Double-flanged polypropylene technique: 5-year results

Three-point flanged optic piercing intrascleral fixation of multifocal intraocular lenses

PURPOSE

To evaluate the feasibility of a three-point flanged optic piercing intrascleral fixation technique for replacing a dislocated multifocal intraocular lens (IOL).

DESIGN

Retrospective cross-sectional study.

METHODS

In total, 13 eyes from 13 patients with a dislocated single-piece C-loop or double C-loop diffractive multifocal IOL were enrolled to undergo dislocated multifocal IOL replacement through three-point flanged optic piercing 120 degrees apart intrascleral fixation using 7-0 polypropylene sutures at 2.5 mm posterior to the limbus. Preoperative and postoperative uncorrected distance visual acuity (UDVA), postoperative uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, residual refractive errors, and the amount of IOL decentration were evaluated.

RESULTS

There were six multifocal IOLs and seven multifocal toric IOLs. There was a notable improvement in visual acuity, with the mean UDVA improving from 0.79 ± 0.72 logMAR preoperatively to 0.06 ± 0.08 logMAR postoperatively (P = 0.004). The mean postoperative UIVA and UNVA were 0.04 ± 0.05 and 0.10 ± 0.12 logMAR, respectively. The mean residual refractive sphere, cylinder, and spherical equivalent were -0.04 ± 0.48 D, -0.29 ± 0.25 CD, and -0.18 ± 0.47 D, respectively. The mean residual cylinder was -0.25 ± 0.25 CD in eyes with multifocal toric IOL fixation. The mean amount of IOL decentration was 0.22 ± 0.05 mm.

CONCLUSION

The three-point flanged optic piercing intrascleral fixation technique for dislocated multifocal IOLs could provide good distance, intermediate, and near vision alongside excellent IOL centration.

The VaMa (Vatavuk and Marić) Artificial Intraocular Lens Capsule: A Novel Device and Method for Reversible Secondary Intraocular Lens Implantation in Patients with Aphakia Without Efficient Capsular Support

We describe a novel experimental device, the VaMa (Vatavuk and Marić) artificial intraocular lens (IOL) capsule, and a method that enables all IOL types to be implanted in the bag. We present the application of the device and the procedure in patients with aphakia and native capsule damage and without efficient capsular support. The VaMa device and the method facilitate IOL exchange due to refractive errors and, in the case of their invention, the implementation of superior IOLs in the future. The postoperative results after the implantation of the VaMa capsule along with IOLs in three patients are promising, with significant visual improvement and without adverse events 7 to 10 months postoperatively.

Comparison of flanged polypropylene scleral intraocular lens fixation with scleral sutured fixation

OBJECTIVE

To compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket.

METHODS

Retrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center.

RESULTS

A total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (-0.63 ± 2 and -2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29).

CONCLUSION

Comparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.

Reverse 4-Flanged Technique for Intrascleral Fixation of a Foldable Hydrophobic Intraocular Lens in the Absence of Capsular Support Through a 2.2-mm Corneal Incision

PURPOSE

The purpose of this study was to describe a modified technique for sutureless intrascleral intraocular lens fixation in patients without capsular support: the reverse 4-flanged technique.

METHODS

A 2.2-mm corneal incision was made for aphakic patients. The 6-0 polypropylene sutures were threaded through a 30-gauge needle outside the eye. An MDJ injector was employed to insert the intraocular lens into the eye. A suture-needle snare with 7-0 polypropylene was used to exteriorize the superior end of the sutures through the sclerotomy. The 6-0 polypropylene was heated with a cautery to create the flanges.

RESULTS

Nine eyes of nine patients underwent the reverse 4-flanged technique. The median follow-up time was 182 days (range 174-195). Best-corrected distance visual acuity improved from 20/400 [hand movement-20/33] to 20/120 [20/400-20/21]. No vitreous hemorrhage, retinal detachment, endophthalmitis, intraocular lens luxation, or flange exposure was recorded during the follow-up.

CONCLUSION

The reverse 4-flanged technique maintains the advantages of the original 4-flanged technique in terms of intraocular lens stability while reducing the incision size and surgical maneuvers performed inside the eye. This modification promises to be a reliable, safe, and relatively simple technique to correct aphakia in the absence of capsular support.

