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Mahmoudzadeh R, Oh GJ, Patel N, Patel SN, Tien T, Xu D, Finklea BD, Gupta OP, Ayres BD, Khan MA. Pars plana vitrectomy and scleral-fixated intraocular lenses: comparison of Gore-Tex suture and flanged intrascleral haptic fixation techniques. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00138-8. [PMID: 38815959 DOI: 10.1016/j.jcjo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/08/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To compare clinical outcomes of combined pars plana vitrectomy (PPV) and secondary scleral fixation of an intraocular lens (IOL) using Gore-Tex suture versus flanged intrascleral haptic fixation (FIHF) using double needles. DESIGN Single-centre retrospective cohort series. PARTICIPANTS Eyes undergoing PPV with simultaneous scleral fixation of an IOL. METHOD Eyes that underwent fixation of a Bausch & Lomb Akreos AO60 or enVista MX60E IOL using Gore-Tex suture or a Tecnis ZA9003 or Zeiss CT LUCIA 602 IOL using FIHF were included. The primary outcome was change from baseline visual acuity to postoperative month 3. Secondary outcomes included deviation from refractive target aim and rates of postoperative complications. RESULTS Seventy-nine eyes of 72 patients were included. Mean (±SD) follow-up was 16 ± 10.5 months (range, 4.5-45.2 months). Fifty-three eyes (67.1%) underwent Gore-Tex suture fixation, and 26 eyes (32.9%) underwent FIHF. Across all eyes, mean visual acuity improved from 1.30 ± 0.74 logMAR (20/399 Snellen equivalent) preoperatively to 0.36 ± 0.36 logMAR (20/45 Snellen equivalent) at 3 months (p < 0.001). No difference in visual acuity at month 3 was noted between the 2 techniques (p = 0.34). Mean deviation from refractive target aim was not significantly different between the Gore-Tex and FIHF groups (+0.14 ± 1.33 D vs -0.16 ± 0.88 D; p = 0.45). Reoperation rates were similar between groups (2 of 53 eyes in the Gore-Tex group vs 3 of 26 eyes in the FIHF group; p = 0.32). CONCLUSION Combined PPV and scleral fixation of IOLs with Gore-Tex suture and FIHF resulted in similar improvements in visual acuity. No significant differences in refractive outcome and postoperative complication profiles were noted.
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Affiliation(s)
| | - Glenn J Oh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Neil Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Samir N Patel
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Thomas Tien
- Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - David Xu
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brenton D Finklea
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - Omesh P Gupta
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brandon D Ayres
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Cornea Service, Wills Eye Hospital, Philadelphia, PA
| | - M Ali Khan
- Retina Service, Wills Eye Hospital, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
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Oh R, Bae K, Yoon CK, Yoon CH, Lee EK, Park UC. Longer axial length is associated with better prediction for refractive error after sutureless flanged intrascleral fixation of intraocular lens. Eye (Lond) 2024; 38:988-993. [PMID: 37985727 DOI: 10.1038/s41433-023-02819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/21/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE To investigate refractive outcomes and associated factors after sutureless flanged intrascleral fixation of intraocular lens (SFIF-IOL). METHODS We retrospectively reviewed the medical records of consecutive patients who underwent SFIF-IOL at a single centre. The prediction error (PE; difference between the achieved and target refractive error) and absolute PE (APE) were analysed. Risk factors associated with refractive surprise, defined as APE > +0.5 D, were investigated using multivariable logistic regression analysis. RESULTS Ninety-one eyes were included. At the final follow-up, the mean PE and APE were +0.07 ± 0.88 and +0.68 ± 0.56 D, respectively. Refractive surprise was observed in 44 eyes (54.3%) and was associated with a shorter axial length (AL) [odds ratio, 0.825; 95% confidence interval, 0.688-0.991; P = 0.039]. APE showed a significant correlation with AL at the final visit (⍴ = -0.269, P = 0.010), and eyes with AL ≥ 26 mm had significantly lower APE than did those with AL of 24-26 mm (P = 0.021) and AL < 24 mm (P = 0.0059). CONCLUSIONS The refractive outcome after SFIF-IOL using manufacturer's A constant was favourable on average. Eyes with a longer AL were more likely to show a smaller deviation from the target refraction.
