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Sevimli N, Karadag R, Çakıcı Ö. A review of techniques and challenges in performing sutureless intrascleral fixation of intraocular lens. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1999807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Neslihan Sevimli
- Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | | | - Özgür Çakıcı
- Ophthalmology, Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
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152
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Tamiya R, Akimoto M. Repairing Cyclodialysis by Riveting: A Flanged Polypropylene Suture. Case Rep Ophthalmol 2021; 12:784-790. [PMID: 34720978 PMCID: PMC8525294 DOI: 10.1159/000518431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022] Open
Abstract
Cyclodialysis causes intraocular lens (IOL) pupillary capture. It requires surgical repair to prevent this risk of IOL pupillary capture. However, since repairing cyclodialysis is often technically difficult, other methods such as barricading by suturing, pupilloplasty, and pars plana fixation of the IOL were preferred. We applied a double-flanged (riveting) technique for repairing cyclodialysis to prevent IOL pupillary capture following intrascleral fixation of the IOL. Cyclodialysis was surgically repaired by riveting with double-flanged 6-0 polypropylene sutures in 3 cases with no recurrence of pupillary capture during at least 12 months of follow-up. When pupillary capture is related to cyclodialysis, repairing cyclodialysis may help prevent pupillary capture after intrascleral fixation of the IOL. Riveting using a double-flanged 6-0 polypropylene suture could possibly make the procedure simpler and more efficient.
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Affiliation(s)
- Ryosuke Tamiya
- Department of Ophthalmology, Osaka Red Cross Hospital, Osaka, Japan
| | - Masayuki Akimoto
- Department of Ophthalmology, Osaka Red Cross Hospital, Osaka, Japan
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153
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Choi HJ, Kwon OW, Byeon SH, Song JH. Clinical outcomes of combined pars plana vitrectomy and scleral fixation of the intraocular lens with a suspension bridge method in eyes with aphakia or insufficient capsular support. Acta Ophthalmol 2021; 99:e1006-e1012. [PMID: 33421312 PMCID: PMC8596542 DOI: 10.1111/aos.14758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/16/2020] [Indexed: 12/25/2022]
Abstract
Purpose To describe a modified technique of scleral fixation for intraocular lens (IOL) implantation and report the clinical outcomes of combined pars plana vitrectomy and scleral IOL fixation using the suspension bridge method. Methods This retrospective case series included 57 eyes (56 patients) of aphakia or phakic and pseudophakic eyes with insufficient capsular support that underwent IOL implantation or dislocated IOL repositioning with scleral fixation using the ‘suspension bridge’ method by a single surgeon between 1 July 2010 and 1 March 2019. Preoperative status, changes in visual acuity, refractive outcomes as spherical equivalent and related complications were assessed with a minimum follow‐up of 3 months. Results The mean follow‐up period was 25.5 ± 25.4 months. Preoperative visual acuity (logarithm of the minimum angle of resolution) was 1.32 ± 0.68 (20/400 Snellen), and it significantly improved to 0.80 ± 0.53 (20/125), 0.59 ± 0.56 (20/80) and 0.24 ± 0.37 (20/35) at 1 week, 1 month and 3 months, respectively (p < 0.001). Postoperative complications included corneal wound dehiscence (n = 1), vitreous incarceration (n = 1), optic‐iris capture (n = 6) and cystoid macular oedema (n = 1). The above‐mentioned complications were successfully corrected with simple procedures. However, one case of IOL dislocation required reoperation. Conclusion The modified technique of the suspension bridge method precludes the need for a scleral flap, with the advantage of easy adjustment of the IOL position. It is a simple and feasible technique with good surgical results and low complication rates.
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Affiliation(s)
- Hun Jin Choi
- Department of Ophthalmology Ajou University School of Medicine Suwon Korea
- Department of Ophthalmology Ilsan Paik Hospital Inje University College of Medicine Goyang Korea
| | | | - Suk Ho Byeon
- Department of Ophthalmology The Institute of Vision Research Yonsei University College of Medicine Seoul Korea
| | - Ji Hun Song
- Department of Ophthalmology Ajou University School of Medicine Suwon Korea
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Shahid SM, Flores-Sánchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, Charteris DG. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond) 2021; 35:2930-2961. [PMID: 34117388 PMCID: PMC8526814 DOI: 10.1038/s41433-021-01571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/08/2022] Open
Abstract
Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.
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Affiliation(s)
- S M Shahid
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK.
| | | | - E W Chan
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - R Anguita
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - S N Ahmed
- Ophthalmology Department, Northampton General Hospital, Cliftonville, Northampton, UK
| | - L Wickham
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - D G Charteris
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
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155
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Evaluation of anterior segment structures with Scheimpflug camera in patients undergoing sutureless scleral fixation by modified Yamane technique. Int Ophthalmol 2021; 42:645-651. [PMID: 34719757 DOI: 10.1007/s10792-021-02107-2] [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: 02/14/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate anterior segment parameters in patients undergoing sutureless scleral fixation intraocular lens implantation with the modified Yamane technique (SSF-IOL-MY) by using Scheimpflug camera system. METHODS Each group of 25 patients was included for aphakia undergoing SSF-IOL-MY and for senile cataract undergoing uneventful phacoemulsification and intraocular lens implantation (Phaco+IOL). Anterior chamber depth (ACD), iridocorneal angle (ICA), anterior chamber volume (ACV) and keratometric values were evaluated by Scheimpflug camera (Sirius, CSO, Italy) system. RESULTS It was seen that the ACD, ICA and ACV display wider structures in patients with SSF-IOL-MY group compared to Phaco+IOL group. However, the ACD (p = 0.828) and ICA (p = 0.219) have not a statistically significant difference, while ACV (p = 0.007) has a statistically significant difference. In terms of keratometric values of the patients, there was no statistically difference in K1, K2 and Kmax values (p = 0.348, p = 0.106, p =0.269, respectively). Although there was no statistically significant difference between the groups in terms of anterior corneal astigmatism, posterior corneal astigmatism was statistically higher in the Phaco+IOL group (p = 0.192, p = 0.031, respectively). CONCLUSION SSF-IOL-MY surgery affects anterior segment parameters similar to the Phaco+IOL method, which is the gold standard in cataract surgery. In this surgery, it was approached to the gold standard method in terms of IOL position with the ACD, ACV and ICA values and the results of the corneal incision with the keratometric values.
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156
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Van Os L, Hildebrand GD, Tassignon MJ. Adapted Bag-in-the-Lens Implantation Technique in Children with Congenital Ectopia Lentis. Klin Monbl Augenheilkd 2021; 238:1058-1064. [PMID: 34662920 DOI: 10.1055/a-1633-4316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Subluxation of the crystalline lens in childhood confronts the surgeon with a dilemma: to operate or to wait and see. Surgery is usually not performed when the subluxation is still limited. However, postponing the surgery increases the surgical difficulty as the capsular bag becomes more difficult to use as a means of support for the intraocular lens (IOL). A large number of children already present a pronounced subluxation at first presentation. In this paper, we describe a technique to optimise centration and fixation of the bag-in-the-lens (BIL) IOL in children younger than 7 years of age with congenital ectopia lentis. METHODS Between October 2019 and December 2020, we performed lens extraction using a combination of bean-shaped segments to support the BIL IOL and a 6 - 0 polypropylene loop fixated at the sclera, following the Yamane technique, for the purpose of centration. We used this technique for seven eyes of four patients. The patients were between 2 and 6 years old; 3 boys and 1 girl. A definite diagnosis of Marfan syndrome was made for two children; for the other two, there was no proven underlying pathology. The luxation was upwards in all cases. The degree of luxation was severe in all eyes. The preoperative refraction values showed high astigmatism values for all eyes, ranging from 6.5 to 11.25 dioptres. Three out of the four patients were myopic, ranging from - 1.5 to - 9 dioptres. RESULTS The surgery could be performed without major complications in all eyes. Good centration was obtained, which remained stable in the postoperative period. Refraction improved with greatly diminished degrees of astigmatism (ranging from 0.25 to 3 dioptres) and myopia (spheres ranging from - 2 to + 1.75 dioptres). CONCLUSION Our novel technique incorporated the BIL technique with the addition of bean-shaped segments and a polypropylene 6/0 suture fixated at the sclera. In this way, we were able to obtain good centration and stability of the implanted IOL, as well as a good refractive outcome in all cases.