Clinical Outcomes of Pars Plana Vitrectomy and Polytetrafluoroethylene (Gore-Tex) Scleral Fixation of a Monofocal Aspheric Intraocular Lens (Akreos AO60)

Purpose: To evaluate the visual outcomes and complications with a polytetrafluoroethylene (Gore-Tex)-fixated intraocular lens (IOL) (Akreos AO60, Bausch + Lomb). Methods: Eyes with inadequate capsule support for in-the-bag IOL implantation had pars plana vitrectomy (PPV) and IOL placement at a single center. The main outcome measures were the postoperative visual acuity (VA) and complication rates. Results: During the study, 783 surgeries were performed. The mean visual acuity gain was 28.5 Early Treatment Diabetic Retinopathy Study letters (P < .01), with a mean time to best VA of 3.05 months. Statistical hypotony (intraocular pressure <6.5 mm Hg) was present in 214 cases (27.3%), and clinical features of hypotony were present in 46 cases. Five percent of the complications were directly related to the IOL. There were 3 cases of IOL opacification, 2 with silicone oil endotamponade and 1 with perfluoropropane endotamponade. Conclusions: PPV with Akreos IOL implantation was an effective technique for secondary IOL placement. Complications directly related to the IOL were uncommon.

Reverse pupillary block, in contemporary scleral intraocular lens procedures

BACKGROUND

To evaluate the frequency and anterior segment optical coherence tomography parameters of patients with scleral fixated intraocular lenses (IOL) and reverse pupillary block (RPB).

METHODS

Retrospective analysis at a tertiary care centre (Department for Ophthalmology and Optometry, Medical University of Vienna, Austria). We researched our records for patients who underwent scleral fixated IOL implantation from January 2018 till February 2023. Patients were included only if there was at least one adequate post-operative scan of anterior segment optical coherence tomography (AS-OCT) available. Initially, AS-OCT scans were assessed for IOL tilt and decentration employing a 3D scan and then later for anterior chamber angle (ACA), aqueous anterior chamber depth (AQD), pupil diameter and iris-IOL distance using the 2D scan at a 0° angle. Both an iris-IOL distance of 0 or less and an ACA of more than 70° were required to define an RPB.

RESULTS

A total of 110 patients met the inclusion criteria, 41 were treated using the Carlevale, 33 the four flanged, 24 the Yamane and 12 the Scharioth technique, respectively. RPB was found in 32 patients (29%). Twenty patients with RPB were treated using YAG peripheral iridotomy, mean ACA decreased from 91.91° ± 13.77 to 61.02° ± 8.52, (p < 0.001), mean AQD decreased from 4.67 mm ± 0.47 to 4.31 ± 0.36 mm (p < 0.001) and mean iris-IOL distance increased from -0.09 ± 0.04 to 0.33 ± 0.30 (p < 0.001).

CONCLUSIONS

RPB is found in a third of eyes who have undergone scleral fixated IOL implantation without iridectomy. YAG peripheral iridotomy is a potent option to treat RPB, and subsequently reduce the risk of iris chafing and secondary inflammation or glaucoma.

Comparison of outcomes between modified double-flanged sutureless scleral fixation and conventional sutured scleral fixation

This retrospective study aimed to compare the outcomes of modified double-flanged sutureless scleral fixation versus sutured scleral fixation. Medical records of 65 eyes from 65 patients who underwent double-flanged scleral fixation (flange group) or conventional scleral fixation (suture group) between 2021 and 2022 were reviewed. Visual and refractive outcomes, as well as postoperative complications, were compared 1, 2, and 6 months after surgery. We included 31 eyes in the flange group and 34 eyes in the suture group. At 6 months postoperatively, the flange group showed better uncorrected visual acuity (0.251 ± 0.328 vs. 0.418 ± 0.339 logMAR, P = 0.041) and a smaller myopic shift (- 0.74 ± 0.93 vs. - 1.33 ± 1.15 diopter, P = 0.007) compared to the suture group. The flange group did not experience any instances of iris capture, while the suture group had iris capture in 10 eyes (29.4%; P < 0.001). In the flange group, all intraocular lenses remained centered, whereas in the suture group, they were decentered in 8 eyes (23.5%; P = 0.005). The double-flanged technique not only prevented iris capture and decentration of the intraocular lens but also reduced myopic shift by enhancing the stability of the intraocular lens.

Flange depth for scleral pocket vs no pocket techniques for intrascleral intraocular lens fixation

PURPOSE

To compare flange depth for a modified scleral pocket (SP) vs no scleral pocket (NSP) technique (Yamane technique) for intrascleral intraocular lens (IOL) fixation.

SETTING

Instituto de Oftalmología Santa Fe, Santa Fe, Argentina.

DESIGN

Prospective, randomized, single-surgeon, observational study.