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Affiliation(s)
- Richul Oh
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Kunho Bae
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
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Kabata Y, Oki T, Nakano T. Comparison of Refractive Prediction Error by Axial Length in Flanged Intrascleral Intraocular Lens Fixation. Clin Ophthalmol 2024; 18:895-900. [PMID: 38529004 PMCID: PMC10962658 DOI: 10.2147/opth.s455178] [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: 12/15/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To evaluate the refractive prediction error in flanged intrascleral intraocular lens (IOL) fixation using the SRK/T formula and compare the axial length using a single IOL. Methods Seventy-six eyes from 70 patients (45 males and 25 females) were included in this study. The mean age at the time of surgery was 73.4 ±12.3 years. The patients underwent flanged IOL fixation using a PN6A (Kowa). All surgeries were performed by two surgeons (Y. K. and T. O.) between Jan 2020 and Dec 2022 at Jikei University Daisan Hospital. IOL power was calculated using the SRK/T formula with IOL Master 700 (Carl Zeiss) as the bag power. The recommended value of 119.0 was used for the A-constant. The actual refractive spherical equivalent was calculated and compared with preoperative predictions. Refractive prediction errors were defined as the deviation of the actual postoperative spherical equivalent refraction in diopters from the predicted preoperative spherical equivalent refraction. The patients were divided into three groups according to axial length: <22.0 mm (short eyes), 22.0-24.5 mm (medium eyes), and >24.5 mm (long eyes), and the refractive prediction errors and mean absolute errors were compared. Results The mean refractive prediction error was -0.20 ± 0.52D. The mean absolute error was 0.44 ± 0.33D. The mean refractive prediction errors were not significantly different between the 22.0-24.5 mm (medium eyes) and >24.5 mm (long eyes) groups. (P=0.06) The mean absolute errors were not significantly different between the two groups (P=0.10). Conclusion The SRK/T formula worked well regardless of whether the eyes were medium or long according to the axial length in the flanged intrascleral IOL fixation.
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Affiliation(s)
- Yoshiaki Kabata
- Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Tetsutaro Oki
- Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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Drummond SC, Feist JE, Crosson JN, Haider AA, Fuerst JS, Hughes DA, Feist RM. Scleral Fixated Secondary IOLs: An Outcomes Comparison Between the Yamane and Gore-Tex-Sutured Techniques. Ophthalmic Surg Lasers Imaging Retina 2024:1-7. [PMID: 38530983 DOI: 10.3928/23258160-20240226-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Among secondary intraocular lens (IOL) techniques, scleral fixated IOLs (SFIOLs) offer advantages in cases without capsular support. In this article, we compare outcomes between two types of Gore-Tex scleral sutured IOLs with the Yamane technique. PATIENTS AND METHODS This study was a retrospective chart review of patients who underwent SFIOL implantation. RESULTS Analysis revealed a statistically significant improvement in final postoperative visual acuity (VA) for sutured SFIOLs (P < 0.001, Envista (n = 29) 95% CI 0.47-1.04, Akreos (n = 23) 95% CI 0.32-0.81) with no statistical improvement in the Yamane group (P = 0.44, n = 15, 95% CI -0.33-0.71). Outcomes analysis revealed greater incidences of cystoid macular edema (CME) in the Yamane cohort (P < 0.05) and a higher rate of reoperations in the Akreos cohort (P < 0.02). All complications related to suture material (n = 4) and IOL decentration (n = 2) occurred in the sutured SFIOL group. CONCLUSIONS The sutureless Yamane technique offered fewer subsequent surgeries and suture-specific complications while revealing diminished VA improvement in long-term follow-up compared to the sutured SFIOLs. [Ophthalmic Surg Lasers Imaging Retina 2024;55:xx-xx.].
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Hung JH, Wang LA, Hsu SH, Hsu SM, Yamane S. Double-Needle Haptic Repositioning: A Troubleshooting Technique for Flanged Intraocular Lens Fixation. Retina 2023; 43:2064-2067. [PMID: 36161994 DOI: 10.1097/iae.0000000000003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Haptic repositioning during flanged intraocular lens (IOL) fixation can be difficult, and the haptic requiring repositioning may be at increased risk of excessive bending or breakage. This study aimed to report double-needle haptic repositioning technique outcomes for the aforementioned difficulty during flanged IOL fixation. METHODS This retrospective case series included seven eyes requiring haptic repositioning during flanged IOL fixation. The method features reinsertion of an already externalized haptic into the needle lumen followed by a needle-haptic complex internalized through the original tract into the eyeball. Thus, an adequate configuration for contralateral haptic can be achieved for insertion into the needle lumen to create a double-needle condition before both haptics are successfully externalized. RESULTS The median follow-up duration was 24 months (range, 4-24 months). Postoperatively, the IOL was well-centered, and corrected distance visual acuity improved from 20/320 (20/4,000-20/70) to 20/50 (20/250-20/20). No intraoperative or postoperative complications were noted. CONCLUSION The technique produced encouraging results in patients undergoing haptic repositioning during flanged IOL fixation. This technique could potentially reduce haptic overbending risk and facilitate haptic adjustment. Further studies are needed to confirm the feasibility of the technique.
