The simply modified intrascleral fixation using round flange (SMURF) technique for intrascleral intraocular lens fixation

AbstractWe describe a simply modified intrascleral fixation using round flange (SMURF) technique and report the clinical outcomes of the surgery. Forty-one eyes of 41 consecutive patients, with intraocular lens (IOL) dislocation, crystalline lens subluxation, and zonular weakness, who underwent surgery using the SMURF technique were included. The modified technique included the use of a conventional 27-gauge needle, a non-bent needle, oblique sclerotomy, direct threading of the leading haptic, and simple placement of the following haptic. IOLs were successfully placed and showed good centring. There were no cases of wound leakage or hypotony during the early postoperative period. Postoperative complications included vitreous haemorrhage in one eye (2.4%), intraocular pressure elevation in one eye (2.4%), and iris capture in six eyes (14.6%). There were no cases of postoperative retinal detachment, cystoid macular oedema, endophthalmitis, or IOL dislocation during the follow-up period. We proposed a few modifications in the intrascleral flanged technique for IOL fixation. The modified technique is a simple, easy, and minimally invasive procedure for successful IOL intrascleral fixation.

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Modified Flapless and Sutureless Technique of Scleral Fixation of Intraocular Lens in the Management of Dislocation of Crystalline Lens Following Closed Globe Injury

10.21203/rs.3.rs-230197/v1 ◽

2021 ◽

Author(s):

Naresh Babu Kannan ◽

Sagnik Sen ◽

Gauri Khare ◽

Obuli Ramachandran ◽

Kim Ramasamy

Keyword(s):

Intraocular Lens ◽

Demographic Data ◽

Crystalline Lens ◽

Modified Technique ◽

Prospective Longitudinal Study ◽

Scleral Fixation ◽

Sutureless Technique ◽

Pars Plana ◽

Prospective Longitudinal

Abstract Purpose To evaluate the outcomes of management of subluxation of lens following closed globe injury with a modified technique of scleral fixation of intraocular lens (SFIOL). Methods This prospective longitudinal study evaluated eyes with subluxation of crystalline lens which underwent combined pars plana vitrectomy (PPV), lensectomy (PPL) along with a sutureless and flapless technique of SFIOL implantation. We documented clinico-demographic data of all eyes at baseline and final anatomical and visual outcomes at 6 months after the surgery. Results We evaluated 113 eyes of 113 subjects with a mean age of 51.5 +- 15.7 years. 48.7% of eyes had a partial subluxation of lens from patellar fossa, while 51.3% of eyes had complete subluxation. After 6 months, the baseline visual acuity of 1.40 +- 0.66 logMAR (Snellen equivalent = 6/180) increased to 0.23 +- 0.27 (Snellen equivalent = 6/9) (p < 0.001). Eyes having VA < 6/36 reduced from 79.6% at baseline to 4.4% at final follow-up (p < 0.001). Eyes having VA > = 6/12 increased from 8.8–85.8% (p < 0.001). The proportion of eyes having raised intraocular pressure reduced from 20.4–1.8% at final follow-up (p < 0.001). The most common cause of subnormal visual gain was macular degeneration secondary to commotio retinae. Conclusion Subluxation of lens is a common entity faced by ophthalmologists across the world. Lensectomy with PPV and SFIOL is an effective method of refractive rehabilitation for subluxation eyes following closed globe injury. Visual prognosis may still depend upon the initial insult on the retina.

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Sutureless Intrascleral Haptic-Hook Lens Implantation Using 25-Gauge Trocars

Journal of Ophthalmology ◽

10.1155/2018/9250425 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Zhi-Xiang Hu ◽

HaiShuang Lin ◽

Lingying Ye ◽

Zhong Lin ◽

Tianyu Chen ◽

...

Keyword(s):

Vitreous Hemorrhage ◽

Crystalline Lens ◽

Intraocular Lenses ◽

Posterior Chamber ◽

Axial Stability ◽

Wound Leakage ◽

The Mean ◽

A New Technique ◽

Posterior Chamber Iol

Purpose. To report a new technique for sutureless intrascleral fixation of three-piece foldable intraocular lenses (IOLs) using 25-gauge trocars. Methods. We performed this technique on patients with insufficient posterior capsule support. Seventeen eyes from 15 patients with aphakia, dislocated IOL, or subluxated crystalline lens undergoing posterior chamber sutureless implantation of an IOL were studied. The haptics of the IOL were externalized using two 25-gauge forceps. The haptics were bended back (hook-like) into the vitreous cavity through a scleral incision made by using a 25-gauge trocar. And, IOL tilt was determined by using a slit lamp and UBM, and complications were recorded. Results. The IOLs were fixed with exact centration and axial stability. No wound leakage was reported even without the use of sutures. The mean best-corrected visual acuity (BCVA) was 0.82 logarithm of the minimum angle of resolution (logMAR) units preoperatively, and the mean BCVA was 0.44 logMAR units at the 6-month follow-up visit. No postoperative retinal detachment, endophthalmitis, IOL tilt or dislocation, or vitreous hemorrhage was noted. Conclusion. Sutureless intrascleral haptic-hook posterior chamber IOL implantation using 25-gauge trocars provides good IOL fixation with reliable wound closure without the use of sutures. This trial is registered with ChiCTR1800017436.

