Posterior Chamber vs Anterior Chamber Intraocular Lenses After Vitreous Presentation in the Presence of Adequate Capsular Support

Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement of the IOL in the anterior chamber, fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the preoperative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.

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Scleral IOL fixation using limbal mini-pockets: description of the method and clinical cases

Ophthalmology journal ◽

10.17816/ov2019285-90 ◽

2019 ◽

Vol 12 (2) ◽

pp. 85-90

Author(s):

Vitaly V. Potemkin ◽

Elena V. Goltsman ◽

Dmitriy A. Yarovoy ◽

Syao Yuan Van

Keyword(s):

Intraocular Lenses ◽

New Method ◽

Posterior Chamber ◽

Actual Problem ◽

New Techniques ◽

Iol Fixation ◽

Capsular Support ◽

Clinical Cases

The search for new techniques of fixation intraocular lenses (IOL) cases of its dislocation or inadequate capsular support continues to be an actual problem. The most physiological is the IOL position in the posterior chamber. In this article, a new method for scleral IOL fixation using limbal mini-pockets proposed by the authors will be presented.

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Risk Factors for and Management of Anterior Chamber Intravitreal Dexamethasone Implant Migration

10.21203/rs.2.159/v3 ◽

2019 ◽

Author(s):

Daniel Röck ◽

Karl Ulrich Bartz-Schmidt ◽

Tobias Röck

Keyword(s):

Risk Factors ◽

Anterior Chamber ◽

Intraocular Lenses ◽

Posterior Chamber ◽

Dexamethasone Implant ◽

Implant Migration ◽

Intravitreal Dexamethasone Implant ◽

Increased Risk ◽

Intravitreal Dexamethasone ◽

Capsular Bag

Abstract Background This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). Methods A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher's exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. Results Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). Conclusions The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant with a 20-gauge alligator forceps over a 2.75-mm long clear corneal tunnel is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.

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Risk Factors for and Management of Anterior Chamber Intravitreal Dexamethasone Implant Migration

10.21203/rs.2.159/v2 ◽

2019 ◽

Author(s):

Daniel Röck ◽

Karl Ulrich Bartz-Schmidt ◽

Tobias Röck

Keyword(s):

Risk Factors ◽

Anterior Chamber ◽

Intraocular Lenses ◽

Posterior Chamber ◽

Dexamethasone Implant ◽

Implant Migration ◽

Intravitreal Dexamethasone Implant ◽

Increased Risk ◽

Intravitreal Dexamethasone ◽

Capsular Bag

Abstract Background This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). Methods A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher's exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. Results Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). Conclusions The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant with a 20-gauge alligator forceps over a 2.75-mm long clear corneal tunnel is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.

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