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Chang YM, Weng TH, Tai MC, Chen YH, Lee CH, Chang WC, Hsieh MW, Chien KH. A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia. Sci Rep 2024; 14:2044. [PMID: 38267491 PMCID: PMC10808084 DOI: 10.1038/s41598-023-49084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
This study compared the visual outcomes and complications between sutureless scleral-fixated intraocular lens and iris claw intraocular lens implantation in aphakia without adequate capsule and/or zonule support. Studies comparing the clinical outcomes of scleral-fixated intraocular lens and iris claw intraocular lens implantation published until April 2022 were retrieved from the PubMed, EMBASE, Cochrane Library, and Google Scholar databases. The outcomes included postoperative final visual acuity, surgical time, surgery-induced astigmatism, and complications. The weighted mean difference and odds ratio were calculated. Two randomized controlled trials and five cohort studies, including 244 and 290 eyes in the scleral-fixated intraocular lens group and iris claw group, respectively, were included. Scleral-fixated intraocular lens implantation results in a better postoperative final corrected distance visual acuity compared with iris claw intraocular lens implantation; however, it is more time-consuming. Scleral-fixated intraocular lens implantation seems to have lesser incidences of surgery-induced astigmatism. Furthermore, both procedures have a similar complication rate. Therefore, based on current best evidence, these two procedures should be considered according to patient's conditions.
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Affiliation(s)
- Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Cheng Chang
- Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital; and School of Medicine,, National Defense Medical Center, Number 325, Section 2, Chang-Gong Rd, Nei-Hu District, Taipei, 114, Taiwan, Republic of China.
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Khoramnia R, Baur ID, Auffarth GU. Aetiology and Management of IOL Dislocations. Klin Monbl Augenheilkd 2023; 240:971-980. [PMID: 37494272 DOI: 10.1055/a-2074-9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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Yoo WS, Cho YW, Park MH, Kang HJ, Kim SJ. New Surgical Approach for Secondary Intraocular Lens Implantation Using an Artificial Bag with Optic Capture in Patients with Intraocular Lens Dislocation. Retina 2023; 43:1403-1407. [PMID: 32947433 PMCID: PMC10627538 DOI: 10.1097/iae.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We present a newly developed approach to secondary intraocular lens (IOL) implantation, which uses an artificial bag with optic capture (i.e., ABC technique) in patients with IOL dislocation. METHODS This is a retrospective, noncomparative, and interventional case series that reveals the results of secondary IOL implantation using an artificial bag with optic capture in four cases of IOL dislocation. All patients underwent the abovementioned surgery and were followed up for at least 6 months. RESULTS The best-corrected visual acuity of patients ranged from 20/30 to 20/20. The IOL of all patients showed no tilting or decentration with normal intraocular pressure. CONCLUSION We believe that this method produces satisfactory results and will be especially beneficial to retinal surgeons for the management of patients with IOL dislocation.
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Affiliation(s)
- Woong-Sun Yoo
- Department of Ophthalmology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea
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Zong Y, Wu K, Fang W, Yu J, Jiang C, Xu G. Modified Intrascleral Fixation for Repositioning the Dislocated Single-Piece, Rigid PMMA Intraocular Lens. Retina 2023; 43:1019-1023. [PMID: 32604344 DOI: 10.1097/iae.0000000000002876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a modified intrascleral fixation technique for repositioning single-piece rigid polymethyl methacrylate intraocular lenses (IOLs). METHODS Four patients with dislocated IOLs were enrolled. Surgical modifications included using ≤1-mm scleral incision for haptic externalization, placing the IOL haptic placement in scleral tunnels, and using 8-0 absorbable sutures. Patients were followed up for 6 months with routine ophthalmic examinations, corneal endothelial cell counts, and ultrasound biomicroscopy (UBM). RESULTS The mean follow-up time was 13.5 ± 5.45 months. The IOL was well centered and the spherical refraction improved (+10.25 ± 2.21 vs. -0.81 ± 1.59 D, P < 0.05), whereas the best-corrected visual acuity (pre 20/43 Snellen, 0.42 ± 0.33 logarithm of the minimum angle of resolution equivalent and post 20/36 Snellen, 0.31 ± 0.22 logarithm of the minimum angle of resolution equivalent; P = 0.235), intraocular pressure (pre 13.8 ± 3.21, post 13.55 ± 5.14 mmHg), corneal endothelium density (pre 2,423.8 ± 279.6/mm 2 , post 2,280.25 ± 350.7/mm 2 ), and total astigmatism (pre -1.94 ± 0.43, post -1.69 ± 0.59 D) remained unchanged. The average horizontal and vertical IOL tilt was 0.33 ± 0.22° and 0.81 ± 0.38°, respectively. Intraocular lens decentration was 0.10 ± 0.03 mm horizontally and 0.13 ± 0.06 mm vertically. CONCLUSION The modified intrascleral fixation technique shows encouraging midterm results in patients with dislocated single-piece, rigid polymethyl methacrylate IOLs. Larger samples and longer follow-up are required to confirm the outcomes of this technique.
