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Lou W, Chen Z, Huang Y, Jin H. Flapless and Conjunctiva-Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support. J Ophthalmol 2023; 2023:4032011. [PMID: 37124064 PMCID: PMC10132900 DOI: 10.1155/2023/4032011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose To evaluate refractive outcomes, intraocular lens (IOL) power calculation, and IOL position following a novel conjunctiva-sparing transscleral fixation technique. Methods Forty-one eyes of 40 patients managed with a flapless transscleral-sutured technique were included. Preoperative and postoperative refractive errors (spherical equivalents, SE) were compared. IOL position was assessed on the Scheimpflug images. IOL power was calculated by SRK/T, Holladay 1, and Hoffer Q formulas. Results The mean age was 57.39 ± 14.83 years (range: 26 to 79 years), and the mean follow-up was 7.46 ± 6.42 months (range: 1 to 24 months). Surgical indications were aphakia (n = 14), subluxated lenses (n = 3), and IOL dislocation (n = 24). The SE was 4.50 ± 6.38 diopter (D) (range: -3.75 to 13.75 D) preoperatively and -1.68 ± 1.57 D (range: -5.50 to 1.13 D) postoperatively (P < 0.001). The mean tilt angle and decentration were 2.90° ± 1.93° (range: 0.39° to 9.10°) and 0.23 ± 0.19 mm (range: 0.02 to 0.94 mm) vertically, and 1.75° ± 1.41° (range: 0.24° to 7.65°) and 0.18 ± 0.19 mm (range: 0.02 to 1.06 mm) horizontally, which were clinically insignificant. All three IOL formulas produced myopic errors (range: -0.29 to -0.50 D). The SRK/T had the lowest median absolute error (0.55 D), followed by the Holladay 1 (0.70 D) and the Hoffer Q (0.74 D). The three formulas had the same percentage of prediction errors (PEs) within ±0.5 D (43.48%), while the Hoffer Q had the highest percentage of PEs within ±1.0 D (82.61%). Conclusion The present technique can serve as an alternative approach for transscleral IOL fixation and refractive correction in eyes with compromised capsular support, ensuring the stability of IOLs and reasonable IOL power calculation accuracy.
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Affiliation(s)
- Wei Lou
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziang Chen
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Huang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiying Jin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Intracorneal Knot or Flange Depot Fixation: a New Transscleral Technique for Intraocular Implant Fixation. J Cataract Refract Surg 2022; 48:745-749. [DOI: 10.1097/j.jcrs.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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Anisimova NS, Arbisser LB, Shilova NF, Kirtaev RV, Dibina DA, Malyugin BE. Late dislocation of the capsular bag-intraocular lens-modified capsular tension ring complex after knotless transscleral suturing using 9-0 polypropylene. Digit J Ophthalmol 2021; 26:7-16. [PMID: 33867876 DOI: 10.5693/djo.02.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of late breakage of a 9-0 polypropylene transscleral suture used for fixation of a dislocated capsular bag-intraocular lens-modified capsular tension ring complex in a 52-year-old woman with Marfan syndrome. Breakage occurred despite use of a cow-hitch technique for external and internal fixation. We believe breakage was caused by the suture chafing on the sharp edges of the modified capsular tension ring eyelet. Cross-sectional analysis of Malyugin-modified capsular tension rings from two different manufacturers revealed a difference with respect to radius of curvature. Suturing intraocular implants with relatively sharp edges may cause suture breakage; further studies are needed to identify the critical parameters for the surface quality of sutured intraocular implants.
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Affiliation(s)
- Natalia S Anisimova
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Lisa B Arbisser
- John A. Moran Eye Center, University of Utah, Salt Lake City
| | | | - Roman V Kirtaev
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Daria A Dibina
- S. Fyodorov Eye Microsurgery Institution, Moscow, Russia
| | - Boris E Malyugin
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,S. Fyodorov Eye Microsurgery Institution, Moscow, Russia
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Modified Technique for Scleral-Sutured Fixation with the Double Knots Technique for Posterior Chamber Intraocular Lens: Short-Term Observation. J Ophthalmol 2021; 2021:6697230. [PMID: 33728058 PMCID: PMC7937454 DOI: 10.1155/2021/6697230] [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: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the short-term safety and efficacy of a novel approach of utilizing the 9-0 looped polypropylene suture with double knots buried into the scleral groove and the scleral tunnel to minimize the risk of the suture erosion and suture knot exposure. Design Clinical-based retrospective study. Methods Records of consecutive patients who had anterior vitrectomy and scleral-fixated posterior chamber intraocular lens (IOL) implantation between July 2018 and April 2020 with a minimum follow-up of 3 months were reviewed. Results This study enrolled a total of 21 eyes from 20 patients (15 male). These patients had a mean age of 58.52 ± 8.55 years and were followed for an average of 1.08 ± 0.58 years postoperatively. Best-corrected visual acuity (BCVA) improved from a preoperative mean of 0.43 ± 0.41 logMAR to a significantly higher mean 3-month postoperative value of 0.09 ± 0.21 logMAR (Z = -3.35, p < 0.01). There were no statistical differences between the preoperative and postoperative corneal endothelial cell density (p=0.71). The postoperative complications included transient increased intraocular pressure in 5 eyes (24%). No other complications were detected during the follow-up. Conclusions The modified technique proposed is a safe, effective, and reliable approach resulting in good visual outcomes. Our procedure might have the potential benefit to avoid suture-related complications in scleral-fixated IOL implantation. Trial registration. Retrospective case series study, not applicable.