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Late within the Capsular Bag Intraocular Lens Dislocation (Ten – Year Experience)

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i2.1110 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Munir Amjad Baig ◽

Rabeeya Munir

Keyword(s):

Cataract Surgery ◽

Intraocular Lens ◽

Inclusion Criteria ◽

Lens Dislocation ◽

Mature Cataract ◽

Intraocular Lens Dislocation ◽

Plate Design ◽

Capsular Bag ◽

Iol Dislocation

Purpose: To find out the frequency and causes of within the bag intraocular lens dislocation. Study Design: Descriptive, retrospective study. Place and Duration of Study: Federal Government Services Hospital Islamabad, from 2008 to 2018. Methods: Records of all the patients who underwent uneventful phacoemulsification were studied. Patients with Pseudoexfoliation and glaucoma were excluded. Out-of-the bag IOL dislocations and early dislocations that occurred within first three months after the cataract surgery were also not included. Percentage of patients with dislocated lens within the capsular bag after three months or more was calculated and the cause of dislocation was found. Results were presented in percentages. Results: Three thousand patients underwent uneventful phacoemulsification. Two thousand nine hundred thirty two (2932) patients fulfilled the inclusion criteria while 68 patients did not return for follow up. Age ranged between 25 and 75 years. There were 1600 males and 1332 were females. One thousand seven hundred and sixty were right eyes and one thousand one hundred and seventy two were left eyes. Sixty one (2.08%) developed late IOL dislocations, 35 (57.3%) males and 26 (42.7%) females. Patients of age group 50 – 75 years had more IOL dislocations. Causes of dislocation included; advanced mature cataract 21.3%, 19.7% with postoperative trauma, uveitis 14.7%, Myopia 9.8%, Silicon plate design in 9.8%, eccentric capsulorhexis 8.1%, small capsulorhexis 6.5%, retinitis pigmentosa 3.2% and in 6.5% no cause was found. Conclusion: Advanced mature cataract and postoperative trauma were the commonest causes of IOL dislocation. Key Words: Cataract surgery, Phacoemulsification, Trauma, Capsulorhexis. Intra ocular lens dislocation.

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Possible Predisposing Factors for Late Intraocular Lens Dislocation After Routine Cataract Surgery

Medicina ◽

10.3390/medicina49050037 ◽

2013 ◽

Vol 49 (5) ◽

pp. 37 ◽

Cited By ~ 6

Author(s):

Lina Krėpštė ◽

Loreta Kuzmienė ◽

Arūnas Miliauskas ◽

Ingrida Janulevičienė

Keyword(s):

Cataract Surgery ◽

Intraocular Lens ◽

Odds Ratio ◽

University Hospital ◽

Intraocular Lens Dislocation ◽

Complicated Cataract ◽

Study Results ◽

The University ◽

Iol Dislocation

Objective. The aim of this study was to evaluate possible risk factors for late intraocular lens (IOL) dislocation after routine cataract surgery. Material and Methods. A retrospective analysis of medical records of all the patients who were treated in the university hospital between 2011 and 2012 for late IOL dislocation requiring surgical management after routine cataract surgery was performed. In total, 58 patients (58 eyes) were included into the study. Results. The mean time between cataract surgery and late IOL dislocation was 67.8 months (SD, 34.9). A negative correlation was found between the patient age at cataract surgery and the time between cataract surgery and IOL dislocation (r=–0.29; P=0.042). Late in-the-bag dislocation occurred in 87.9% and late out-of-the-bag dislocation in 12.1% of the cases. Pseudoexfoliation was present in 56.9% and 42.9% of the eyes with in-the-bag and out-of-the-bag dislocation, respectively. The odds ratio for IOL dislocation within 43 months after complicated cataract surgery was 24.0 (95% confidence interval [95% CI] 4.5–127.4; P<0.001) and for in-the-bag IOL dislocation 24.9 (95% CI, 4.2–148.0; P<0.001). The odds ratio for in-the-bag IOL dislocation within 43 months after advanced cataract surgery was 18.8 (95% CI, 2.0–180.0; P=0.011). Moreover, in-the-bag IOL dislocation occurred earlier in the patients with past uveitis (P=0.020) or zonule laxity (P=0.037). Conclusions. Complicated cataract surgery increased the risk of both late in-the-bag and out-ofthe- bag IOL dislocation, and advanced cataract increased the risk of late in-the-bag IOL dislocation. The time to in-the-bag IOL dislocation shortens with pseudoexfoliation syndrome, advanced age, or past uveitis. These factors must be taken into account while planning a postoperative follow-up.