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Affiliation(s)
- Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China ; and
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Kaicheng Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China ; and
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Wangyi Fang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China ; and
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China ; and
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China ; and
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Gezhi Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China ; and
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
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GamalElDin SA, ElShazly MI, Salama MM. Trocar-assisted flanged transconjunctival intrascleral sutureless intraocular lens fixation. Eur J Ophthalmol 2022; 32:3699-3702. [PMID: 35435770 DOI: 10.1177/11206721221094398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the safety and efficacy of 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation in patients with insufficient posterior capsular support. METHODS Five aphakic eyes with capsular insufficiency were included in this prospective interventional case series study, at Dar El Oyoun Hospital, Cairo, Egypt. Twenty five-gauge trocar-assisted flanged intrascleral sutureless technique was used for IOL fixation, in which retinal microforceps were used to capture and externalize both haptics through a scleral tunnel. CDVA, IOP measurements and IOL centralization were reported pre- and one day, one & 3 months postoperatively. Any intra- or postoperative complications were recorded. RESULTS The mean LogMAR CDVA had significantly improved one day, 1 & 3 months postoperatively (0.74 ± 0.1, 0.42 ± 0.07 and 0.26 ± 0.08 respectively, p < 0.001) compared to the preoperative value (1.7 ± 0.17). The mean IOP showed no significant changes along the follow-up period (16.9 ± 0.1; 16.2 ± 1.1; 16.3 ± 0.9 mmHg, p = 0.68, 0.58, 0.89) respectively at 1st day, 1 & 3 months postoperatively) compared to the preoperative measurement (16.4 ± 1.8 mmHg). The IOL was found to be centralized in all cases. No intra- or postoperative complications were encountered. CONCLUSION 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation is found to be a reliable and effective technique that overcomes Yamane technique's challenges for IOL fixation in cases with posterior capsular insufficiency.
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Affiliation(s)
| | - Malak I ElShazly
- Assistant Professor of Ophthalmology, 63527Cairo University, Cairo, Egypt
| | - Marwa M Salama
- Assistant Professor of Ophthalmology, 63527Cairo University, Cairo, Egypt
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Anterior Versus Retropupillary Iris-Claw Intraocular Lens: Indications, Visual Outcome and Postoperative Complications. Ophthalmol Ther 2022; 11:771-784. [PMID: 35149965 PMCID: PMC8927565 DOI: 10.1007/s40123-022-00474-2] [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: 12/03/2021] [Accepted: 01/26/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction In cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations.
Methods We retrospectively examined the characteristics and outcomes of patients who underwent iris-claw “Artisan®” intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications. Results In this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior iris-claw IOL patients had more high intraocular pressure readings and macular edema. Conclusions This study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.
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Modified Yamane technique with a 26-gauge needle: single corneal incision and simplified haptic insertion. J Cataract Refract Surg 2022; 48:e1-e4. [PMID: 34524208 DOI: 10.1097/j.jcrs.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
A modified Yamane technique with a 26-gauge needle for aphakia correction is described. Single corneal or corneoscleral incision is set at 12 o'clock. The 26-gauge needles are used to make 2 angled incisions parallel to the limbus to fix the haptics of a 3-piece intraocular lens. The modifications provide an easier and safer way of haptic insertion into the needle tip and decreases the possibility of bending or breaking the haptic.
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Behera UC, Thakur PS. Scleral Fixation of Intraocular Lens in Aphakic Eyes without Capsular Support: Description of a New Technique. Clin Ophthalmol 2021; 15:4689-4696. [PMID: 34949910 PMCID: PMC8689012 DOI: 10.2147/opth.s344506] [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: 10/21/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the efficacy and safety of a modified trans-scleral intraocular lens (IOL) fixation technique in aphakic eyes when performed by ophthalmologists in training. Methods The study was conducted in an institutional setting that included 43 surgeries performed by surgeons training in small incision cataract surgeries. The data were analyzed for stability and position of IOL, refractive changes, best-corrected vision, and associated complications. Results Mean age of the subjects was 53.8 ± 18.5yrs (range 6–81yrs). Surgical aphakia (58.14%) was the most common cause. The corrected distance visual acuity improved significantly at six weeks (p = 0.0003). The mean residual spectacle correction was +0.74 ± 1.2D spherical equivalent (cylinder −1.6±1.5D at 84 ± 50°) at the 6th-month follow-up (24.35 ± 6.71wks). Lens tilt on ultrasound biomicroscopy (kappa 0.762; p < 0.001) and the IOL centration (kappa 0.411; p = 0.001), assessed by two independent masked observers, were satisfactory at the 6th-month visit. Transient postoperative vitreous hemorrhage was the most common complication (46.5%). Cellular deposits on the IOL surface (18.6%), cystoid macular edema (11.6%), subconjunctival haptic exposure (4.66%), and haptic slippage (2.33%) were the other complications. Conclusion This method of trans-scleral IOL fixation is an effective rescue procedure for eyes with deficient capsular support when ophthalmologists perform in training.