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Ni S, Wang W, Chen X, Wu X, He S, Ma Y, Xu W. Clinical observation of a novel technique: transscleral suture fixation of a foldable 3-looped haptics one-piece posterior chamber intraocular lens implantation through scleral pockets with intact conjunctiva. BMC Ophthalmol 2019; 19:105. [PMID: 31072310 PMCID: PMC6507106 DOI: 10.1186/s12886-019-1113-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background To present the follow-up outcomes of a modified technique of transscleral suture fixation of posterior chamber intraocular lens (PCIOL) in eyes with inadequate capsule support. Methods A retrospective chart review of 21 patients underwent transscleral suture fixation of a foldable 3-looped haptics one-piece PCIOL implantation through scleral pockets was conducted. Preoperative data and follow-up data for at least 3 months were collected for all patients. Results The mean operative duration was 36.62 ± 10.70 min. The mean pre- and post-operative LogMAR uncorrected distance visual acuity was (1.25 ± 0.50 vs. 0.41 ± 0.22, P < 0.01). The mean pre- and post-operative LogMAR best corrected visual acuity was (0.48 ± 0.25 vs. 0.33 ± 0.24, P < 0.01). The mean proportion of postoperative endothelial cell loss was 11.46 ± 4.78%. The mean postoperative anterior chamber depth was 3.05 ± 0.44 mm. The mean postoperative IOL tilt degree was 2.81 ± 1.41°, and the mean postoperative IOL decentration degree was 0.31 ± 0.13 mm. Four patients with transient corneal edema (19.0%) and three patients with transiently elevated IOP (14.3%) were observed after operation, and such complications were resolved within 1 week. No severe complications were observed. Conclusions The modified technique was a feasible method of PCIOL implantation. Electronic supplementary material The online version of this article (10.1186/s12886-019-1113-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuang Ni
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wang
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Chen
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingdi Wu
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suhong He
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Suichang Hospital of Traditional Chinese Medicine, Suichang, China
| | - Yajuan Ma
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Rongjun Hospital, Jiaxing, China
| | - Wen Xu
- Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Kang MJ, Joo CK. Three cases of a torn haptic after scleral fixation using a hydrophobic acrylic intraocular lens: Case reports. Medicine (Baltimore) 2018; 97:e9853. [PMID: 29465569 PMCID: PMC5841957 DOI: 10.1097/md.0000000000009853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE We report 3 cases of a torn haptic after successful scleral fixation with a hydrophobic acrylic intraocular lens. PATIENT CONCERNS Patients complained of decreased visual acuity about 1 week to 1 month after scleral fixation. DIAGNOSES In all 3 cases, the direction of the damaged haptic correlated with the direction of the pulling force made by the hung suture material. Observation of a cheese-wiring effect on scanning electron microscopy suggested that the haptic was cut by the suture. INTERVENTIONS Patients underwent re-scleral fixation with caution. OUCTOMES There was no complication of broken haptic after re-scleral fixation. LESSONS To avoid unexpected haptic tears, great caution is needed; surgeons should avoid applying excessive pulling force to the intraocular lens when performing scleral fixation using a hydrophobic acrylic intraocular lens.