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Affiliation(s)
- Luc Van Os
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium.,Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Göran Darius Hildebrand
- Paediatric ophthalmology, Oxford Eye Hospital, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Marie-José Tassignon
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium.,Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
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157
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Outcomes of flanged IOL fixation combined with microhook trabeculotomy. Int Ophthalmol 2021; 42:799-804. [PMID: 34652544 DOI: 10.1007/s10792-021-02045-z] [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: 03/12/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of flanged intraocular lens fixation combined with microhook trabeculotomy. PATIENTS AND METHODS This study was a retrospective case series and included nine eyes of nine exfoliation glaucoma patients with subluxated lens or intraocular lens who underwent flanged intraocular lens fixation combined with microhook trabeculotomy between May 2019 and February 2020 at the Kochi University Hospital. The mean best-corrected visual acuity, intraocular pressure, and number of antiglaucoma medications were compared before and after surgery. RESULTS The mean follow-up period was 5.67 ± 2.50 months. The mean best-corrected visual acuity improved significantly from 0.83 ± 0.72 preoperatively to 0.22 ± 0.34 at the last visit (p = 0.015). The mean intraocular pressure had significantly reduced from 27.1 ± 8.12 mmHg preoperatively to 13.2 ± 3.73 at the last visit (p = 0.008). The mean number of antiglaucoma medications decreased significantly from 4.56 ± 1.88 to 2.0 ± 1.0 at the last visit (p = 0.008). Postoperative intraocular pressure control to 21 mmHg or lower was achieved or maintained in all patients. Postoperative vitreous hemorrhage was observed in six eyes (66.7%), two of which needed reoperation. CONCLUSIONS This study showed that flanged intraocular lens fixation combined with microhook trabeculotomy might be effective for exfoliation glaucoma with subluxated lens or intraocular lens.
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158
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Yuan A, Ma K, Sharifi S, Pineda R. Biomechanical Testing of Flanged Polypropylene Sutures in Scleral Fixation. Am J Ophthalmol 2021; 230:134-142. [PMID: 33945819 PMCID: PMC10560604 DOI: 10.1016/j.ajo.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To optimize the flanged belt-loop technique of scleral fixation through biomechanical testing and report clinical outcomes of resultant modifications. DESIGN Experimental study. METHODS The force to disinsert flanged polypropylene suture from human cadaveric sclera was assessed using a tensile testing machine and compared to the breaking strengths of 9-0 and 10-0 polypropylene. The effects of modifying suture gauge (5-0, 6-0, 7-0, or 8-0), amount of suture cauterized (0.5 or 1.0 mm), and sclerotomy size (27, 30, 32, 33 gauge) were investigated. Belt-loop intrascleral fixation using 6-0 and 7-0 polypropylene with 30 and 32 gauge needles, respectively, was performed in 4 patients. Main outcome measures were flanged suture disinsertion forces in cadaveric sclera. RESULTS The average force to disinsert a flange created by melting 1.0 mm of 5-0, 6-0, 7-0, and 8-0 polypropylene suture from human cadaveric sclera via 27, 30, 32, and 33 gauge needle sclerotomies was 3.0 ± 0.5 N, 2.1 ± 0.3 N, 0.9 ± 0.2 N, and 0.4 ± 0.1 N, respectively. The disinsertion forces for flanges formed by melting 0.5 mm of the same gauges were 72%-79% lower (P < .001). In comparison, the breaking strengths of 9-0 and 10-0 polypropylene were 0.91 ± 0.4 N and 0.52 ± 0.03 N. Belt-loop fixation using 6-0 and 7-0 polypropylene with 30 and 32 gauge sclerotomies demonstrated good outcomes at 6 months. CONCLUSIONS The flanged belt-loop technique is a biomechanically sound method of scleral fixation using 1.0 mm flanges of 5-0 to 7-0 polypropylene paired with 27, 30, and 32 gauge sclerotomies. In contrast, 8-0 polypropylene and 0.5 mm flanges of any suture gauge will likely be unstable with this technique.
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Affiliation(s)
- Amy Yuan
- From the Department of Ophthalmology, University of Washington, Seattle, Washington, USA (A.Y.)
| | - Kevin Ma
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (K.M., R.P.)
| | - Sina Sharifi
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA (S.S.)
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (K.M., R.P.).
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159
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Adjustment of intraocular lens tilt during intrascleral fixation assisted by intraoperative OCT. J Cataract Refract Surg 2021; 47:1308-1313. [PMID: 34544086 DOI: 10.1097/j.jcrs.0000000000000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/04/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the efficacy of using intraoperative optical coherence tomography (iOCT) to adjust the tilting of an intraocular lens (IOL) during implantation with intrascleral fixation. SETTING Kyorin University Hospital, Tokyo, Japan. DESIGN Retrospective, case-control, single-center study. METHODS Thirty-seven eyes of 37 patients who had undergone pars plana vitrectomy with intrascleral fixation of an IOL by a single surgeon were retrospectively studied. The length of the externalized haptics was determined when the anterior surface of the IOL was parallel to the plane of the iris as observed by iOCT. The maximal IOL tilt relative to the visual axis and to the iris plane was measured by anterior segment OCT (CASIA2; Tomey Corp.). RESULTS Intraoperative crosssectional OCT (RESCAN 700: Carl Zeiss Meditec AG) scans were used to adjust the degree of IOL tilt in 23 eyes (iOCT group) and not used in 14 eyes (control group). The maximal angle of IOL tilt relative to the visual axis was significantly smaller in the iOCT group than that in the control group (5.45 ± 2.63 degrees vs 10.38 ± 10.48 degrees, P = .034). The maximal angle of the IOL tilt to the iris plane was also significantly smaller in the iOCT group than that in the control group (4.58 ± 1.86 degrees vs 9.60 ± 10.82 degrees; P = .040). The distance of decentration was greater in the iOCT group (0.56 ± 0.29 mm) than that of the control group (0.41 ± 0.41 mm, P = .005). CONCLUSIONS Intraoperative OCT can be used to adjust the degree of IOL tilt to reduce the lenticular astigmatism during intrascleral fixation surgery.
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160
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Supporting IOL'S in a Deficient Capsular Environment: The Tale of No "Tails". J Ophthalmol 2021; 2021:9933486. [PMID: 34557313 PMCID: PMC8455193 DOI: 10.1155/2021/9933486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of the following three distinct surgical procedures for secondary IOL implantation without capsular support: Iris-claw lens, flanged transscleral fixated IOLs (Yamane technique), and sutureless transscleral hook IOL fixation (Carlevale IOL). Materials and Methods In this retrospective comparative study, three different sutureless IOL implantation techniques were compared in patients without any capsular support. Visual acuity and outcomes were analyzed in 24 eyes of 23 patients (14 male and 9 female). Study included 13 iris-claw lenses (Artisan Ophtec), 6 flanged transscleral fixated IOLs (Yamane technique using a MA60MA Alcon Inc IOL), and 5 transscleral Carlevale IOLS (Carlevale IOL, Soleko, Italy). Results logMAR mean best-corrected visual acuity (BCVA) improved from 0.49 ± 0.19 to 0.19 ± 0.10 at three months after surgery (p < 0.05). Postoperative BCVA was similar in all three groups, and no intergroup difference was noted. Three eyes (12.5%) had a raised IOP >25 mmHg, 2 eyes (8%) presented a subluxated/dislocated IOL, 4 eyes (16%) had corneal edema longer than 7 days, 3 eyes (12.5%) had irregular pupil profile, 2 eyes (8%) had vitreous hemorrhage, 7 eyes had (29%) corneal astigmatism over 3 diopters, and one patient (4%) developed cystoid macular edema (CME). Conclusions All three surgical procedures can be considered adequate to correct aphakia in patients without capsular support with significant improvement in visual acuity and low complication.