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Affiliation(s)
- Umesh Chandra Behera
- Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, India
| | - Pratima Singh Thakur
- Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, India
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A Modified Intrascleral Intraocular Lens Fixation Technique Using 27-Gauge Blunted Needles with Fewer Intraocular Manipulations. J Ophthalmol 2021; 2021:6791977. [PMID: 34845425 PMCID: PMC8627344 DOI: 10.1155/2021/6791977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
A new method for intraocular lens (IOL) fixation in the scleral tunnel using two common 27G blunted needles and an ultrathin 30G needle with fewer intraocular manipulations was developed. Half-depth scleral flaps were prepared, and vertically angled sclerotomies were performed under each scleral flap, 2 mm from the limbs with a 20G microblade or a 26G needle. Two bent 27G blunted needles connected the sclerotomy and corneoscleral incisions. One haptic was inserted into this bent 27G blunted needle extraocularly and extruded through the sclerotomy site. Each haptic was inserted into the lumen of the preplaced ultrathin 30G needle and buried into the scleral tunnel. In this retrospective study, we reviewed the outcomes of this new technique in patients with at least 3 months' follow-up data. Iris capture of the IOL was not observed in any case, and IOL repositioning was not performed either. Astigmatism induced by intraocular aberration was almost as same as that with other methods. Our technique can be performed in any operation room without any extra instruments. This trial is registered with UMIN000044350.
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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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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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Thulasidas M. Retropupillary Iris-Claw Intraocular Lenses: A Literature Review. Clin Ophthalmol 2021; 15:2727-2739. [PMID: 34211261 PMCID: PMC8240859 DOI: 10.2147/opth.s321344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 01/02/2023] Open
Abstract
Retropupillary iris-claw intraocular lenses (ICIOLs) have been increasingly chosen by surgeons nowadays as a primary or secondary procedure of IOL implantation in eyes with insufficient capsular or zonular support. They have gained popularity due to their simple fast technique, favourable functional outcomes, and safety. The transition in the ICIOL fixation from prepupillary to a more biologically appropriate retropupillary position and change in the optic design from biconvex to convex-concave have provided better visual outcomes and improved safety. A peer-reviewed literature search was conducted in Medline (PubMed), Embase, and Cochrane Library using the keywords "retropupillary iris claw" and "iris claw". The search yielded 310 articles that were screened. Forty-three articles on retropupillary ICIOLs were finally found to be relevant and reviewed in full-text versions. The functional outcomes following retropupillary implantation of ICIOLs have been acceptable in eyes with no ocular co-morbidities otherwise. However, the indications for surgery may affect the outcomes. The major postoperative complications directly associated with ICIOLs include pupil ovalization and redislocation. Nevertheless, the rate of disenclavation depends on the experience and skill of the surgeon. This review is based on a literature review, and it focuses on the preoperative evaluation, surgical technique, postoperative outcomes, and associated complications. Prospective randomized trials with a larger sample size and longer follow-up are needed for comparison with other techniques of IOL fixation and confirmation of long-term safety profile.
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Affiliation(s)
- Mithun Thulasidas
- Cataract and Glaucoma services, Sankara Eye Hospital, Coimbatore, Tamil Nadu, 641035, India
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Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds. J Ophthalmol 2021; 2021:6613205. [PMID: 34239720 PMCID: PMC8241495 DOI: 10.1155/2021/6613205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/19/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Siderosis bulbi may occur as a result of retained intralenticular foreign bodies (ILFBs) that were missed during examination in patients with self-sealing wounds and without a significant decrease in visual acuity. This study aimed to explore the clinical characteristics and visual outcomes of ILFBs with self-sealing corneal penetrating wounds. Methods Fifteen eyes of 15 patients with ILFBs and self-sealing corneal penetrating wounds, seen between October 2014 and September 2019, were retrospectively analyzed. Data regarding the patient demographics, clinical features, surgical procedure, and initial and final best-corrected visual acuity (BCVA) were analyzed. Results All patients were male with a mean age of 41 years. The foreign bodies passed through the cornea, sometimes through the iris, through the anterior capsule, and finally localized in the lens. All ILFBs were pointed and metallic objects and were successfully removed with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Anterior capsule violation was found in three eyes, but no posterior capsule rupture was found. The IOL was placed in a capsule bag in all the cases. The BCVA ranged from 20/200 to 20/25 preoperatively and improved to between 20/32 and 20/20 at the last follow-up visit. The IOLs were well-centered. Apart from posterior capsule opacity in four eyes, no other postoperative complications were found. Conclusions In patients with a pointed metallic ILFB and self-sealing corneal penetrating wounds (with or without cataracts), early diagnosis and removal of the metallic ILFB combined with lens removal and IOL implantation may avoid late complications and achieve good visual outcomes.