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Lens Placement in the Absence of Capsular Support: Scleral-fixated Versus Iris-fixated IOL Versus ACIOL. Int Ophthalmol Clin 2017; 56:93-106. [PMID: 27257725 DOI: 10.1097/iio.0000000000000116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sindal MD, Nakhwa CP, Sengupta S. Comparison of sutured versus sutureless scleral-fixated intraocular lenses. J Cataract Refract Surg 2016; 42:27-34. [PMID: 26948775 DOI: 10.1016/j.jcrs.2015.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the intermediate-term anatomic and visual results of scleral-fixated intraocular lens (IOL) implantation using 4-point suture fixation or transscleral sutureless fixation. SETTING Tertiary referral eye care center in South India. DESIGN Retrospective case series. METHODS Medical records of consecutive patients who had scleral-fixated IOL surgery from January 1, 2010, to March 31, 2014, with more than 1 year of follow-up were retrospectively analyzed. Indication for scleral-fixated IOL implantation was aphakia after cataract extraction or trauma. The surgical technique was based on individual surgeon preference. The uncorrected distance visual acuity (UDVA), previous surgery, type of trauma, surgical technique, and complications were analyzed. RESULTS One hundred nine cases were analyzed. The mean follow-up was 18.9 months ± 8.7 (SD). The majority of eyes experienced an improvement in UDVA after surgery; 93 eyes (86%) had a Snellen equivalent corrected distance visual acuity of 6/12 or better. The baseline characteristics and final visual outcomes in the sutured scleral-fixated IOL group (n = 52) and sutureless scleral-fixated IOL group (n = 59) were comparable. Patients with previous trauma (n = 52) were predominantly men and were significantly younger than those in the cataract group. The visual and refractive outcomes were comparable between eyes with previous trauma and eyes with previous cataract surgery. Transient cystoid macular edema was the most common complication (12%); retinal detachment occurred in 5 cases (4.5%). CONCLUSIONS Scleral-fixated IOLs provided excellent visual rehabilitation of aphakic eyes without capsular support. The sutured technique and sutureless technique appear to be equally good in eyes with aphakia after cataract surgery or trauma. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Manavi D Sindal
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India.
| | - Chinmay P Nakhwa
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Sabyasachi Sengupta
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
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Abstract
BACKGROUND Several techniques for the reposition of a posterior chamber intraocular lens (IOL) posterior dislocating into the vitreous cavity have been developed. However, most of these methods are complicated or include externalizing part of the IOL from a corneal or scleral wound. We here describe a 27-gauge needle-assisted technique for management of a dislocated posterior chamber IOL. METHODS This is a retrospective, noncomparative, interventional case series that discusses the results of 27-gauge needle-assisted reposition of the posterior chamber IOL with transscleral sulcus fixation in 5 consecutive cases with an IOL dislocated into vitreous cavity. These patients underwent IOL reposition with the above-mentioned technique between April 2013 and October 2014 and were followed up for at least two months thereafter. RESULTS The IOLs of the five cases were stable with proper centrations. The postoperative best-corrected visual acuity ranged from 20/30 to 20/20. CONCLUSION The technique of 27-gauge needle-assisted reposition of the posterior chamber IOL with transscleral fixation is effective for reposition of a dislocated IOL. This technique provides good IOL fixation without creating a large corneal wound or scleral flap.
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Smith JM, Erlanger M, Olson JL. Injectable suture device for intraocular lens fixation. J Cataract Refract Surg 2016; 41:2609-13. [PMID: 26796441 DOI: 10.1016/j.jcrs.2015.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/29/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED We describe a surgical technique for scleral fixation of a posterior chamber intraocular lens (PC IOL) using a 24-gauge injectable polypropylene suture delivery system. A 3-piece PC IOL is inserted into the anterior chamber of the eye. Two sclerotomies are made 1.5 mm posterior to the limbus using a microvitreoretinal blade. The 24-gauge injector delivers a preformed suture loop into the eye with the double-armed needles still external to the eye. Each polypropylene IOL haptic is directed through the loop using microforceps. The suture loop is tightened around the haptic, and the attached needles are used to fixate the IOL to the sclera and close the sclerotomies simultaneously. This technique has been used in an ex vivo porcine eye and in an aphakic patient. In the latter, the IOL was quickly fixated to the sclera and maintained a stable position postoperatively. FINANCIAL DISCLOSURE Dr. Olson has a patent pending for the device described in this article. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jesse M Smith
- From the Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado, Aurora, Colorado, USA
| | - Michael Erlanger
- From the Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado, Aurora, Colorado, USA
| | - Jeffrey L Olson
- From the Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado, Aurora, Colorado, USA.