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Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: Four- year follow-up

Journal of Cataract & Refractive Surgery ◽

10.1016/s0886-3350(02)01944-2 ◽

2003 ◽

Vol 29 (1) ◽

pp. 34-38 ◽

Cited By ~ 35

Author(s):

José L. Güell ◽

Andrés F. Rodriguez-Arenas ◽

Oscar Gris ◽

Francoise Malecaze ◽

Fortino Velasco

Keyword(s):

Intraocular Lens ◽

High Myopia ◽

Crystalline Lens

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Scleral pockets for an innovative technique of intrascleral fixation of intraocular lens

European Journal of Ophthalmology ◽

10.1177/1120672119866018 ◽

2019 ◽

Vol 30 (5) ◽

pp. 985-990 ◽

Cited By ~ 2

Author(s):

Maurizio Postorino ◽

Alessandro Meduri ◽

Leandro Inferrera ◽

Giuseppe Tumminello ◽

Miguel Rechichi ◽

...

Keyword(s):

Intraocular Lens ◽

Medical Records ◽

Posterior Chamber ◽

Modified Technique ◽

Scleral Fixation ◽

Innovative Technique ◽

Posterior Chamber Intraocular Lens ◽

The Mean ◽

23 Gauge

The aim of this article is to report the results of an innovative technique for a scleral fixation of a posterior chamber intraocular lens using our new modified technique. We retrospectively reviewed the medical records of 15 eyes of 15 patients who underwent sutureless intrascleral intraocular lens fixation using our modified technique. We used a 23-gauge knife to perform sclerotomy and create two parallel scleral pockets for the haptics. The mean follow-up period was 3 years (3 ± 1). No complications were detected during the follow-up period. The creation of two parallel scleral pockets, parallel to the limbus, greatly simplifies the introduction of intraocular lens haptics.

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Stability of Cachet Phakic Intraocular Lens Position During 6-Months Follow-Up

The Open Ophthalmology Journal ◽

10.2174/1874364101307010020 ◽

2013 ◽

Vol 7 (1) ◽

pp. 20-23 ◽

Cited By ~ 1

Author(s):

D Schiano Lomoriello ◽

M Lombardo ◽

L Gualdi ◽

L Iacobelli ◽

L Tranchina ◽

...

Keyword(s):

Anterior Chamber ◽

Intraocular Lens ◽

Minimum Distance ◽

Anterior Segment ◽

Crystalline Lens ◽

Optic Disk ◽

Anterior Surface ◽

Phakic Intraocular Lens ◽

High Position

Purpose: To evaluate the position stability of a phakic intraocular lens (Cachet pIOL; Alcon, Laboratories, Inc., Fort Worth, TX) in the anterior chamber (AC) during a 6-months follow-up. Methods: Thirty eyes of 16 subjects underwent a Cachet pIOL implantation for the correction of high myopia from -6.50 to -16.00 D with plano targeted refraction. The position stability of the Cachet pIOL was evaluated using an Anterior Segment-OCT (AS-OCT, Carl Zeiss AG, Oberkochen, Germany) at 1- and 6-months postoperatively. Three measurements have been taken into account: 1) the minimum distance between the anterior surface of the Cachet pIOL optic disk and the central corneal endothelium; 2) the minimum distance between the optic disk’s edges of the pIOL and the endothelium; 3) the minimum distance between the posterior surface of the pIOL optic disk and the anterior surface of the crystalline lens. The endothelial cell density (ECD) was also recorded. Results: No statistically significant changes of the Cachet pIOL position in the AC were found during follow-up. The average changes were ≤0.1 mm between 1- and 6-months postoperatively (P>0.05). At the end of follow-up, The mean ECD loss was 0.7 % (from 2794 ± 337 cell/mm2 to 2776 ± 388 cell/mm2; P>0.05). Conclusion: A high position stability of the Cachet pIOL in the anterior chamber was shown during a 6-months follow-up.