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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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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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Wong HM, Kam KW, Rapuano CJ, Young AL. A Systematic Review on Three Major Types of Scleral-Fixated Intraocular Lens Implantation. Asia Pac J Ophthalmol (Phila) 2021; 10:388-396. [PMID: 33481393 DOI: 10.1097/apo.0000000000000369] [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] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. DESIGN Systematic review. METHODS We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. RESULTS Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. CONCLUSIONS Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.
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Affiliation(s)
- Ho Ming Wong
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, US
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
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Tamburrelli C, Tamburrelli AC. Sutureless Scleral Fixated IOL: The "Catcher Pole" Technique. Clin Ophthalmol 2021; 15:121-128. [PMID: 33469258 PMCID: PMC7811465 DOI: 10.2147/opth.s288769] [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: 11/01/2020] [Accepted: 11/26/2020] [Indexed: 01/27/2023] Open
Abstract
Purpose To describe a new surgical technique for sutureless intrascleral intraocular lens (IOL) fixation with an adapted retinal scraper used as an instrument “the Catcher Pole” to retrieve the IOL haptic through a scleral tunnel. Setting Public Eye Hospital, Roma, Italy. Design Retrospective case series. Methods Twenty-one eyes from 19 patients who underwent sutureless intrascleral IOL fixation were studied. A standard three-piece posterior chamber IOL (PCIOL) was implanted in aphakia or rescued and fixated in cases of dislocated PCIOL. A 23 to 25 G retinal loop scraper (the “Catcher Pole“) was inserted through a 1.5 mm long tunneled sclerotomy performed on the horizontal meridian, to capture, hold and externalize the tip of the haptic of the IOL. A flange created with an handheld cautery on the externalized haptic tip prevents IOL slippage. The best-corrected visual acuity (BCVA), central corneal pachymetry (CCP), IOL tilt and complications were assessed. Results In twenty-one eyes of 19 patients, the mean preoperative BCVA was 0.61 logMAR units ±0.05 SD, and the mean postoperative BCVA improved significantly to 0.18 logMAR units at three months ±0.05 SD (P=0.002). The mean preoperative CCP was 610 µ ±17 SD and the mean postoperative CCP 623 µ ±16 SD, (P=0.73). In the subgroup that underwent IOL tilt evaluation, mean IOL tilt was 3.19±2.01. The postoperative complications included iris capture of the IOL in one eye (4,7%) and transient ocular hypertension in two eyes (9,4%). Conclusions The “Catcher Pole” sutureless intrascleral IOL fixation technique is easy to perform with reduced anterior chamber manipulations and achieves both anatomical and optical stability. ![]()
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Luo S, Yu J, Ding N, Chen Y, Wu Z. Efficacy of 25G vitrectomy combined with intrascleral intraocular lens implantation. Medicine (Baltimore) 2020; 99:e21173. [PMID: 32791691 PMCID: PMC7387027 DOI: 10.1097/md.0000000000021173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
We investigated the clinical efficacy and safety of 25-gauge (G) vitrectomy combined with intrascleral intraocular lens (IOL) implantation. A 25G vitrectomy combined with intrascleral IOL implantation was performed on 39 patients diagnosed with lens dislocation, IOL dislocation, or aphakia. Changes in visual acuity, intraocular pressure (IOP), number of corneal endothelial cells, location of IOL, anatomic success of IOL, recurrence rate of IOL dislocation, and complications were analyzed. One week postoperatively, the IOL was in the centered position in all patients (100%), and 1 month postoperatively, it was centered in 36 patients (92.3%). IOL haptics were exposed under the conjunctiva in one patient (2.6%). Reimplantation of IOL for IOL dislocation was required in two patients (5.1%). Three to six months postoperatively, the IOLs were in the optimum position in 36 patients (92.3%). There were significant differences between the average logarithm of minimal angle of resolution (logMAR) visual acuity at 1 week, 1 month, 3 months, and 6 months postoperatively and that before surgery (P < .05). The average IOP at 1 week, 1 month, 3 months, and 6 months postoperatively was significantly lower than the preoperative IOP (P < .05). A 25G vitrectomy combined with intrascleral IOL implantation is effective and safe for the treatment of eyes without capsular support.