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Affiliation(s)
- Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Ophthalmology, National Cheng Kung University Hospital, 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
| | - Shin Yamane
- College of Medicine, National Cheng Kung University, Tainan, Taiwan; and
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Ma CJ, Schallhorn CC, Stewart JM, Schallhorn JM. Modified intrascleral haptic fixation of the light adjustable lens in a case of spontaneous adult-onset bilateral lens subluxation. Am J Ophthalmol Case Rep 2023; 31:101864. [PMID: 37427094 PMCID: PMC10323170 DOI: 10.1016/j.ajoc.2023.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/02/2023] [Accepted: 05/20/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To describe the application of the light adjustable lens (LAL) using an intrascleral haptic fixation (ISHF) technique for the correction of aphakia and post-operative refractive error. Observation The LAL was placed using a modified trocar-based ISHF technique for visual rehabilitation following removal of bilateral cataracts in a patient with ectopia lentis. She ultimately obtained an excellent refractive outcome after adjustment with micro-monovision. Conclusions and Importance Secondary intraocular lens placement has a much higher risk of residual ametropia than traditional in-the-bag lens placement. The ISHF technique with the LAL presents a solution for eliminating postoperative refractive error in patients requiring scleral-fixated lenses.
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Affiliation(s)
- Chu Jian Ma
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Craig C. Schallhorn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie M. Schallhorn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
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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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8
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Cheng KKW, Tint NL, Sharp J, Alexander P. Surgical management of aphakia. J Cataract Refract Surg 2022; 48:1453-1461. [PMID: 36449676 DOI: 10.1097/j.jcrs.0000000000000954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022]
Abstract
Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.
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Affiliation(s)
- Kelvin K W Cheng
- From the Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom (Cheng, Tint); Cambridge University Hospitals, Cambridge, United Kingdom (Sharp, Alexander)
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9
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Yee C, Joye AS, Nanji AA, Chamberlain WD. Cyclodialysis Cleft After Secondary Intraocular Lens Placement With Yamane Technique. Cornea 2022; 41:1455-1457. [PMID: 36219215 PMCID: PMC9554359 DOI: 10.1097/ico.0000000000003059] [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: 01/17/2022] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report a rare case of cyclodialysis cleft after secondary intraocular lens (IOL) placement using the Yamane flanged intrascleral haptic fixation technique. METHODS This study is an observational case report. RESULTS A 74-year-old man with an ocular history of spontaneously dislocated IOL and subsequent anterior chamber IOL (ACIOL) placement presented with monocular diplopia secondary to ACIOL subluxation. The patient underwent explantation of the subluxed ACIOL and placement of a scleral-fixated IOL using the Yamane technique. The postoperative course was complicated by persistent hypotony, prompting ultrasound biomicroscopy, which revealed a cyclodialysis cleft adjacent to one of the externalized IOL haptics. The haptic was discovered in the involved supraciliary space while performing direct cyclopexy. The cyclodialysis cleft closed with return to physiologic intraocular pressure. CONCLUSIONS Cyclodialysis cleft formation is a possible complication of scleral IOL fixation and should be suspected in cases of prolonged postoperative hypotony. Extended longitudinal tracking of the needle and haptic through the supraciliary space may be one mechanism for cyclodialysis cleft formation in the Yamane technique.