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161
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The SWISS IOL Technique (Small-Width Incision Scleral Suture): A Mini-Invasive Technique. J Ophthalmol 2021; 2021:8448996. [PMID: 34552765 PMCID: PMC8452445 DOI: 10.1155/2021/8448996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the outcomes and safety of a minimally invasive technique for sutured IOL scleral fixation in case of compromised capsular and iris support. Materials and Methods In this retrospective study, we explain our mini-invasive technique and assess the outcomes in terms of visual acuity, pre- or postoperative complications, and IOL position (Sensar AR40e, AMO) in a case series of three patients. Results The expected best corrected visual acuity could be achieved after one month. Surgeries were uneventful with a stable eye. No postoperative complications occurred except for one patient who had a conjunctival disinsertion. Neither postoperative hypotony nor raised IOP was found. Additionally, no patient experienced corneal edema at one week control, IOL dislocation, vitreous hemorrhage, or new pupil's irregularity. Conclusions In conclusion, each scleral technique has its own advantages and its inherent postoperative complications. To date, there is no evidence of superiority of any single technique. By improving our scleral sutured lens techniques, we could improve peroperative ocular stability, potentially decrease postoperative complication rate, and offer a rapid recovery with a stable visual acuity within a month.
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162
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"In-N-Out" Technique - A double flanged suture ab-interno iridodialysis repair. J Cataract Refract Surg 2021; 48:251-253. [PMID: 34561363 DOI: 10.1097/j.jcrs.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT The procedure presented here is for iridodialysis repair using an elegant, cost-effective and quick technique using 6-0 polypropylene sutures, low-temperature electrocautery, and a 27-gauge needle. Previously, all methods required performing a conjunctival peritomy to expose bare sclera, then typically intricate movements and knot tying. Described here is a method combining the sewing machine technique and a modified Yamane scleral fixation technique to treat iridodialysis that requires no knots, peritomies or specialized equipment.
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163
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Karaca U, Kucukevcilioglu M, Ozge G, Durukan AH. Late onset endophthalmitis after sutureless intrascleral IOL implantation with Yamane Technique. Int J Ophthalmol 2021; 14:1449-1451. [PMID: 34540624 DOI: 10.18240/ijo.2021.09.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Umut Karaca
- Department of Ophthalmology, Isparta Suleyman Demirel University Faculty of Medicine, Isparta 32040, Turkey
| | - Murat Kucukevcilioglu
- Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara 06010, Turkey
| | - Gokhan Ozge
- Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara 06010, Turkey
| | - Ali Hakan Durukan
- Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara 06010, Turkey
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164
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Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy. J Ophthalmol 2021; 2021:4617583. [PMID: 34513084 PMCID: PMC8428990 DOI: 10.1155/2021/4617583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare the visual outcomes and complications of patients who underwent flanged transconjunctival sutureless intrascleral intraocular lens (SIS IOL) implantation after anterior and pars plana vitrectomy. Methods All patients who underwent flanged transconjunctival SIS IOL fixation using a 27-gauge needle between September 2017 and November 2019 and were followed up for at least six months were evaluated. The cases in which anterior vitrectomy was performed were classified as Group 1, and those that underwent pars plana vitrectomy were classified as Group 2. The best-corrected visual acuity (BCVA), spherical equivalent values, corneal endothelial cell density, and intraocular pressures were compared between the two groups before and after the operation. Intraoperative and postoperative complications were assessed. Results The study included 108 eyes of 108 patients who were included in the study. Group 1 consisted of 48 patients and Group 2 comprised of 60 patients. When the findings between Groups 1 and 2 were compared in the postoperative period, there was no statistically significant difference in terms of the mean intraocular pressure increase, endothelial cell density, BCVA, and spherical equivalent value (P=0.818, 0.601, 0.368, and 0.675, respectively). When all the patients were considered as a single group, the mean spherical value at the sixth postoperative month was 0.3 ± 2.2 D (min-max, (−5.5)–(+6)), the mean cylindrical value was −1.7 ± 2.4 D (min-max, (−9.25)–(+4)), and the mean spherical equivalent value was −0.5 ± 2.3 D (min-max, (−6.5)–(+6)). Conclusion The flanged transconjunctival SIS IOL fixation technique performed using a 27-gauge needle is safe and effective in the patient group with aphakia and lens/IOL dislocation or subluxation. However, in patients planned to undergo flanged transconjunctival SIS IOL implantation, pars plana vitrectomy seems to be a more suitable option than anterior vitrectomy to reduce complications.
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165
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Intraocular surgery under adalimumab therapy in patients with refractory uveitis: a single center study of 23 eyes. Jpn J Ophthalmol 2021; 65:836-842. [PMID: 34491475 DOI: 10.1007/s10384-021-00871-3] [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: 07/29/2020] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We assessed the efficacy and safety of performing intraocular surgery for refractory uveitis under adalimumab (ADA) therapy. STUDY DESIGN Single-center cohort study between 2016 and 2019. METHODS In uveitis patients undergoing intraocular surgery under ADA treatment, we collected clinical data before surgery, and at the first visit, 6 months and last visit after surgery (follow-up 19.3 ± 8.1 months). Primary outcomes were visual acuity (VA) improvement in patients after cataract surgery, intraocular pressure (IOP) in patients after trabeculectomy and intraocular inflammation in all patients. Secondary outcomes were activated inflammation, vitreous opacity (OCV), uveitic macula edema (UME) and infection. RESULTS Of 81 patients (161 eyes) initiated ADA therapy for uveitis, 19 patients (23 eyes) underwent intraocular surgery and were analyzed. Twelve of 18 eyes (66.6%) that underwent cataract surgery or vitrectomy with/without cataract surgery had improved VA at the last visit compared to before surgery. All 5 eyes that underwent trabeculectomy showed controlled IOP 6 months after surgery. Intraocular inflammation was resolved in 22 of 23 eyes at the first postoperative visit. Postoperative intraocular inflammation recurred in 3 eyes; 2 with UME, 1 with OCV. No eyes developed infection postoperatively. Preoperative ADA therapy duration was unrelated to relapse of intraocular inflammation. CONCLUSION Surgery for refractory uveitis under ADA treatment is safe and achieves good visual outcome and uveitis control if inflammation exists before surgery. ADA does not increase the risk of infections. Intraoperative findings of UME at surgery requires attention for postoperative relapse.
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Tao Y, Ren X, Zhang Y, Gao Y, Tao M, Gou Y, Gao Y, Zhang M. Outcomes of the flanged intrascleral haptic fixation with double-needle technique in patients with Marfan syndrome. Eur J Ophthalmol 2021; 32:2166-2172. [PMID: 34493106 DOI: 10.1177/11206721211044636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the clinical outcomes and complications associated with the flanged intrascleral haptic fixation with double-needle technique (a.k.a. the Yamane technique/FIHFT) in patients with Marfan syndrome (MFS) with subluxated or dislocated lenses. METHODS Eighteen eyes of 11 patients with MFS with subluxated or dislocated lenses who had undergone intraocular lens implantation using the FIHFT from March 2019 to October 2020 were evaluated. All patient data were retrospectively collected from medical records, including a complete ophthalmologic examination at baseline and follow-up examinations of uncorrected visual acuity (UCVA, logMAR), best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), and slit-lamp examination. RESULTS The median follow-up period was 6 ± 3 (range, 3-12) months. The average patient age at the time of surgery was 13 ± 9 (range, 4-34) years. The mean preoperative BCVA was 0.49 ± 0.20 logMAR (Snellen equivalent visual acuity, 20/60), while the mean postoperative BCVA at the end of follow-up was 0.21 ± 0.14 logMAR (20/30), indicating an improvement of 0.28 ± 0.20 logMAR (20/40) postoperatively (p < 0.001). Postoperative iris capture occurred in six eyes (38.9%). No cases of hypotony, IOP elevation, or vitreous hemorrhage were noted, and no patients developed intraocular lens dislocation, retinal detachment, or endophthalmitis. CONCLUSIONS To our knowledge, the present study is the first to report outcomes of the FIHFT in patients with MFS. Our findings suggested that scleral lens fixation is safe and effective for improving visual acuity in patients with MFS who have subluxated or dislocated lenses.