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Donnadieu B, Comet A, Gascon P, Ramtohul P, Callet M, Denis D, Matonti F. Scleral fixated intraocular lens by a modified technique: Methods and results. J Fr Ophtalmol 2020; 43:312-318. [PMID: 32115270 DOI: 10.1016/j.jfo.2019.08.013] [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: 03/27/2019] [Revised: 08/02/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE A certain number of conditions can result in compromised anterior and/or posterior capsular integrity. Several surgical options have been employed for repositioning dislocated intraocular lenses in the absence of adequate capsular support. The purpose of this study is to assess the functional outcomes and complication profile of a modified surgical technique for replacing dislocated intraocular lenses. MATERIAL AND METHODS All patients who had undergone the modified surgical procedure for dislocated intraocular lenses between 2012 and 2017 were retrospectively reviewed for visual outcomes and complications. Patient demographic characteristics, pre- and postoperative visual acuity, surgical indications, refractive outcomes, intraocular pressure and postoperative complications were recorded and analysed at baseline and at six months, which was the conclusion of the study. We also present our modified surgical technique. RESULTS Sixty-eight eyes of sixty-eight patients (74% male) were included. Mean age at surgery was 58 years (range 4-89 years). Mean best-corrected visual acuity increased significantly from 0.80 (SD±0.2) LogMar to 0.40 (SD±0.1) LogMar (P<0.005). Median astigmatic error at the conclusion of follow-up remained stable. There were no intraoperative complications and a low postoperative complication rate (10.2%), mainly related to the surgical context. CONCLUSION Sutureless intrascleral fixation of dislocated intraocular lenses is an option in case of deficient capsular support. Visual outcomes and complication rates are comparable to other case series.
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Affiliation(s)
- B Donnadieu
- Assistance Publique-Hôpitaux de Marseille, centre hospitalier universitaire NORD, chemin des Bourrely, 13015 Marseille, France.
| | - A Comet
- Assistance Publique-Hôpitaux de Marseille, centre hospitalier universitaire NORD, chemin des Bourrely, 13015 Marseille, France
| | - P Gascon
- Assistance Publique-Hôpitaux de Marseille, centre hospitalier universitaire NORD, chemin des Bourrely, 13015 Marseille, France; Institut de neurosciences de la Timone, CNRS, Aix-Marseille Université, UMR 7289, Campus Santé Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - P Ramtohul
- Assistance Publique-Hôpitaux de Marseille, centre hospitalier universitaire NORD, chemin des Bourrely, 13015 Marseille, France
| | - M Callet
- Assistance Publique-Hôpitaux de Marseille, centre hospitalier universitaire NORD, chemin des Bourrely, 13015 Marseille, France
| | - D Denis
- Assistance Publique-Hôpitaux de Marseille, centre hospitalier universitaire NORD, chemin des Bourrely, 13015 Marseille, France
| | - F Matonti
- Institut de neurosciences de la Timone, CNRS, Aix-Marseille Université, UMR 7289, Campus Santé Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France; Centre Paradis-Monticelli, Marseille, France
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20
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Yang Y, Yao TT, Zhou YL, Wang YX, Wang ZY. A modified intrascleral intraocular lens fixation technique with fewer anterior segment manipulations: 27-gauge needle-guided procedure with built-in 8-0 absorbable sutures. BMC Ophthalmol 2019; 19:234. [PMID: 31752875 PMCID: PMC6873762 DOI: 10.1186/s12886-019-1239-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/05/2019] [Indexed: 12/28/2022] Open
Abstract
Background To report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsular support. Methods Eyes from 14 patients who underwent 27-gauge needle-guided intrascleral IOL fixation with built-in 8–0 absorbable sutures were studied. The 8–0 absorbable sutures were inserted into 27-gauge round needles and used to create sclerotomies at the 4 o’clock and 10 o’clock positions under the scleral flap. The sutures were used to tie knots at the end of each haptic and guide haptic externalization through the sclerotomy. After externalization, a sufficient flange was created at the end of each haptic and fixed under the scleral flaps. The best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), IOL tilt and decentration, previous surgery history, and complications were determined. Results Fourteen cases were analyzed. The majority of eyes exhibited an improvement in the BCVA after surgery. When comparing the last follow-up to preoperative visual acuity, the mean change in BCVA was + 26.32 letters (p = 0.011). Postoperative complications included postoperative hypotony in 3 eyes, ocular hypertension in 2 eyes. No cases of postoperative cystoid macular edema (CME), vitreous hemorrhage (VH), IOL dislocation, or endophthalmitis were observed. Conclusions The 27-gauge needle-guided intrascleral IOL fixation technique with built-in 8–0 absorbable sutures is easy to perform with fewer anterior chamber manipulations and achieves both anatomical and optical stability.
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Affiliation(s)
- Yuan Yang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Teng-Teng Yao
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Ya-Li Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yi-Xiao Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Zhao-Yang Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, No. 639 Zhizaoju Road, Shanghai, 200011, China.
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Bedda AM, ElGoweini HF, Abdelhadi AM, Elhady AM. Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation. Int J Ophthalmol 2019; 12:1283-1289. [PMID: 31456918 DOI: 10.18240/ijo.2019.08.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens (PCIOL) implantation in aphakic eyes with insufficient or no capsular support. METHODS A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure (IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy (UBM) was done for 10 cases to evaluate optic tilt. RESULTS The study evaluated 42 eyes of 42 patients. The follow-up period was 6mo. Improvement of best corrected visual acuity (BCVA) one line occurred in 10 cases (23.8%) and loss of one line in 3 cases (7.1%). Intraoperative complications included: haptic kink in 4 cases (9.5%), haptic breakage in 1 case (2.4%), haptic dislocation in 1 case (2.4%), haptic slippage in 3 cases (7.1%), IOL dislocation in 1 case (2.4%) and sclerotomy related bleeding in 1 case (2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases (7.1%), choroidal detachment in 1 case (2.4%), cystoid macular edema (CME) in 1 case (2.4%), optic capture in 1 case (2.4%), subconjunctival haptic in 2 cases (4.8%), ocular hypotony in 4 cases (9.5%) and ocular hypertension in 1 case (2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases (30%). CONCLUSION Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus-provided axial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6mo.