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Affiliation(s)
- Claudine Yee
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
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10
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Tsatsos M, Vartsakis G, Athanasiadis I, Papavasileiou E, Yesilirmak N, Ziakas N. Intraocular lens implantation in the absence of capsular support: iris fixation. Eye (Lond) 2022; 36:1718-1720. [PMID: 35332288 PMCID: PMC9391370 DOI: 10.1038/s41433-022-02023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/02/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Tsatsos
- Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Vartsakis
- Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ioannis Athanasiadis
- Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | - Nikolaos Ziakas
- Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Complications of Secondary Scleral-fixated Intraocular Lens Placement. Int Ophthalmol Clin 2022; 62:93-102. [PMID: 35752888 DOI: 10.1097/iio.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Yuan A, Mustafi D, Banitt MR, Rezaei KA. Long-term outcomes of modified glued versus flanged intrascleral haptic fixation techniques for secondary intraocular lenses. Graefes Arch Clin Exp Ophthalmol 2022; 260:2887-2895. [PMID: 35389059 DOI: 10.1007/s00417-022-05647-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report the long-term refractive outcomes and complications of two scleral fixation techniques for secondary intraocular lenses (IOL). METHODS Consecutive patients who underwent secondary IOL insertion at a tertiary care academic hospital using either modified glued ("glued") or flanged intrascleral haptic fixation (FISHF) techniques with over 12 months of follow-up were retrospectively reviewed. Pre- and postoperative corrected distance visual acuity (CDVA), postoperative complications, and refractive surprises were reported. RESULTS Thirty-eight patients underwent "glued" fixation and 22 underwent FISHF, with mean follow-up times of 3.1 ± 0.5 and 2.0 ± 1.2 years, respectively. Aphakia secondary to trauma was the main surgical indication. MA50BM or MA60AC IOLs (Alcon Laboratories Inc., Fort Worth, TX) were implanted in 92% of "glued" patients, while CT Lucia 602 IOLs (Carl Zeiss Meditec Inc., Dublin, CA) were used in 96% of FISHF patients. Postoperative spherical equivalent significantly improved compared to preoperative values (p < 0.001). No significant difference in CDVA was seen between the two techniques. FISHF resulted in mean hyperopic surprises of + 0.81D and + 0.69D using the Holladay 2 and Barrett Universal II formulae, respectively, which was significantly greater than the "glued" patients. A higher rate of IOL dislocation was seen in the "glued" cohort (13%) compared to FISHF (0%). CONCLUSIONS Retrospective long-term outcomes of patients with complex ocular comorbidities undergoing a modified "glued" technique demonstrated a higher rate of IOL dislocation but more predictable refractive outcomes compared to the FISHF technique. The FISHF technique resulted in a significant hyperopic shift using fourth-generation IOL calculators.
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Affiliation(s)
- Amy Yuan
- Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA
| | - Debarshi Mustafi
- Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA
| | | | - Kasra A Rezaei
- Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA.
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13
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Fan KC, Patel NA, Al-Khersan H, Townsend JH. Outcomes of Flanged Intrascleral Haptic Fixation with CT Lucia Three-Piece Intraocular Lens. Ophthalmic Surg Lasers Imaging Retina 2021; 52:658-662. [PMID: 34908480 DOI: 10.3928/23258160-20211127-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the clinical outcomes of the flanged intrascleral haptic fixation technique (FIHFT) with the Zeiss CT Lucia 602 three-piece intraocular lens (IOL). PATIENTS AND METHODS This was a retrospective case series of patients who received FIHFT secondary implantation of the Zeiss CT Lucia 602 IOL from January 2018 to August 2020. Clinical and refractive outcomes were assessed including best-corrected visual acuity (BCVA), refractive prediction error, and complications. RESULTS Of the 22 patients in the series, 19 were included in the study. Mean vision improved from logarithm of the minimum angle of resolution (log-MAR) 1.14 to 0.54 (P = .03). BCVA of those without preoperative trauma improved from logMAR 0.68 to logMAR 0.25 (P = .02). Refractive spherical equivalent improved from 2.46 diopters (D) to 0.50 D (P = .07), but astigmatism increased from 1.09 D to 1.31 D (P = .67). CONCLUSIONS FIHFT with the Zeiss CT Lucia 602 three-piece lens is a safe and effective option for secondary IOL placement. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:658-662.].
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Shahid SM, Flores-Sánchez BC, Chan EW, Anguita R, Ahmed SN, Wickham L, Charteris DG. Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments. Eye (Lond) 2021; 35:2930-2961. [PMID: 34117388 PMCID: PMC8526814 DOI: 10.1038/s41433-021-01571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/08/2022] Open
Abstract
Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.
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Affiliation(s)
- S M Shahid
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK.