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Affiliation(s)
- Yunhan Tao
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiang Ren
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yifan Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuzhu Gao
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Mengying Tao
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yueqin Gou
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Gao
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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167
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One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens. J Ophthalmol 2021; 2021:3838456. [PMID: 34484813 PMCID: PMC8413050 DOI: 10.1155/2021/3838456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess one year results and stability of the implantation of a scleral anchored intraocular lens (IOL). Design Interventional prospective case series. Methods Sixty eyes of 60 patients affected by either aphakia or IOL dislocation were included in this study. Patients underwent vitrectomy, scleral fixation of the IOL, and, if present, dislocated IOL removal. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery by best-corrected distance visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, corneal specular microscopy, and optical coherence tomography (OCT) of both the macula and anterior segment. Results At twelve months, mean BCVA significantly improved (p < 0.0001), and none of the patients experienced a decrease of visual acuity. A 10% decrease of endothelial cell count occurred after surgery. Cystoid macular edema occurred in three patients (5%). A transient increase of intraocular pressure was noted in 7 cases (12%). At one month, horizontal and vertical IOL tilt was 1.04 ± 0.87 and 0.74 ± 0.71 degrees, respectively, and did not significantly change in the follow-up (p > 0.05). None of the patients had decentration or dislocation of scleral-fixated IOL during the follow-up. Conclusion Implantations of scleral plug fixated IOL provide good visual results, low complication rate, and excellent stability of the lens until one-year follow-up.
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168
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Kokame GT, Tanji TT, Omizo JN. Long-Term Stability of Sutured Scleral Fixation of a Posterior Chamber Intraocular Lens With 10-0 Polypropylene for More Than 30 Years. JOURNAL OF VITREORETINAL DISEASES 2021; 5:452-454. [PMID: 37008711 PMCID: PMC9976114 DOI: 10.1177/2474126420978870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.
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Affiliation(s)
- Gregg T. Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, HI, USA
- The Retina Center at Pali Momi, Aiea, HI, USA
- Retina Consultants of Hawaii, Aiea, HI, USA
- Hawaii Macula and Retina Institute, HI, USA
- University of Hawai’i John A. Burns School of Medicine, Honolulu, HI, USA
| | - Tarin T. Tanji
- The Retina Center at Pali Momi, Aiea, HI, USA
- Retina Consultants of Hawaii, Aiea, HI, USA
- Hawaii Macula and Retina Institute, HI, USA
| | - Jase N. Omizo
- The Retina Center at Pali Momi, Aiea, HI, USA
- Retina Consultants of Hawaii, Aiea, HI, USA
- Hawaii Macula and Retina Institute, HI, USA
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169
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170
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Correcting optic capture with 2 flanged 6-0 sutures after intrascleral haptic fixation with ViscoNeedling. J Cataract Refract Surg 2021; 47:1234-1236. [PMID: 32991503 DOI: 10.1097/j.jcrs.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
A 6-0 polypropylene suture was introduced in the eye through an ophthalmic viscosurgical device syringe in a completely closed system. The procedure was used to correct optic capture of the intraocular lens by the pupil after 2 cases of Yamane technique.
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171
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Vaiano AS, Hoffer KJ, Greco A, Greco A, D'Amico G, Pasqualitto V, Carlevale C, Savini G. Long-term Outcomes and Complications of the New Carlevale Sutureless Scleral Fixation Posterior Chamber IOL. J Refract Surg 2021; 37:126-132. [PMID: 33577699 DOI: 10.3928/1081597x-20201207-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcomes and possible complications of a new foldable sutureless scleral fixation intraocular lens (SSF-IOL), the Carlevale IOL (Soleko). METHODS The SSF-IOL, which has two T-shaped self-blocking plugs on each haptic, was inserted into the posterior chamber. Both haptics was grabbed through two sclerotomies and the two short arms were blocked under the scleral flap, without any suture. A complete clinical evaluation was done preoperatively and at 3, 6, and 12 months postoperatively. RESULTS A total of 54 eyes of 50 consecutive patients were retrospectively analyzed. The mean corrected distance visual acuity was 0.93 ± 0.61 logMAR preoperatively and improved to 0.42 ± 0.34 logMAR at 3 months, 0.42 ± 0.37 logMAR at 6 months, and 0.38 ± 0.38 logMAR at 12 months postoperatively (all P < .0001). The mean corneal endothelial cell density decreased from 1,725.37 ± 528.06 to 1,612.81 ± 522.91 cells/mm2 at 12 months postoperatively (P < .0001). The mean IOL tilt value was 3.1 ± 1.1° at 12 months postoperatively. The authors observed 6 cases (11.1%) of intraoperative rupture of the IOL haptics, 4 cases (7.4%) of early hyphema, 4 cases (7.4%) of macular cystoid edema, 2 cases (3.7%) of haptic exposure under the conjunctiva, and 1 (1.8%) late retinal detachment. CONCLUSIONS This newly introduced surgical technique provided promising results regarding efficacy and safety. Complications occurred in a few cases and were successfully managed. The Carlevale IOL seems to be a surgical solution combining the advantages of an easy and minimally invasive implantation with a good functional recovery with minimal complications. [J Refract Surg. 2021;37(2):126-132.].
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172
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Asif MI, Bafna RK, Kapoor A, Sharma N. Intrascleral haptic fixation for haptic exposure after Yamane technique. BMJ Case Rep 2021; 14:e243627. [PMID: 34404655 PMCID: PMC8375743 DOI: 10.1136/bcr-2021-243627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/03/2022] Open
Abstract
A 55-year-old patient presented with exposure of both the haptics beyond the conjunctiva of the scleral fixated multipiece intraocular lens (IOL). Two diagonally opposite scleral pockets were created, and the exposed haptics was redirected and repositioned aseptically into these pockets to facilitate intrascleral fixation. Herein, we report a simple rescue method for management of exposed haptic after Yamane technique of scleral fixated IOL.
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Affiliation(s)
| | - Rahul Kumar Bafna
- Ophthalmology, R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India
| | - Anirudh Kapoor
- Ophthalmology, R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India
| | - Namrata Sharma
- Ophthalmology, R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India
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173
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Junqueira NB, Chaves LJ, Poli-Neto O, Scott IU, Jorge R. Scleral fixation using a hydrophilic four-haptic lens and polytetrafluoroethylene suture. Sci Rep 2021; 11:15793. [PMID: 34349221 PMCID: PMC8339062 DOI: 10.1038/s41598-021-95428-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
To assess the safety of scleral fixation using the Akreos AO60 intraocular lens (IOL) and Gore-Tex suture. Prospective evaluation of 20 patients who underwent scleral fixation of an Akreos AO60 with Gore-Tex. Patients presenting with aphakia or dislocated IOL without capsular support were enrolled in the study. Main outcome measures included visual acuity, endothelial cell density, and postoperative complications over 6 months of follow-up. Mean ± standard deviation (SD) uncorrected logMAR visual acuity improved from 1.92 ± 0.23 (20/1600 Snellen equivalent) preoperatively to 0.80 ± 0.56 (20/125) at 6 months postoperatively (p < 0.001). Mean ± SD best-corrected visual acuity (BCVA) logMAR was 0.43 ± 0.23 preoperatively and 0.37 ± 0.24 (20/50) at 3-6 months postoperatively (p = 0.312). The mean ± SD endothelial cell density was 1740.50 ± 522.92 cells/mm2 and 1187.19 ± 493.00 cells/mm2 (p < 0.001) pre and postoperatively, respectively. Mean ± SD postoperative spherical equivalent was - 1.12 ± 1.50D. Postoperative complications included exposure of suture in 40% of the patients, hypotony in 15%, ocular hypertension in 10%, transient vitreous hemorrhage in 10%, retinal detachment in 5%, and transient lens opacification in 5%. Scleral fixation with an Akreos AO60 and Gore-Tex appears generally safe. However, given the high incidence of suture erosion observed, the use of scleral flaps or rotating and burying the knots is recommended in order to reduce the risk of this complication.