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Affiliation(s)
- Ahmed M Bedda
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Hesham F ElGoweini
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Ahmed M Abdelhadi
- Department of Ophthalmology, Alexandria University, Alexandria 11511, Egypt
| | - Amr M Elhady
- Department of Ophthalmology, the General Ophthalmology Hospital, Alexandria 21515, Egypt
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Comparative Analysis of the Safety and Functional Outcomes of Anterior versus Retropupillary Iris-Claw IOL Fixation. J Ophthalmol 2018; 2018:8463569. [PMID: 30524757 PMCID: PMC6247566 DOI: 10.1155/2018/8463569] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose To compare the functional and clinical outcomes of the iris-claw intraocular lens (IOL) placed on the anterior versus posterior surface of the iris. Patients and Methods A multicenter, retrospective study. Data on eyes that underwent anterior or retropupillary iris-claw IOL implantation because of inadequate capsular support secondary to complicated cataract surgery, trauma, and dislocated/opacified IOLs since January 2015 were analyzed. For study inclusion, evaluation results had to be available in the medical records both preoperatively and at 1 and 12 months after implantation. The following parameters were compared between the groups: best-corrected distance visual acuity (BCDVA), spherical and cylindrical refractive error, endothelial cell density (ECD), central macular thickness (CMT), and percentage and type of postoperative complications. Results In total, 60 eyes of 60 patients aged 73 ± 13 years were included: 28 eyes (47%) involved anterior, and 32 eyes (53%) retropupillary, iris-claw IOL fixations. Preoperatively, the groups were similar in all parameters except for a significantly higher proportion of retropupillary fixations in patients who had previously experienced a closed-globe trauma (p=0.03). The groups showed comparable improvements in BCDVA after surgery (final BCDVA: 0.34 ± 0.45 vs. 0.37 ± 0.50 logMAR in the anterior and retropupillary placement groups, respectively). During follow-up, no group difference was observed in refractive error or CMT. Both groups experienced similarly marked ECD loss and showed similar incidence of postoperative complications, with cystoid macular edema being the most common complication. Multivariable linear regression showed that BCDVA at 1 month was the best predictor of the final BCDVA. Conclusions Anterior chamber and posterior chamber iris-claw IOL fixations proved equally effective and safe for aphakic correction in eyes with inadequate capsular support.
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SILICONE MICROTUBE-ASSISTED SCLERAL FIXATION OF A POSTERIOR CHAMBER INTRAOCULAR LENS. Retina 2018; 38 Suppl 1:S146-S153. [PMID: 29561385 DOI: 10.1097/iae.0000000000002143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a novel technique for intrascleral fixation of a posterior chamber intraocular lens using a silicone microtube to manipulate the haptics into position. METHODS Intrascleral fixation was performed in six eyes and the results evaluated in this retrospective case series. A silicone microtube with a 0.2-mm external diameter was passed from a sclerocorneal incision through the chamber and a sclerotomy made using a 30-gauge needle. The tips of the intraocular lens haptics were connected to the silicone microtube outside the eye. After the intraocular lens was injected into the posterior chamber, the haptics were drawn through the scleral incision through their attachment to the silicone microtube. RESULTS The mean postoperative corrected visual acuity was 0.62 logarithm of the minimum angle of resolution (20/43) with a mean refraction error of -0.06 ± 0.4 diopter, which did not differ significantly (P = 0.53) from the expected value. The postoperative complications included transient ocular hypotension, vitreous hemorrhage, and choroidal detachment. CONCLUSION Our technique using a silicone microtube reduces the number of intraocular procedures compared with previous methods using forceps or needles for moving the intraocular lens haptics from the posterior chamber to the outside through sclerotomies.
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Li X, Ni S, Li S, Zheng Q, Wu J, Liang G, Xu W. Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis. Am J Ophthalmol 2018; 192:10-19. [PMID: 29750951 DOI: 10.1016/j.ajo.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). DESIGN Systematic review and network meta-analysis. METHODS The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. RESULTS A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. CONCLUSIONS Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.