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A modified intrascleral intraocular lens fixation technique with fewer anterior segment manipulations: 27-gauge needle-guided procedure with built-in 8-0 absorbable sutures

10.21203/rs.2.11405/v1 ◽

2019 ◽

Author(s):

Yuan Yang ◽

Tengteng Yao ◽

Yali Zhou ◽

Yixiao Wang ◽

Zhaoyang Wang

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Anterior Segment ◽

Vitreous Hemorrhage ◽

Fixation Technique ◽

Absorbable Sutures ◽

Support Methods ◽

Iol Fixation ◽

Iol Dislocation

Abstract Background To report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsule 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 angled sclerotomies at the 4 o’clock and 10 o’clock positions under the scleral flap. The sutures were used to tie knots at the ends of the haptics and guide haptic externalization through sclerotomy. After externalization, a sufficient flange was created at the end of the haptics and fixed under the scleral flaps. The best corrected visual acuity (BCVA), previous surgery history, and complications were determined. Results Fourteen cases were analyzed. The majority of eyes exhibited an improvement in 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 postoperative cystoid macular edema, vitreous hemorrhage, IOL dislocation, or endophthalmitis was observed. Conclusions The 27-gauge needle-guided intrascleral IOL fixation technique with built-in 8-0 absorbable sutures is easy to manipulate with fewer anterior chamber manipulations and achieves both anatomical and optical stability.

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Outcomes and Complications of Sutured Scleral-Fixated Foldable Intraocular Lens Implantation: A Retrospective Study of 5-Year Follow-Up

Journal of Ophthalmology ◽

10.1155/2021/5525064 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ting Yu ◽

Mengting Yu ◽

Wenjie Wu ◽

Xinna Wu ◽

Suzhen Xiao ◽

...

Keyword(s):

Retrospective Study ◽

Intraocular Lens ◽

Tertiary Hospital ◽

Long Term Outcomes ◽

Iol Implantation ◽

Minimum Angle ◽

The Mean ◽

Iol Dislocation

Purpose. To evaluate long-term outcomes and complications of sutured scleral-fixated foldable intraocular lens (IOL) implantation. Design. Retrospective study. Methods. Patients who underwent sutured scleral-fixated foldable IOL implantation using 10-0 polypropylene suture were followed up for at least 5 years at one Chinese tertiary hospital and two primary hospitals. Results. 52 eyes among 48 patients (35 male and 13 female) were evaluated. The mean age (years) was 50.27 ± 20.08 (range: 6 to 81). The mean postoperative follow-up time (months) was 79.70 ± 18.84 (range: 60 to 121). The mean best-corrected visual acuity (BCVA) improved from 0.83 ± 0.69 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.50 ± 0.45 logMAR at the last follow-up visit. There was improved or unchanged BCVA in 44 eyes (84.62%) and reduced BCVA in 8 eyes (15.38%). Mild intraoperative intravitreal hemorrhage was observed in 3 eyes (5.77%). Early postoperative complications included transient elevated intraocular pressure (IOP) in 5 eyes (9.62%) and hypotony in 1 eye (1.92%). Secondary epimacular membrane occurred in 5 eyes (9.62%) and retinal detachment (RD; 3 years postsurgery), subconjunctival suture knot exposure (5 years postsurgery), and persistent elevated IOP (in a GRAVES patient) occurred in 1 eye (1.92%) each. No suture erosion or breakage nor IOL dislocation was observed. No visually threatening IOL tilt or decentration was reported in any patient. Conclusion. Sutured scleral-fixated foldable IOL implantation demonstrated satisfactory long-term outcomes and rare suture-related complications. This technology was safe and did not require complicated equipment and is of considerable interest in the setting of aphakia without adequate capsule support.

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A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

Journal of Ophthalmology ◽

10.1155/2020/6699103 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Yingying Hong ◽

Hongzhe Li ◽

Yang Sun ◽

Yinghong Ji

Keyword(s):

Retinitis Pigmentosa ◽

Intraocular Lens ◽

Retinal Pigment ◽

Retinal Pigment Epithelial Cells ◽

Posterior Capsular Opacification ◽

Complicated Cataract ◽

Retinal Degenerative Diseases ◽

Pigment Epithelial Cells ◽

Iol Dislocation

Retinitis pigmentosa (RP) is a set of inherited retinal degenerative diseases that affect photoreceptor and retinal pigment epithelial cells (RPEs), possibly associated with some ocular complications, including cataract. The complicated cataract formation is most likely the result of RP-related inflammation response, and the most common morphology category is posterior subcapsular cataract (PSC). Despite the absence of curative pharmacologic treatment, phacoemulsification with intraocular lens implantation to deal with opacification in the lens is preferred due to the considerable visual outcomes. However, the incidence of intraocular and postoperative complications is higher in RP patients than those without, including intraoperative phototoxic retinal damage, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased postoperative intraocular pressure (IOP), and intraocular lens (IOL) dislocation. Hence, it needs much attention to surgery progress and close follow-up. In this review, we discuss the current understanding of RP patients with complicated cataracts from morphology to potential pathogenesis to cataract surgical procedure and provide a concise description and the recommended management of related surgery complications to broaden the knowledge and lower the latent risks to yield better clinical outcomes.

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