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Affiliation(s)
- Natacha B Junqueira
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.,Federal University of Mato Grosso Do Sul, Três Lagoas, MS, Brazil
| | - Leandro J Chaves
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Omero Poli-Neto
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
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174
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In vivo evaluation of a 1-piece foldable sutureless intrascleral fixation intraocular lens using ultrasound biomicroscopy and anterior segment OCT. J Cataract Refract Surg 2021; 47:316-322. [PMID: 32991506 DOI: 10.1097/j.jcrs.0000000000000444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the optic plate and haptics of a specially designed sutureless intrascleral-fixated intraocular lens (IOL) using ultrasound biomicroscopy and anterior segment optical coherence tomography (AS-OCT). SETTING Department of Ophthalmology, San Marino Hospital, Republic of San Marino. DESIGN Retrospective observational case series. METHODS Eyes that underwent intrascleral fixation with IOL implantation (Carlevale) were included. Preoperative and postoperative refractive outcomes were reported. Optic plate tilt and haptics position were assessed with ultrasound biomicroscopy, whereas intrascleral plug depth and conformation were evaluated with AS-OCT. RESULTS The study comprised 10 aphakic eyes. Postoperative visual acuity improved in all patients. At postoperative month 3, 3 eyes (30%) had a vertical tilt of more than 100 μm, whereas no horizontal tilt was observed in any patient. The mean vertical intraocular tilt was 0.19 ± 0.22 mm. Of 20 haptics, 13 (65%) passed through the ciliary sulcus, 4 (20%) posterior to the ciliary body, and 3 (15%) through the ciliary body. AS-OCT scans showed a mean intrascleral plug depth of 247.20 ± 62.82 μm in the nasal sector and 265.50 ± 30.11 μm in the temporal sector, with adequate integration of the T-shaped plugs in the scleral tissue. CONCLUSIONS This secondary IOL showed good intraocular stability and safe haptics fixation, making it suitable for the intrascleral fixation technique. The specific foldable design results in a low predisposition to optic plate tilt and haptic torsion. In long eyes, the sulcus-to-sulcus distance should be carefully evaluated preoperatively because the flexible structure of the IOL could be subjected to excessive stretching.
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175
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Mahler OS, Biron R, Hecht I, Pras E, Einan-Lifshitz A. Intrascleral 4-flanged technique for in-the-bag intraocular lens subluxation. J Cataract Refract Surg 2021; 47:476-481. [PMID: 33149040 DOI: 10.1097/j.jcrs.0000000000000474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a series of cases in which the 4-flanged technique was used in the management of in-the-bag intraocular lens (IOL) subluxation. SETTING Shamir Medical Center, Israel. DESIGN Retrospective cohort analysis. METHODS Included were consecutive cases with secondary IOL subluxation that underwent scleral fixation with the 4-flanged technique using 6-0 polypropylene and low temperature cautery. Surgeries were performed during September 2019 to April 2020. Postoperative IOL angle tilt was evaluated using high-resolution ocular coherence tomography. RESULTS Eleven eyes of 11 patients were included. The mean age was 82.7 ± 5.5 years, and 60% were men. Pseudoexfoliation was noted in 82% of patients, and only 1 case was related to trauma. The mean corrected distance visual acuity (CDVA) postoperatively was within 1 line of the original presubluxation CDVA (0.55 ± 0.41 vs 0.54 ± 0.6 logMAR, P = .965). The mean postoperative IOL tilt was 5.78 ± 3.85 degrees. Surgery duration decreased from 70 ± 14 minutes to 39 ± 15 minutes (first to last operations). No intraoperative complications were reported. Postoperatively, transient intraocular pressure elevation, which resolved at 1 week, was recorded in 45% of cases. Cystoid macular edema, which resolved within a few months under topical treatment, was seen in 2 patients. CONCLUSIONS Among a cohort of patients with secondary in-the-bag IOL subluxation, the 4-flanged technique was safe and resulted in satisfactory visual outcomes and a stable IOL position, with a short learning curve.
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Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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176
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Knot-free suture scleral fixation of dislocated intraocular lenses: clinical results of a novel surgical technique. J Cataract Refract Surg 2021; 47:898-901. [PMID: 33315738 DOI: 10.1097/j.jcrs.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe and report surgical outcomes of a novel, knot-free technique to manage dislocated intraocular lenses (IOLs). SETTING Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. DESIGN Retrospective observational clinical study. METHODS The files of 47 patients were retrospectively reviewed, and the patients who had a follow-up time of 6 months or more were included in this study. The surgery of every case was watched for the surgical complications and calculation of the surgical time. The postoperative complications and success rate were specifically tabulated. RESULTS Thirty-five eyes of 35 patients were included in this study (23 men, 12 women; mean age 63.1 ± 19.2 years). The mean follow-up time was 22.5 ± 9.9 months. The mean surgical time was 28.2 ± 6.8 minutes. Corrected distance visual acuity improved significantly after surgery (P = .001). Anatomic success rate was 97.1% after a single surgery. Most common complications included transient intraocular pressure (IOP) elevation (n = 2), persistent IOP elevation (n = 1), mild IOL tilt (n = 1), mild IOL decentration (n = 1), secondary IOL dislocation requiring intervention (n = 1), transient corneal edema (n = 1), and bullous keratopathy (n = 1). DISCUSSION Knot-free suture scleral fixation of dislocated IOLs was a minimally invasive approach for the management of dislocated IOLs and required only two 20-gauge corneal incisions without the need for scleral flaps or incisions. This technique had a low complication rate and delivered successful results in most cases.
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177
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Accuracy of intraocular lens calculation formulas for flanged intrascleral intraocular lens fixation with double-needle technique. J Cataract Refract Surg 2021; 47:855-858. [PMID: 33315743 DOI: 10.1097/j.jcrs.0000000000000540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the refractive prediction error (RPE) of intraocular lens (IOL) calculation formulas in eyes that have undergone the Yamane technique for scleral fixation of IOLs. SETTING Alkek Eye Center, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. DESIGN Retrospective case series from electronic chart review. METHODS Patients who had undergone scleral fixation of secondary IOLs were selected. The IOL RPEs for 4 IOL prediction formulas-Barrett Universal II, Holladay 1, Hoffer Q, and SRK/T formulas-were obtained by subtracting the predicted spherical equivalent from the postoperative spherical equivalent. The arithmetic mean RPE, mean absolute error (MAE), and percentages of eyes with prediction error of 0.50 diopter (D) or lesser and 1.00 D or lesser were calculated and compared. RESULTS Forty eyes of 40 patients met inclusion criteria. All formulas produced hyperopic mean arithmetic RPE. MAE values were 0.73 D for Holladay 1, 0.76 D for Barrett Universal II, 0.80 D for SRK/T, and 0.86 D for Hoffer Q formulas. The percentage of eyes with prediction error of 0.50 D or lesser and 1.00 D or lesser with these formulas were 45% (18 eyes) and 75% (30 eyes) for Holladay 1, 38.5% (15 eyes) and 77% (30 eyes) for Barrett Universal II, 32.5% (13 eyes) and 67.5% (27 eyes) for SRK/T, and 27.5% (11 eyes) and 62.5% (25 eyes) for Hoffer Q formulas. There were no statistically significant differences in prediction errors between the 4 formulas. CONCLUSIONS Refractive outcomes of the Yamane technique were less predictable than those of standard cataract surgery. Arithmetic RPE ranged from hyperopic to predicted values for all formulas tested.