| | | | - E W Chan
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - R Anguita
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - S N Ahmed
- Ophthalmology Department, Northampton General Hospital, Cliftonville, Northampton, UK
| | - L Wickham
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
| | - D G Charteris
- Vitreoretinal Service, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
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15
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Evaluation of anterior segment structures with Scheimpflug camera in patients undergoing sutureless scleral fixation by modified Yamane technique. Int Ophthalmol 2021; 42:645-651. [PMID: 34719757 DOI: 10.1007/s10792-021-02107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate anterior segment parameters in patients undergoing sutureless scleral fixation intraocular lens implantation with the modified Yamane technique (SSF-IOL-MY) by using Scheimpflug camera system. METHODS Each group of 25 patients was included for aphakia undergoing SSF-IOL-MY and for senile cataract undergoing uneventful phacoemulsification and intraocular lens implantation (Phaco+IOL). Anterior chamber depth (ACD), iridocorneal angle (ICA), anterior chamber volume (ACV) and keratometric values were evaluated by Scheimpflug camera (Sirius, CSO, Italy) system. RESULTS It was seen that the ACD, ICA and ACV display wider structures in patients with SSF-IOL-MY group compared to Phaco+IOL group. However, the ACD (p = 0.828) and ICA (p = 0.219) have not a statistically significant difference, while ACV (p = 0.007) has a statistically significant difference. In terms of keratometric values of the patients, there was no statistically difference in K1, K2 and Kmax values (p = 0.348, p = 0.106, p =0.269, respectively). Although there was no statistically significant difference between the groups in terms of anterior corneal astigmatism, posterior corneal astigmatism was statistically higher in the Phaco+IOL group (p = 0.192, p = 0.031, respectively). CONCLUSION SSF-IOL-MY surgery affects anterior segment parameters similar to the Phaco+IOL method, which is the gold standard in cataract surgery. In this surgery, it was approached to the gold standard method in terms of IOL position with the ACD, ACV and ICA values and the results of the corneal incision with the keratometric values.
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Abstract
PURPOSE OF REVIEW To review variations of flanged intraocular lens fixation (Yamane technique) and their outcomes. RECENT FINDINGS Sutureless intrascleral IOL fixation has become popular, and many techniques have been reported. Among them, the Yamane technique has been widely used in recent years, and there are many variations. However, there are no reports that systematically compare them. SUMMARY There are variations of the Yamane technique, such as those used to create a scleral tunnel or to dock needles and haptics. Although few reports have directly compared each technique, small scleral wounds appear to be beneficial for long-term stability of the IOL. A method of fixing a capsule tension segment or iris using a flange has also been reported, demonstrating the diverse range of uses of the flange.
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Randerson EL, Bogaard JD, Koenig LR, Hwang ES, Warren CC, Koenig SB. Clinical Outcomes and Lens Constant Optimization of the Zeiss CT Lucia 602 Lens Using a Modified Yamane Technique. Clin Ophthalmol 2020; 14:3903-3912. [PMID: 33235431 PMCID: PMC7680091 DOI: 10.2147/opth.s281505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the clinical and refractive outcomes of a modified Yamane technique for scleral fixation of the CT Lucia 602 lens. Design Retrospective case series. Patients One hundred twenty-one eyes with dislocated posterior chamber lens implants, surgical aphakia, subluxed crystalline lenses, capsular tear, anterior chamber, or iris sutured posterior chamber lens intolerance were included. Methods Secondary implantation of the Zeiss CT Lucia 602 lens was performed by a single surgeon using a modified Yamane technique employing a single needle, rather than the double-needle approach. One hundred twelve eyes underwent simultaneous 3 port pars plana vitrectomy and 9 eyes had previously undergone posterior vitrectomy surgery. Exclusion criteria were age <18, simultaneous glaucoma or corneal procedures, staged corneal transplantation, and follow-up <30 days. Main Outcome Measures A paired t-test was used to compare pre- and post-operative corrected distance visual acuity (CDVA), the mean predictive error, and the mean absolute predictive error between the manufacturer’s and optimized constants for Hoffer Q, Holladay I, and SRK/T. Complication rates were reported. Results One hundred twenty-one consecutive eyes with a mean follow-up of 237 days were included. The pre-operative CDVA was 0.871 ± 0.785 logMAR (mean ± standard deviation, Snellen equivalent 20/149), which improved to 0.401 ± 0.608 (Snellen equivalent 20/50) post-operatively. In 109 eyes with reliable postoperative refractions, the mean predictive refractive error (D) ± std was +0.74 ± 1.37 for Hoffer Q, +0.66 ± 1.41 for Holladay 1, and +0.47 ± 1.49 for SRK/T (p<0.05). Refractive outcome analysis yielded a mean optimized personalized anterior chamber depth (pACD) of 5.69, Surgeon Factor of 1.79, and A constant of 118.56. Vision-limiting complications occurred in 11 eyes (9.1%). Conclusion Scleral fixation of the CT Lucia 602 lens using a single-needle modification of the Yamane technique resulted in very good visual acuity, predictable postoperative refractive errors, but some vision-limiting complications in this heterogeneous group of eyes with significant comorbidities.
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Affiliation(s)
- Edward L Randerson
- Department of Ophthalmology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph D Bogaard
- Department of Ophthalmology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Eileen S Hwang
- Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Clinton C Warren
- Department of Ophthalmology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven B Koenig
- Department of Ophthalmology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
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