiva and fixated sclerally. RESULTS The technique is described with a case report. A male patient of 65 years old who underwent a complicated cataract surgery was operated using this technique. No preoperative or postoperative complication was seen. CONCLUSION In this technique, the dislocated IOL is not taken in the anterior segment before the scleral fixation. The haptics are threaded into the 27-G needle directly in the vitreous cavity during the vitrectomy. This is a short cut Yamane technique for posteriorly dislocated three-piece IOLs. This technique may shorten the surgical time and minimize surgical trauma in cases with posteriorly dislocated three-piece IOL.
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95
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Ucar F. Facilitated trailing haptic externalization technique for intrascleral intraocular lens fixation. Eur J Ophthalmol 2023; 33:615-620. [PMID: 36073536 DOI: 10.1177/11206721221125016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe the facilitated trailing haptic externalization technique for intrascleral intraocular lens (IOL) fixation. METHODS In this technique, first the direction of the 4-5 mm tip of the trailing haptic is straightened with the help of forceps. After the second needle enters the posterior chamber, the edge of the IOL optic is pushed towards the opposite scleral tunnel with the needle. The trailing haptic approaching the center from the periphery and the straightened distal part of the haptic towards the direction of the needle facilitate the relatively easily and gently placing of the haptic into the lumen with a one-time use of forceps. RESULTS This technique was performed on 65 eyes of 58 patients, with a mean patient age of 53.0 ± 14.6 years (range, 22-78). No complications such as endothelial touch, vitreous loss, iris or ciliary body damage, and hyphema were encountered during surgery. The mean operation duration was 14.8 ± 2.3 min (range, 12-20). In the postoperative period, there was only mild postoperative anterior chamber reaction in all eyes. Postoperative transient intraocular pressure (IOP) elevation that responded well to topical antiglucomatous therapy was observed in only two cases (3%). No patient developed haptic exposure, IOL dislocation, iris capture, postoperative hypotony, vitreous hemorrhage, choroidal effusion, cystoid macular edema, or retinal detachment. CONCLUSION The facilitated trailing haptic externalization technique provides a safer, simpler, and minimally invasive surgery without significant complications while easing the surgical difficulties of the Yamane technique.
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Affiliation(s)
- Fikret Ucar
- Ophthalmology Department, 590009Konyagoz Eye Hospital, Konya, Turkey
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96
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Malach DS, Guest JM, Adam C, Joffe J, Le K, Kim C, Lin X. Intraocular Lens Formula Comparison of Flanged Intrascleral Intraocular Lens Fixation with Double Needle Technique. Clin Ophthalmol 2023; 17:837-842. [PMID: 36960323 PMCID: PMC10029932 DOI: 10.2147/opth.s389325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/02/2023] [Indexed: 03/13/2023] Open
Abstract
Purpose To analyze visual outcomes and accuracy of intraocular lens (IOL) calculation formulas in predicting postoperative outcomes in patients undergoing flanged intrascleral IOL fixation. Design Case Series. Subjects Twenty-three patients who had undergone secondary IOL placement using flanged intrascleral fixation technique. Methods Retrospective chart review. Main Outcome Measures Corrected distance visual acuity (CDVA) and postoperative spherical equivalent based on manifest refraction. Results Visual acuity improved from 20/577 to 20/58. Overall, the actual refraction was 0.06 D more myopic than predicted. Holladay 2, Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II resulted in mild myopic surprise (-0.55, -0.18 and -0.20 D). Haigis and Hill-RBF (Radial Basis Function) resulted in mild hyperopic surprise (+0.28 and +0.28 D). Hoffer Q and Holladay 1 were the most accurate (-0.02D and -0.08 D). Conclusion Flanged intrascleral IOL fixation improved vision even in patients with other posterior segment pathologies. The effective lens positioning is likely similar to in-the-bag positioning. Hoffer Q and Holladay 1 formulas with in-the-bag calculations were the most accurate.