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Adaptation of flanged intrascleral intraocular lens fixation technique with a glaucoma valve in aphakic glaucoma. J Cataract Refract Surg 2021; 47:1092-1093. [PMID: 33298782 DOI: 10.1097/j.jcrs.0000000000000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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179
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Chee SP, Ti SE, Chan NSW. Management of the subluxated crystalline lens: A review. Clin Exp Ophthalmol 2021; 49:1091-1101. [PMID: 34264007 DOI: 10.1111/ceo.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Cataract surgery for the subluxated crystalline lens is challenging. A thorough preoperative evaluation is important to determine the appropriate surgical approach for lens removal and the subsequent technique of intraocular lens placement. Important considerations include the extent and location of zonular weakness, and whether the zonular deficiency is caused by a static or progressive disease. The capsular bag should be preserved where possible. Creating a good-sized and centred continuous curvilinear capsulorhexis is crucial to facilitate the use of capsular retractors and capsular tension devices, which provide capsular stability. Nucleus sculpting and rotation should be minimised to reduce zonular stress. Being cognisant of the possible intraoperative complications that may occur at each stage of the surgery and knowing how to reduce the risk of these complications occurring will enable surgeons to perform safe cataract surgery in these complex cases.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
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180
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Vaiano AS, Hoffer KJ, Greco A, Greco A, D'Amico G, Pasqualitto V, Carlevale C, Savini G. Accuracy of IOL Power Calculation Using the New Carlevale Sutureless Scleral Fixation Posterior Chamber IOL. J Refract Surg 2021; 37:472-476. [PMID: 34236911 DOI: 10.3928/1081597x-20210401-01] [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: 11/20/2022]
Abstract
PURPOSE To evaluate the refractive outcomes of the new Carlevale foldable sutureless scleral fixation intraocular lens (SSF-IOL) (Soleko in eyes without capsular support. METHODS This retrospective, single-center, noncomparative interventional case series included 25 consecutive eyes of 25 consecutive patients with either aphakia or lens/IOL dislocation due to capsular or zonular defects. The Hoffer Q, Holladay 1, and SRK/T formulas, which do not need measurements of the anterior chamber depth to predict the IOL position, were used to calculate the IOL power. Constant optimization was performed to zero out the mean prediction error (PE). The main outcome measures were mean PE ± standard deviation, median absolute error (MedAE), mean absolute error (MAE), and percentage of eyes with a PE within ±0.50 and ±1.00 diopters (D). RESULTS Mean axial length was 24.09 ± 2.09 mm (range: 21.85 to 32.17 mm). No statistically significant differences were found among the three formulas for any parameter. The PE was zero due to constant optimization and its standard deviation ranged between 0.89 and 0.95 D. The MedAE ranged between 0.30 and 0.34 D, whereas the MAE ranged between 0.62 and 0.67 D. The percentage of eyes with a PE within ±0.50 D was between 56% and 64% and the percentage of eyes with a PE within ±1.00 D was between 69% and 72%. CONCLUSIONS Reasonably good refractive outcomes can be obtained when implanting SSF-IOLs in eyes with no capsular support, although the accuracy is lower than what is reported for normal in-the-bag IOL implantation. [J Refract Surg. 2021;37(7):472-476.].
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181
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Yoshida N, Kojima T, Ichikawa K. Early Clinical Outcomes of Intrascleral Fixation Using an Intraocular Lens with Hook-Shaped Haptics. Clin Ophthalmol 2021; 15:2885-2892. [PMID: 34262248 PMCID: PMC8274230 DOI: 10.2147/opth.s320460] [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: 05/16/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study, we aimed to report on the early results of intrascleral intraocular lens (IOL) fixation using a hook-shaped haptic IOL (hsh-IOL). Patients and Methods We enrolled 27 consecutive eyes of 27 patients (mean age, 74±11.4 years) who underwent intrascleral IOL fixation with an hsh-IOL and were followed-up for 3 months postoperatively. The reasons for surgery included insufficient capsular support, including IOL dislocation, aphakia, or dislocated crystalline lens. The haptic of the hsh-IOL was externalized from the eye using forceps, and the hook was buried in the scleral tunnel. We investigated the preoperative and 3-month postoperative corrected visual acuity (VA), intraocular pressure (IOP), corneal endothelial cell density, refractive prediction error, postoperative intraocular astigmatism, surgically induced astigmatism, and intraoperative and postoperative complications. Results The mean postoperative corrected VA (logMAR, 0.083±0.18) was significantly better than the mean preoperative value (0.42±0.60, p=0.0007). The 3-month postoperative mean absolute prediction error was 1.00±0.96 D. The mean IOL-induced astigmatism was 0.95±0.70 D. Further, the mean postoperative corneal endothelial cell count (2036±644 cells/mm2) was significantly lower than the preoperative value (2316±527 cells/mm2) (p=0.009). No patient had a 1-month postoperative IOP <5 mmHg or >25 mmHg. There were no intraoperative or vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, due to postoperative haptics misalignment. Conclusion Intrascleral IOL fixation using hsh-IOL is an effective option for eyes with insufficient capsular support.
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Affiliation(s)
- Norihiko Yoshida
- Department of Ophthalmology, Japanese Red Cross Gifu Hospital, Gifu, Japan
| | - Takashi Kojima
- Department of Ophthalmology, Japanese Red Cross Gifu Hospital, Gifu, Japan.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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182
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Sül S, Kaderli A, Karalezli A, Kaya C. Comparison of decentration, tilt and lenticular astigmatism of ıntraocular lens between sutured and sutureless scleral fixation techniques. J Fr Ophtalmol 2021; 44:1174-1179. [PMID: 34226085 DOI: 10.1016/j.jfo.2020.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. METHODS We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. RESULTS The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001). CONCLUSION In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.
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Affiliation(s)
- S Sül
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey
| | - A Kaderli
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey.
| | - A Karalezli
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey
| | - C Kaya
- Mugla Sitki Kocman University, Ophthalmology Department, Kötekli, Mugla, Turkey
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183
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Ma KK, Yuan A, Sharifi S, Pineda R. A Biomechanical Study of Flanged Intrascleral Haptic Fixation of Three-Piece Intraocular Lenses. Am J Ophthalmol 2021; 227:45-52. [PMID: 33626366 PMCID: PMC10479968 DOI: 10.1016/j.ajo.2021.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Flanged intrascleral haptic fixation (FISHF) is a useful method for securing intraocular lenses (IOLs) in eyes without capsular support. Biomechanical studies were conducted to support the use of this technique. DESIGN Laboratory investigation. METHODS Haptics of 3-piece IOLs were passed through cadaveric human sclera using 30- and 27-gauge needles. Flanges were created by melting 1.0 mm from the haptic ends using cautery. The forces required to remove the flanged haptic from the sclera and disinsert the haptic from the optic were measured using a mechanical tester and a custom-fabricated mount. RESULTS The mean FISHF dislocation force using 30-gauge needles was greatest with the CT Lucia 602 (2.04 ± 0.24 newtons [N]) compared to the LI61AO (0.93 ± 0.41 N; P = .001), ZA9003 (0.70 ± 0.34 N; P = <.001), and MA60AC (0.27 ± 0.19 N; P <.001). Using 27-gauge needles with the CT Lucia resulted in a lower dislocation force (0.56 ± 0.36 N; P <.001). The FISHF dislocation force was correlated with the flange-to-needle diameter ratio (r = 0.975). The FISHF dislocation forces of the CT Lucia and LI61AO using 30-gauge needles were not significantly different from their haptic-optic disinsertion forces (P = .79 and .27, respectively). There were no differences in flange diameters between 1.0 mm and 2.0 mm haptic melt lengths across the IOLs (P = .15-.85). CONCLUSIONS These data strongly support the biomechanical stability of FISHF with the polyvinylidene fluoride haptics of the CT Lucia using small diameter instruments for the creation of an intrascleral tunnel. 1.0 mm of haptic may be the optimal melt length.
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Affiliation(s)
- Kevin K Ma
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Yuan
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Sina Sharifi
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberto Pineda
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA..
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184
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Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
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Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
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185
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Kang HG, Jun JW, Choi EY, Byeon SH, Kim SS, Koh HJ, Kim M. Comparison of long-term surgical outcomes for scleral-fixated versus retropupillary iris-claw intraocular lens. Clin Exp Ophthalmol 2021; 49:686-695. [PMID: 34185377 DOI: 10.1111/ceo.13965] [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: 01/12/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To compare the clinical features and long-term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral-fixated (SFIOL) versus retropupillary iris-claw IOL (RPICIOL). METHODS Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best-corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation. RESULTS This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (p = 0.76) or endothelial cell density (ECD) (p = 0.39). Compared with the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, p = 0.005) sustained to over 36 months (p = 0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, p = 0.027), and shorter operation times (52.7 vs. 60.9 min, p = 0.015). There was no difference in ECD after 12 months (P = 0.282). Over a mean follow-up duration of 33 months (152 cases >3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, p = 0.006), suture exposure (7 vs. 0, p = 0.045), and redislocation (17.7% vs. 10.1%, p < 0.001). Multivariable regression showed that a final BCVA below 20/40 was associated with SFIOL (P = 0.007), older age (p = 0.001), intraoperative complications (p = 0.002), past history of vitrectomy/glaucoma surgery or uveitis (p = 0.046), and surgically induced astigmatism >1D (p = 0.029). CONCLUSIONS RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long-term follow-up, comparing favourably against conventional SFIOL.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Won Jun
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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186
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Unsal U, Akmaz B, Kilic D. Outcomes of a new suture technique for the treatment of dislocated intraocular lenses: locked loop on the haptic. Int Ophthalmol 2021; 41:3663-3673. [PMID: 34173904 DOI: 10.1007/s10792-021-01927-6] [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: 12/23/2020] [Accepted: 06/19/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate surgical and refractive outcomes of a new sutured scleral fixation technique in the management of subluxated intraocular lenses (IOLs). METHODS Nineteen eyes treated with the new scleral fixation technique were included. The mean corrected distance visual acuity (CDVA), postoperative refraction error, mean endothelial cell count (ECC), and complications were recorded. All patients were evaluated immediately postoperatively, at 1 and 7 days, and then at 1, 3, and 6 months. RESULTS The mean duration of follow-up of the patients was 10 months (range, 6-15 months). The mean CDVA was 0.41 ± 0.1 logMAR (logarithm of minimum angle of resolution) preoperatively and was 0.08 ± 0.07 logMAR postoperatively. The mean astigmatism was - 2.22 ± 1.86 D preoperative and was - 0.86 ± 0.58 D postoperative. The mean preoperative and postoperative ECC was 2455 ± 288 and 2352 ± 288, respectively. One patient (5.26%) experienced vitreous hemorrhage, and two (10.52%) experienced intraocular pressure elevation. IOL tilt and decentralization, conjunctival erosion, and cystoid macular edema were not observed in any eyes during follow-up. CONCLUSION This new IOL repositioning technique can be applied in a short surgical time and provides a stable IOL centration on long-term follow-up.