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Can E, Gül A, Birinci H. A safe method of ciliary sulcus fixation of foldable intraocular lens using a ciliary sulcus guide. Int Ophthalmol 2015; 36:463-8. [PMID: 26439372 DOI: 10.1007/s10792-015-0132-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Abstract
To describe a novel technique for implantation of intraocular lens in the absence of capsular support using a ciliary sulcus guide. Based on the anatomic knowledge of the ciliary sulcus and the sclera, a new instrument was developed to pierce the needle safely through the ciliary sulcus and sclera. While the foldable lens is stored inside the cartridge, the leading haptic is sutured with a cow-hitch knot. The needle is then inserted into the ciliary sulcus guide. The tip of the guide is inserted from the corneal incision and proceeded under the iris to touch and fit the ciliary sulcus. The needle is pushed from back side. The needle comes out at precise point at the sclera. Implantation of the lens was performed through a 2.8 mm clear cornea incision using the injector. The trailing haptic is tied after implantation, and then the same procedure is performed at the opposite side. We performed this technique to 15 aphakic eyes without sufficient capsular support. There was no bleeding or other intraoperative complication. All the points coming out the sclera were between 2 and 2.5 mm from the limbus. The ab interno technique for scleral fixation of IOL is quicker, easier and less traumatic then ab externo techniques. A new ciliary sulcus guide which is usable with both straight and curved needles eliminates the blind maneuvers of ab interno technique and makes this technique more safe and precise.
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Affiliation(s)
- Ertuğrul Can
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey.
| | - Adem Gül
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey
| | - Hakkı Birinci
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey
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Long C, Wei Y, Yuan Z, Zhang Z, Lin X, Liu B. Modified technique for transscleral fixation of posterior chamber intraocular lenses. BMC Ophthalmol 2015; 15:127. [PMID: 26432550 PMCID: PMC4592543 DOI: 10.1186/s12886-015-0118-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/28/2015] [Indexed: 12/19/2022] Open
Abstract
Background Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens (PCIOL). We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of PCIOL. Methods The modified surgical technique is as following: at first, two 3 mm × 4 mm square scleral pockets were created from groove incisions at opposite positions. A straight needle attached to a 10–0 polypropylene suture was passed through one incision groove. Then, a 27-Gauge hollow needle passed through the opposite sclera incision bed was used to retrieve the straight fine needle via its barrel. The sutures were tied to themselves after one more bite on the scleral bed. At last, the suture ends were left long (about 4 mm) and laid flat into corresponding laminar scleral pockets. This modified technique of PCIOL was performed in 48 post-traumatic aphakic vitrectomized eyes from 48 patients (47 male, one female) with mean age of 34.8 ± 14.8 years. Main outcome measures included best corrective visual acuity (BCVA), IOL decentration, IOL tilt, and postoperative complications. Results The mean follow-up was 32.3 ± 10.8 months (3–67 months). The LogMAR BCVA remained stable, from a preoperative value of 0.46 ± 0.34 to postoperative 0.44 ± 0.34 (p = 0.69). Mild IOL tilt (5–10°) was observed in five eyes, and slight IOL decentration (0.5–1.0 mm) was seen in three cases. No case of suture exposure, suture breakage, IOL dislocation, or endophthalmitis was observed during the follow up period. Conclusion The modified technique allowed stable placement of PCIOLs in post-traumatic aphakic eyes with a wide range of follow-up. Our procedure might have the potential benefit to avoid suture exposure in scleral-fixated IOL implantation. Electronic supplementary material The online version of this article (doi:10.1186/s12886-015-0118-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chongde Long
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Yantao Wei
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Zhaohui Yuan
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Zhiqing Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Xiaofeng Lin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
| | - Bingqian Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, China.