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Affiliation(s)
- Xi Li
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Shuang Ni
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Shuyi Li
- Department of Ophthalmology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Qianyin Zheng
- Department of Ophthalmology, Taizhou Hospital, Taizhou, Zhejiang, China
| | - Jing Wu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Guanlu Liang
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Wen Xu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
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Benarous A, Drimbea A, Milazzo S. [Study of the results scleral-fixated intraocular lenses in the absence of capsular support]. J Fr Ophtalmol 2018; 41:1-13. [PMID: 29331294 DOI: 10.1016/j.jfo.2017.05.015] [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: 05/02/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the absence of sufficient capsular support, scleral fixation of the intraocular lens is an interesting alternative. The goal is to evaluate this implantation technique when traditional implantation is impossible. PATIENTS AND METHODS This is an observational, retrospective, monocentric study at the Amiens university medical center between August 2013 and March 2016. Patients all underwent scleral fixation of a three-piece implant without suturing of the haptics, after posterior vitrectomy. All patients requiring implantation in the absence of stable capsular support were included. Patients with adequate iris or capsular support were excluded from our study. RESULTS Eighteen patients were included, with an average age of 69.3±16.9 years. The surgical indications were: complicated surgery, trauma and endothelial decompensation. The preoperative mean corrected visual acuity was 1.2±0.4 LogMAR while the postoperative acuity was 0.7±0.5 LogMAR. The mean postoperative corneal astigmatism was 1.9±1.9 diopters. The main complications observed were ocular hypertension, macular edema, retinal detachment, iris incarceration and exteriorization of the haptic. DISCUSSION There are two alternatives when faced with lack of a sufficient capsular support: scleral fixation or iris fixation. Our technique is the only one achievable in the presence of iris atrophy. Furthermore, it induces less astigmatism and enables the repositioning of a three-piece implant dislocated into the vitreous. CONCLUSION Scleral fixation is a technique allowing both a satisfactory and a lasting functional result and is to be considered when faced with a lack of sufficient capsular support.
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Affiliation(s)
- A Benarous
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens-Picardie, chemin de Longpré, 80080 Amiens, France; Université de Picardie-Jules-Verne, 80080 Amiens, France.
| | - A Drimbea
- Institut ophtalmologique de Picardie, 80080 Amiens, France
| | - S Milazzo
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens-Picardie, chemin de Longpré, 80080 Amiens, France; Université de Picardie-Jules-Verne, 80080 Amiens, France; Centre européen n(o) 86 EVICR.net, chemin de Longpré, 80080 Amiens, France
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Abstract
The retropupillary implantation of an iris claw intraocular lens (IOL) is an uncomplicated and fast technique for rehabilitation of aphakic eyes without any capsular structures and is presented in a video in the online version of this article. A complete anterior pars plana vitrectomy as shown in our case or an extensive preceding anterior vitrectomy as well as an intact iris are prerequisites. Special instruments for the implantation and fixation of the IOL are available to optimize the operative procedure. In addition to a rapid operating time the advantages of a trained surgeon are low complications rates and fast rehabilitation. For eyes with a defective iris diaphragm, ischemic vitreoretinopathy and uveitis, other implantation techniques should be selected.
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Hung JH, Wang SH, Teng YT, Hsu SM. Motorized injector-assisted intrascleral intraocular lens fixation. Kaohsiung J Med Sci 2017; 33:137-143. [PMID: 28254116 DOI: 10.1016/j.kjms.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/18/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022] Open
Abstract
For eyes with deficient capsular support, intraocular lens (IOL) implantation has long been a technical challenge. Recently, intrascleral fixation of the haptics of a three-piece posterior chamber IOL has become a popular option. In this procedure, externalization of the leading haptic during IOL injection is a stressful step. We present a modified technique to improve the ease and safety of this step. Our modified technique involves IOL injection with a motorized injector with several important modifications described here. With these modifications, a surgeon can easily maintain the correct orientation of the IOL in a well-controlled manner during IOL injection. The records of 13 patients who underwent this technique were retrospectively evaluated. Corrected-distance visual acuity improved significantly after surgery (p<0.05). No postoperative retinal detachment, endophthalmitis, IOL decentration, or vitreous hemorrhage was noted during the follow-up period. In conclusion, the motorized injector-assisted intrascleral IOL fixation technique is a safe and effective alternative to the conventional procedure. This technique makes the process of leading haptic externalization easier and more controllable.
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Affiliation(s)
- Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Hao Wang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ti Teng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Helvaci S, Demirduzen S, Oksuz H. Iris-claw intraocular lens implantation: Anterior chamber versus retropupillary implantation. Indian J Ophthalmol 2016; 64:45-9. [PMID: 26953023 PMCID: PMC4821121 DOI: 10.4103/0301-4738.178139] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To compare the outcomes of anterior chamber and retropupillary implantation of iris-claw Artisan intraocular lenses (IOL). Design: Prospective, randomized, single-blinded study. Patients and Methods: Forty eyes of forty aphakic patients were enrolled. Patients were randomized into two groups. Each group includes twenty patients. Group 1 received anterior chamber Artisan IOL implantation. Group 2 received retropupillary Artisan IOL implantation. Preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and all complications were noted and compared at 6 months follow-up. Results: Each two groups obtained a significant improvement in CDVA (P < 0.05). Four patients in Group 1 and five patients in Group 2 had significant but nonpermanent increase at IOP values. There were one and two pupillary irregularity in Group 1 and Group 2, respectively. In one patient, a shallow and inferior located retinal detachment were encountered in anterior chamber group. Conclusions: The results were not significantly different between the two fixation techniques for iris-claw lens. The surgery procedure is dependent to surgeon experience and eye's conditions.