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Affiliation(s)
- Ugur Unsal
- Department of Ophthalmology, Batigoz Eye Health Center, Izmir, Turkey
| | - Berkay Akmaz
- Department of Ophthalmology, Manisa City Hospital, Izmir, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Kayseri City Training and Research Hospital, Health Science University, Kayseri, Turkey.
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187
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Colantuono D, Seknazi D, Miere A, Amoroso F, Glacet-Bernard A, Souied EH. Sutureless intrascleral fixation using a uniquely designed intraocular lens. J Fr Ophtalmol 2021; 44:957-961. [PMID: 34154871 DOI: 10.1016/j.jfo.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
We report our experience in the surgical technique of sutureless intrascleral posterior chamber intraocular lens (PC IOL) fixation in patients with insufficient capsular support using a uniquely designed, foldable, acrylic Carlevale IOL. It is specifically designed for sutureless scleral fixation and is equipped with a small plug attached to each of two haptics to anchor the lens to the sclera with a self-retaining mechanism. This surgery does not require creation of a scleral tunnel or transscleral exposure or excessive manipulation of the haptics. The harpoon-like plugs provide great stability to this implant, which can be injected through a 2.2mm incision. The characteristics of this IOL and the relative simplicity of this implantation technique makes it widely applicable in aphakic patients after previous complicated cataract surgery.
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Affiliation(s)
- D Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France.
| | - D Seknazi
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - A Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - F Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - A Glacet-Bernard
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
| | - E H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, 40, avenue Verdun, 94010 Créteil, France
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188
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Refractive errors after sutureless intrascleral fixation of intraocular lens. Graefes Arch Clin Exp Ophthalmol 2021; 259:3003-3009. [PMID: 34142189 DOI: 10.1007/s00417-021-05268-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To determine the difference between the attempted and the achieved postoperative refractive error after sutureless intrascleral fixation of the haptics of an implanted intraocular lens (IOL). PATIENTS AND METHODS This was a retrospective study of the medical charts of patients who had undergone sutureless intrascleral fixation of an IOL. The IOLs were fixed by inserting the haptics into scleral tunnels with or without flanges. The differences between the attempted and achieved postoperative refractive error (spherical equivalent) were determined. The relationships between the surgical options and the differences of the refractive error and degree of astigmatism were also determined. RESULTS Two hundred and twenty-three eyes were studied. There was a myopic shift of - 0.38 ± 1.13 diopters (D). The mean of the differences between the achieved postoperative and the attempted refractive error was 0.89 ± 0.79 D. The achieved refractive error was significantly correlated with the attempted refractive error (P < 0.001, R2 = 0.631). The surgical procedures selected were not significantly associated with the differences between the attempted and achieved refractive error. The size of sclerocorneal incision and presence of sutures were significantly associated with the final degree of astigmatism (P = 0.006 and 0.008, respectively). CONCLUSIONS The postoperative refractive error was significantly correlated with the attempted refractive error after intrascleral fixation of an IOL. The wound construction was associated with the postoperative degree of astigmatism.
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189
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Bever GJ, Liu Y, Stewart JM. Modified technique for trocar-based sutureless scleral fixation of intraocular lenses: A new approach to haptic externalization. Am J Ophthalmol Case Rep 2021; 23:101145. [PMID: 34195478 PMCID: PMC8233194 DOI: 10.1016/j.ajoc.2021.101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/18/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe a modified technique of haptic externalization for trocar-based sutureless scleral fixation of intraocular lenses, in order to avoid working with forceps in the iris plane in a manner that may be unfamiliar to the vitreoretinal surgeon. Methods This prospective, interventional case series included four eyes of four patients with dislocated intraocular lens (IOL). The modified haptic externalization technique avoids the pitfalls of iris-plane maneuvers by intentionally dropping the IOL onto the retina and using the forceps to grasp the tips of the haptics prior to direct externalization from the same grab. Results Four patients underwent scleral fixation of IOL using modified haptic externalization technique. One patient was lost to follow up after postoperative day 1. At the last follow up, all eyes demonstrated stability and good centration of scleral fixated IOL. All three patients achieved a best corrected visual acuity same or better compared to before the operation. One patient developed vitreous hemorrhage which later spontaneously resolved. Conclusions The modified haptic externalization technique is a simple and quick modification using maneuvers familiar to vitreoretinal surgeons. It has demonstrated safety among a small pilot group of patients.
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Affiliation(s)
- Gregory J Bever
- University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA.,Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Yingna Liu
- University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA.,Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
| | - Jay M Stewart
- University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA.,Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA
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190
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Mano Y, Mizobuchi K, Watanabe T, Watanabe A, Nakano T. Minimally Invasive Surgery for Intraocular Lens Removal and Intrascleral Intraocular Lens Fixation with Trabeculectomy in a Patient with Dislocated Intraocular Lens and Elevated Intraocular Pressure. Case Rep Ophthalmol 2021; 12:538-542. [PMID: 34248588 PMCID: PMC8255743 DOI: 10.1159/000511593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/12/2020] [Indexed: 11/19/2022] Open
Abstract
A 88-year-old female who was being treated for end-stage pseudoexfoliation syndrome was referred to our hospital for treatment of dislocated intraocular lens (IOL) and the elevated intraocular pressure (IOP) and in the right eye (RE). At the first visit to our hospital, best-corrected visual acuity (BCVA) was 0.2 in the RE and 0.02 in the left eye (LE). IOP was 47 mm Hg in the RE and 21 mm Hg in the LE. Slit-lamp examination showed no abnormalities in anterior segments and dislocated IOL in the RE. Fundus photograph showed optic disc pallor in both eyes. We performed the combined therapy of flanged intrascleral IOL fixation with the double-needle technique and trabeculectomy. Throughout the follow-up period, BCVA slightly improved from 0.2 to 0.4 in the RE. The angle of tilt of the IOL was 6.6, 7.9, and 8.7° as measured by swept-source optical coherence tomography at 1, 4, and 6 months after the surgery, respectively. The IOP remained less than 10 mm Hg without having to administer any other glaucoma medications. Furthermore, any complications associated with the surgery were not confirmed.
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Affiliation(s)
- Yuko Mano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kei Mizobuchi
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomoyuki Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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191
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Nowomiejska K, Haszcz D, Onyszkiewicz M, Choragiewicz T, Czarnek-Chudzik A, Szpringer-Wabicz A, Baltaziak K, Brzozowska A, Toro MD, Rejdak R. Double-Needle Yamane Technique Using Flanged Haptics in Ocular Trauma-A Retrospective Survey of Visual Outcomes and Safety. J Clin Med 2021; 10:jcm10122562. [PMID: 34207903 PMCID: PMC8228832 DOI: 10.3390/jcm10122562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/29/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023] Open
Abstract
To evaluate visual outcomes and safety of the double-needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double-needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow-up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow-up at three months. Further studies with longer follow-up evaluations are required to verify long-term complications.