METHODS

Eyes with aphakia and no capsular support were included. They were divided into 2 groups: one was programmed for a double-needle flanged intrascleral IOL fixation as originally described by Shin Yamane with NSP and the second group had a modified SP technique. Flange depth was measured with anterior-segment optical coherence tomography (AS-OCT) at 1 month, 3 months, 6 months, and 12 months postoperatively, and the results were compared.

RESULTS

Each group comprised 18 eyes of 18 patients, giving a total of 36 flanges per group. The groups were comparable preoperatively. At 12 months, uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were not statistically different for both groups (P = .333; P = .448). Spherical equivalent (SEQ) was not significantly different between groups at 12 months postoperatively (P = .078). AS-OCT revealed a significantly deeper flange position for the SP group at 1 month, 3 months, 6 months, and 12 months postoperatively (P < .05).

CONCLUSIONS

When performing a double-needle intrascleral IOL fixation in aphakic eyes with no capsular support, a modified scleral pocket technique provides a significantly deeper flange position with no difference in CDVA or SEQ 12 months postoperatively.

LONG-TERM OUTCOMES OF SUTURELESS INTRASCLERAL INTRAOCULAR LENS FIXATION IN CHILDREN AND ADULTS: Single-Surgeon Case Series With and Without Haptic Flanging With Up to 11 Years of Follow-Up

PURPOSE

Report and compare long-term outcomes and complications of sutureless scleral tunnel (SST) and flanged haptic (FH) scleral-fixated intraocular lens, with spontaneous intraocular lens (IOL) dislocation as primary outcome measure.

METHODS

Retrospective single-surgeon case series of 95 SST and 458 FH eyes from 2011 to 2022 (553 total eyes). Demographics, surgical indications, ocular history, visual acuity, and complication rates were collected.

RESULTS

Reoperation-requiring spontaneous IOL dislocation rate was significantly different ( P = 0.0167) between FH (3.7%) and SST (10.5%). Mean follow-up was 3.31 ± 0.30 versus 1.58 ± 0.07 years for SST and FH, respectively. There was no significant difference between preoperative (20/305 vs. 20/300) or final postoperative (20/77 vs. 20/62) visual acuity. Other complications included any cystoid macular edema (20.0% vs. 25.3%), elevated intraocular pressure (16.8% vs. 9.6%), IOL tilt requiring reoperation (5.3 vs. 0%), haptic exposure (2.1% vs. 3.3%), and reverse pupillary block (4.2% vs. 1.1%).

CONCLUSION

Haptic flanging resulted in fewer eyes meeting the primary end point of IOL dislocation. We reported the longest-to-date follow-up of both nonflanged SST IOL fixation and our FH-modified Yamane technique. Our FH-modified Yamane technique represents a safe, durable, and potentially superior option for scleral-fixated intraocular lens.

Scleral flaps, pars plana vitrectomy and gore-tex sutured posterior chamber intraocular lens placement: a case series and review of literature

Introduction

Cataract surgery is one of the most common surgical procedures performed worldwide. Intraocular lens (IOL) implants are placed routinely in the capsular bag after successful cataract extraction. However, in the absence of adequate capsular support, IOL may be placed in the anterior chamber, fixated to the iris or fixated to the sclera. The purpose of this study is to report the clinical outcomes and safety profile of a trans-scleral sutured intraocular lens (IOL) technique using scleral flaps, vitrectomy, and Gore-Tex suture to place posterior chamber IOL.

Methods

Retrospective, interventional case series of eyes undergoing scleral fixation of an IOL using Gore-Tex suture with concurrent vitrectomy. Ocular examination with the logarithm of the minimum angle of resolution visual acuity (logMAR BCVA), tonometry, and slit-lamp biomicroscopy was performed on all patients at 1, 3, 6, and 12 months after the operation. All post-operative complications were recorded.

Results

Twenty-five eyes of 25 patients were included. Mean logMAR BCVA improved from 0.43 ± 0.36 (20\40 Snellen equivalent) preoperatively to 0.13 ± 0.18 (20\25 Snellen equivalent) postoperatively at 12 months (p<0.01). Indications included surgical aphakia (16) and dislocated lens implant (9). No cases of IOL opacification, suprachoroidal haemorrhage, post-operative endophthalmitis, IOL dislocation, Gore-Tex exposure, or retinal detachment were observed during the follow-up period.

Conclusion

Ab externo scleral fixation of IOLs with Gore-Tex suture plus scleral flap is well tolerated and associated with a very low rate of suture exposition. Moreover, our study confirms excellent refractive outcomes after surgery.