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Affiliation(s)
- Sezer Helvaci
- Department of Ophthalmology, Adana Numune Training and Research Hospital, Adana, Turkey
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Karadag R, Celik HU, Bayramlar H, Rapuano CJ. Sutureless Intrascleral Fixated Intraocular Lens Implantation. J Refract Surg 2016; 32:586-97. [DOI: 10.3928/1081597x-20160601-03] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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Sekundo W, Bertelmann T, Schulze S. [Retropupillary iris claw intraocular lens implantation technique for aphakia]. Ophthalmologe 2015; 111:315-9. [PMID: 24599663 DOI: 10.1007/s00347-013-2852-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA). MATERIAL AND METHODS A literature search and review of implantation techniques, patient selection, potential complications and management strategies. RESULTS This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications. CONCLUSIONS The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.
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Affiliation(s)
- W Sekundo
- Augenklinik, Philipps Universität Marburg sowie Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldinger Str., 35043, Marburg, Deutschland,
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Takayama K, Akimoto M, Taguchi H, Nakagawa S, Hiroi K. Transconjunctival sutureless intrascleral intraocular lens fixation using intrascleral tunnels guided with catheter and 30-gauge needles. Br J Ophthalmol 2015; 99:1457-9. [PMID: 25855502 DOI: 10.1136/bjophthalmol-2014-306579] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/22/2015] [Indexed: 11/04/2022]
Abstract
We invented a new method for fixing an intraocular lens (IOL) in the scleral tunnel without using a wide conjunctival incision. Modified bent catheter needles were used to penetrate the IOL haptics through the sclerotomy sites. The IOL haptics were inserted into 30-guage (G) scleral tunnels guided by double 30-G needles piercing the sclera. All procedures were performed through the conjunctiva without wide incision. The procedure does not require special forceps, trocars or fibrin glue, only catheter and 30-G needles. The aid of an assistant was not required to support the IOL haptic. The procedures were easily learnt based on our previous method. As with other transconjunctival sutureless surgeries, patients feel less discomfort and the conjunctiva can be conserved for future glaucoma surgery. Complications included two cases of vitreous haemorrhage (16.7%), and one case each of postoperative hypotony, and iris capture (8.3%). Astigmatism induced by intraocular aberration was the same as we reported previously. Our method for fixing the IOL into the scleral tunnel is innovative, less expensive, less invasive and quick. This modified method is a good alternative for fixing IOL haptics into the sclera.
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Akimoto M, Taguchi H, Takayama K, Nakagawa S, Hiroi K. Intrascleral fixation technique using catheter needles and 30-gauge ultrathin needles: Lock-and-lead technique. J Cataract Refract Surg 2015; 41:257-61. [DOI: 10.1016/j.jcrs.2014.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 08/08/2014] [Indexed: 11/25/2022]
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Bow-string technique for iris pupilloplasty and posterior iris-claw artisan intraocular lens implant in traumatic aphakia with associated iris defects. Retina 2014; 34:2306-10. [PMID: 25285811 DOI: 10.1097/iae.0000000000000357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Akimoto M, Taguchi H, Takahashi T. Using catheter needles to deliver an intraocular lens for intrascleral fixation. J Cataract Refract Surg 2014; 40:179-83. [PMID: 24461497 DOI: 10.1016/j.jcrs.2013.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/20/2013] [Accepted: 10/03/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED A new method for delivering intraocular lens (IOL) haptics through sclerotomies for intrascleral fixation using catheter needles was evaluated in pig eyes. A bent catheter needle was used to penetrate the surgical corneal wound from the presumed sclerotomy. Extraocularly, the leading haptic of the IOL was fixated between the external tube and the internal needle of the catheter needle. The fixation was strong enough to support the IOL and to extract the leading haptic through the sclerotomy site. The trailing haptic was fixated using another catheter needle extraocularly and was subsequently delivered through another sclerotomy site. Guiding with a needle was the only intraocular manipulation when delivering the trailing haptic and catheter needle through the sclerotomy. This new method is easy and safe and does not require special devices compared with other methods. Clinical evaluation in human eyes should be performed. FINANCIAL DISCLOSURE Dr. Akimoto is a consultant to Kowa Co. Ltd. A patent application on the modified catheter needle is planned. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Masayuki Akimoto
- From the Department of Ophthalmology, Osaka Red Cross Hospital, Osaka, Japan.
| | - Hogara Taguchi
- From the Department of Ophthalmology, Osaka Red Cross Hospital, Osaka, Japan
| | - Toshihide Takahashi
- From the Department of Ophthalmology, Osaka Red Cross Hospital, Osaka, Japan
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