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Affiliation(s)
- Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
- Correspondence: ; Tel./Fax: +48-81-53-248-27
| | - Dariusz Haszcz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Maksymilian Onyszkiewicz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Tomasz Choragiewicz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Aleksandra Czarnek-Chudzik
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Agata Szpringer-Wabicz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Katarzyna Baltaziak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (D.H.); (M.O.); (T.C.); (A.C.-C.); (A.S.-W.); (K.B.); (M.D.T.); (R.R.)
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192
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Forlini M, Bedi R. Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses. J Cataract Refract Surg 2021; 47:792-801. [PMID: 33278236 DOI: 10.1097/j.jcrs.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Cataract surgery via phacoemulsification with intraocular lens (IOL) placement in the capsular bag is the gold standard in the presence of adequate capsular support. However, when capsule and/or zonular fibers are weak or absent, alternate fixation strategies are required. Common alternative options include retropupillary iris-claw IOLs (RP-IC IOLs) and scleral-fixated IOLs (SF IOLs). In the present review of 87 articles with 2174 eyes implanted with RP-IC IOLs and 2980 eyes with SF IOLs, we discuss the published literature with respect to safety and efficacy. Although the studies reporting outcomes of these IOLs have been performed in patients with different concomitant conditions, visual and refractive outcomes were found to be comparable between RP-IC IOLs and SF IOLs. RP-IC IOL implantation seemed to provide equivalent or a potentially lower rate of complications than SF IOL implantation. Data from the literature also suggest that the surgical technique of RP-IC IOL implantation is relatively simpler with correspondingly shorter surgical times.
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Affiliation(s)
- Matteo Forlini
- From the Domus Nova Hospital, Ravenna, Italy (Forlini); Iris Advanced Eye Center, Chandigarh, India (Bedi)
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193
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A Review and Update on Surgical Management of Intraocular Lens Dislocation. Int Ophthalmol Clin 2021; 61:15-28. [PMID: 33337791 DOI: 10.1097/iio.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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194
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Damodaran S, Babu N, Sen S, Arthur D, Ramasamy K. Frugal model for scleral fixated intraocular lens simulation. Indian J Ophthalmol 2021; 69:463-464. [PMID: 33463619 PMCID: PMC7933904 DOI: 10.4103/ijo.ijo_2524_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sourav Damodaran
- Department of Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Naresh Babu
- Department of Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sagnik Sen
- Department of Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Dhipak Arthur
- Department of Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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195
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Bhatia K, Manaktala R, Sachdev M, Tank N, Saha I, Mishra D. MYX technique: A modified adaptation of Yamane and extraocular needle-guided haptic insertion techniques for scleral-fixated intraocular lens implantation. Indian J Ophthalmol 2021; 69:428-431. [PMID: 33463604 PMCID: PMC7933830 DOI: 10.4103/ijo.ijo_728_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Scleral-fixated intraocular lens implantation in an important tool in the armamentarium of an ophthalmologist for managing aphakia. Various techniques have been described in the literature with variable learning curves. Herein, we describe an easy, fast, reproducible technique; the “MYX” technique, which utilizes the advantages of both the Yamane and the X-NIT technique, where the handshaking of the prolene haptic of a 3-piece PMMA IOL into the lumen of a 26-gauge needle is done externally (like in X-NIT technique), and the exteriorized haptic is cauterized to form a flange transconjunctivally, thereby avoiding the scleral pocket tucking (like Yamane technique), to achieve excellent surgical outcomes.
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Affiliation(s)
- Karan Bhatia
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | - Ruchita Manaktala
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | | | - Nikunj Tank
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | - Indranil Saha
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
| | - Deepak Mishra
- Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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196
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Agrawal V, Raju B. Creating the flange in Yamane's technique. Indian J Ophthalmol 2021; 69:465. [PMID: 33463620 PMCID: PMC7933861 DOI: 10.4103/ijo.ijo_3618_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Biju Raju
- Consultant Vitreoretinal Surgeon, Dr. NSD Raju's Eye Hospital, Kochi, Kerala, India
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197
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Karkhur S, Soni D, Sharma B. Commentary: MYX technique: Best of both worlds - combining extraocular needle-guided haptic insertion and Yamane techniques in aphakia management. Indian J Ophthalmol 2021; 69:431-432. [PMID: 33463605 PMCID: PMC7933881 DOI: 10.4103/ijo.ijo_2376_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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198
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Erakgun T, Gobeka HH. The novel haptic-twist method for a sutureless double-needle intrascleral haptic fixation technique. Int Ophthalmol 2021; 41:3013-3020. [PMID: 34014460 DOI: 10.1007/s10792-021-01862-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Description of a novel modified technique known as haptic-twist method for placing a trailing haptic into a 27 G needle during double-needle intrascleral haptic fixation (Yamane technique) in the absence and/or inadequacy of capsular support. METHODS The trailing haptic was threaded into the needle lumen using a haptic-twist method in 12 eyes of 11 patients with aphakia. The haptic was grasped by a forceps 2-3 mm from the tip, while the forceps was rotated by 180° counter-clockwise around its own axis. This maneuver enabled the trailing haptic to be slightly twisted without any deformation and to coordinate with the needle in the proper angle. The surgical technique has also been mentioned in a surgical video. RESULTS Mean age of the patients was 62 years ± 18 (range 46-78 years). Although the mean pre-operative best-corrected visual acuity was 0.70 ± 0.35 logarithm of the minimum angle of resolution (logMAR) (range 1.30-0.20 logMAR), an improvement of up to 0.40 ± 0.32 logMAR (range 1.0-0.1 logMAR) was observed 3 months after surgery. No trailing haptic bending or breakage was observed during the process. Furthermore, no optical tilting or decentralization was observed post-operatively. CONCLUSIONS Although threading the leading haptic into the needle is reasonably straightforward, the trailing haptic positioning can be difficult due to an inappropriate gesture of both the haptic and the needle. We fervently believe that this novel haptic-twist method can provide a much simpler and easier approach, and thus contribute to better surgical outcomes.
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Affiliation(s)
| | - Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Agri Ibrahim Cecen University Rectorate, Erzurum Yolu 4 Km, 04100, Merkez, Agri, Turkey.
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199
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Ifantides C, Naids SM, Muttuvelu DV, Mian SI, Christopher KL. A Modified Flanged Intrascleral Intraocular Lens Fixation Technique Using an Externalized Needle for Haptic Docking. Clin Ophthalmol 2021; 15:2047-2050. [PMID: 34040338 PMCID: PMC8139677 DOI: 10.2147/opth.s302547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
The Yamane intrascleral flanged haptic fixation technique has obviated the need for resources such as suture or glue. However, intraocular maneuvers to properly dock haptics into the needles for externalization can be difficult for even adept eye surgeons and is especially difficult when visualization through the cornea is poor. Additionally, one traditional resource, intraocular forceps, has been critical in both the original technique and proposed modifications since its inception. We describe a modified flanged intrascleral intraocular lens fixation technique by docking the second haptic externally at the main corneal incision. This technique does not require the use of microforceps, which is advantageous to surgeons who lack access to specialized instrumentation. Additionally, this technique may provide added safety, visibility, and ease for surgeons by docking the haptic externally at the corneal incision rather than within the eye.
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Affiliation(s)
- Cristos Ifantides
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | | | | | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Karen L Christopher
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
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200
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Intraocular lens extraction using the cartridge pull-through technique. J Cataract Refract Surg 2021; 47:e70-e74. [PMID: 34108403 DOI: 10.1097/j.jcrs.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Current intraocular lens (IOL) explantation techniques are limited to cutting the optic and removing the pieces through a small incision, or folding single piece acrylic IOLs using a two-handed technique. Poor execution of IOL explantation can result in injury to intraocular structures, including the corneal endothelium and iris. The minimally invasive "cartridge pull-through technique" was invented, using a cartridge for IOL implantation and novel forceps optimized for secure grasping of the IOL for removal. This method involved less manipulation in the anterior chamber, thereby reducing the risks of complications such as corneal and iris injuries. A "dropped IOL" lying on the retinal surface can be extracted directly without lifting it onto the iris first. The cartridge-pull through technique offers a more streamlined and potentially safer approach for IOL explantation.
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