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Affiliation(s)
- Daniel S Malach
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - John Michael Guest
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - Christopher Adam
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - Jonah Joffe
- Henry Ford Hospital Department of Ophthalmology, Detroit, MI, USA
| | - Kim Le
- Henry Ford Hospital Department of Ophthalmology, Detroit, MI, USA
| | - Chaesik Kim
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
| | - Xihui Lin
- Kresge Eye Institute/Wayne State University Department of Ophthalmology, Detroit, MI, USA
- Correspondence: Xihui Lin, Kresge Eye Institute/Wayne State University Department of Ophthalmology, 4717 St. Antoine, Detroit, MI, 48201, USA, Email
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Miura G, Baba T. Three-Year Follow-Up of Results of Intraocular Lens Fixation in Patients with Retinitis Pigmentosa. Case Rep Ophthalmol 2023; 14:382-387. [PMID: 37901636 PMCID: PMC10601838 DOI: 10.1159/000532107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/16/2023] [Indexed: 10/31/2023] Open
Abstract
This is a retrospective, consecutive, noncomparative case series of 6 eyes of 5 retinitis pigmentosa (RP) patients who had undergone pars plana vitrectomy (PPV) and intraocular lens (IOL) implantation. The aim of this case series was to report the long-term outcomes of PPV with IOL implantation in patients with RP). The surgical procedures, visual function, refractive error, corneal endothelial cell density, intraocular pressure, and retinal morphology were evaluated before and 3 years after the surgery. Six eyes of 5 RP patients that had undergone PPV and IOL implantation with or without suturing for lens dislocation were studied. The visual acuity was maintained or improved at 3 years after surgery in all 6 eyes. No intraoperative complications occurred in any of the cases. The mean deviation of the Humphrey Field Analyzer 10-2 program and the retinal morphology evaluated by optical coherence tomography did not show any abnormal changes before and after surgery. In two eyes, the postoperative refractive error was more myopic than the attempted refractive error. In conclusion, PPV with IOL implantation can be performed safely in RP patients, and the long-term visual acuity can be maintained.
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Affiliation(s)
- Gen Miura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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Lou W, Chen Z, Huang Y, Jin H. Flapless and Conjunctiva-Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support. J Ophthalmol 2023; 2023:4032011. [PMID: 37124064 PMCID: PMC10132900 DOI: 10.1155/2023/4032011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose To evaluate refractive outcomes, intraocular lens (IOL) power calculation, and IOL position following a novel conjunctiva-sparing transscleral fixation technique. Methods Forty-one eyes of 40 patients managed with a flapless transscleral-sutured technique were included. Preoperative and postoperative refractive errors (spherical equivalents, SE) were compared. IOL position was assessed on the Scheimpflug images. IOL power was calculated by SRK/T, Holladay 1, and Hoffer Q formulas. Results The mean age was 57.39 ± 14.83 years (range: 26 to 79 years), and the mean follow-up was 7.46 ± 6.42 months (range: 1 to 24 months). Surgical indications were aphakia (n = 14), subluxated lenses (n = 3), and IOL dislocation (n = 24). The SE was 4.50 ± 6.38 diopter (D) (range: -3.75 to 13.75 D) preoperatively and -1.68 ± 1.57 D (range: -5.50 to 1.13 D) postoperatively (P < 0.001). The mean tilt angle and decentration were 2.90° ± 1.93° (range: 0.39° to 9.10°) and 0.23 ± 0.19 mm (range: 0.02 to 0.94 mm) vertically, and 1.75° ± 1.41° (range: 0.24° to 7.65°) and 0.18 ± 0.19 mm (range: 0.02 to 1.06 mm) horizontally, which were clinically insignificant. All three IOL formulas produced myopic errors (range: -0.29 to -0.50 D). The SRK/T had the lowest median absolute error (0.55 D), followed by the Holladay 1 (0.70 D) and the Hoffer Q (0.74 D). The three formulas had the same percentage of prediction errors (PEs) within ±0.5 D (43.48%), while the Hoffer Q had the highest percentage of PEs within ±1.0 D (82.61%). Conclusion The present technique can serve as an alternative approach for transscleral IOL fixation and refractive correction in eyes with compromised capsular support, ensuring the stability of IOLs and reasonable IOL power calculation accuracy.
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Affiliation(s)
- Wei Lou
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziang Chen
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Huang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiying Jin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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99
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Cheng KKW, Tint NL, Sharp J, Alexander P. Surgical management of aphakia. J Cataract Refract Surg 2022; 48:1453-1461. [PMID: 36449676 DOI: 10.1097/j.jcrs.0000000000000954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022]
Abstract
Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.
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Affiliation(s)
- Kelvin K W Cheng
- From the Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom (Cheng, Tint); Cambridge University Hospitals, Cambridge, United Kingdom (Sharp, Alexander)
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100
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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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