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Lockington D, Ali NQ, Al-Taie R, Patel DV, McGhee CNJ. Outcomes of scleral-sutured conventional and aniridia intraocular lens implantation performed in a university hospital setting. J Cataract Refract Surg 2014; 40:609-17. [PMID: 24560552 DOI: 10.1016/j.jcrs.2013.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/09/2013] [Accepted: 09/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the outcomes of transscleral sutured posterior chamber intraocular lens (PC IOL) implantation. SETTING Public university hospital, Auckland, New Zealand. DESIGN Retrospective case series. METHODS A modified no-touch transscleral sutured PC IOL implantation technique with a 1-piece monofocal IOL (Alcon CZ70BD) or an aniridia IOL (type 67G, Morcher) was assessed. RESULTS Seventy-eight cases (80.8% men; 53.9% aphakic) were identified. The mean follow-up was 35.5 months and the mean age at surgery, 41 years±21 (SD). The preoperative corrected distance visual acuity (CDVA) was worse than 6/30 in 66.7%. Indications included ocular trauma (46.2%), nontraumatic crystalline lens subluxation (16.7%), post-complicated cataract surgery (10.3%), idiopathic IOL dislocation (10.3%), and congenital cataract/aphakia (10.3%). An aniridia IOL was required in 39.7% of eyes. There were no significant intraoperative complications in 74.4% of eyes. Postoperative complications included transient corneal edema (15.4%), wound leak requiring resuturing (7.7%), retinal detachment (7.7%), and cystoid macular edema (6.4%). One eye (1.3%) developed suture breakage-related late IOL dislocation. Overall, 91.3% of eyes had improved visual acuity or were within 1 line of the presenting CDVA. In eyes with a guarded prognosis, 34.8% achieved a CDVA of 6/12 or better and 43.5% a CDVA of 6/15 to 6/48. In the better prognosis group, 73.9% achieved a CDVA of better than 6/12 and all achieved better than 6/30. CONCLUSIONS Scleral-sutured IOLs achieved good visual outcomes in a public hospital setting. The rate of complications was moderate in this series with a high proportion of severe ocular trauma and a large percentage of aniridia IOLs. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David Lockington
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Noor Q Ali
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rasha Al-Taie
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dipika V Patel
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Seki M, Yamamoto S, Abe H, Fukuchi T. Modified ab externo method for introducing 2 polypropylene loops for scleral suture fixation of intraocular lenses. J Cataract Refract Surg 2013; 39:1291-6. [PMID: 23988241 DOI: 10.1016/j.jcrs.2013.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 05/07/2013] [Accepted: 05/23/2013] [Indexed: 11/16/2022]
Abstract
We describe a method that enables the introduction of 2 suture loops for scleral fixation of an intraocular lens (IOL) by a single ab externo procedure. A long needle carrying a polypropylene suture loop is inserted through the scleral fixation site and docked with a hollow needle inserted through the opposite fixation site. The hollow needle pulls the suture needle out, but the suture loop end is left external. Another polypropylene suture loop is placed through the first loop. As the first (leading) suture is pulled, the second (trailing) suture is drawn into the eye. The suture loops are retrieved through the main incision. The IOL haptics are secured with a polypropylene loop by cow hitches. After the IOL is placed in the eye, the sutures are fixated to the sclera. This technique enhances efficiency and control during the introduction of suture loops for scleral fixation of IOLs.
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Affiliation(s)
- Masaaki Seki
- Seki Eye Clinic, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
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McGrath LA, Lee GA. Transscleral fixation of a supplementary toric intraocular lens to prevent rotation in a pseudophakic patient. J Cataract Refract Surg 2013; 39:134-138. [DOI: 10.1016/j.jcrs.2012.07.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
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One-Haptic Fixation of Posterior Chamber Intraocular Lenses without Scleral Flaps. J Ophthalmol 2012; 2012:891839. [PMID: 22919463 PMCID: PMC3420135 DOI: 10.1155/2012/891839] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess visual results and complications of a modified technique of posterior chamber intraocular lenses (PC IOLs) in aphakic eyes without scleral flaps. Methods. Modified one-haptic scleral fixation was performed in one eye each of 25 patients with aphakia and insufficient capsule support. Follow-up period was six months. Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), and postoperative complications. Results. The study included 15 males and 10 females. The preoperative best-corrected visual acuity (BCVA) ranged from 5/60 to 6/9. The operation time ranged from 25 to 45 minutes (mean 35.25 ± 5.34 min). Anterior vitrectomy was performed in 12 cases (48%). There was no major IOL decentration. The final BCVA ranged from 6/36 to 6/9. Seven cases (28%) showed postoperative glaucoma, five cases (20%) had temporary hypotony, and hyphema in 2 eyes (8%). No cases of suture erosion, postoperative endophthalmitis, retinal detachment, or IOL dislocation were detected. Conclusion. This technique of one-haptic scleral fixation of posterior chamber IOLs is a good choice in presence of insufficient capsule support. It reduces the operation time, achieves the IOL stability, and minimizes postoperative suture-related complications.
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Hara S, Borkenstein AF, Ehmer A, Auffarth GU. Retropupillary Fixation of Iris-claw Intraocular Lens Versus Transscleral Suturing Fixation for Aphakic Eyes Without Capsular Support. J Refract Surg 2011; 27:729-35. [DOI: 10.3928/1081597x-20110623-01] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 05/27/2011] [Indexed: 11/20/2022]
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Joo J, Lee YK, Rho CR, Byun YS, Joo CK. Transscleral Fixation of Intraocular Lens Using the Triple Cow-Hitch Method. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jongsoo Joo
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - You Kyung Lee
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Rae Rho
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Soo Byun
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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