Clinical Outcomes and Intraocular Pressure Control After Scleral-glued Intraocular Lens Insertion in Eyes With Pseudoexfoliation

Background. To evaluate the outcome and complications of transscleral suture-fixated posterior chamber intraocular lens (PCIOL) implantation combined with Ahmed glaucoma valve (AGV) surgery in Asian eyes. Design. This was a retrospective study that included 22 eyes from 22 participants. The surgeries were performed at Singapore’s National University Hospital. Participants underwent an Ahmed tube surgery, together with transscleral suture-fixated posterior chamber intraocular lens. Main Outcome Measures. Complete success was defined as 6 ≤ intraocular pressure (IOP) ≤ 21 mmHg without medications at the last follow-up visit, with no reoperation required and no progression to no perception of light (NPL). Results. At the last follow-up, there was a significant reduction in mean IOP (22.4 ± 6.5 mmHg versus 13.9 ± 3.9 mmHg; p<0.001) and mean number of intraocular pressure-lowering medications (2.45 ± 1.30 versus 0.05 ± 0.21; p<0.001). There was no significant change in visual acuity [1.43 ± 1.21 (LogMAR) versus 1.09 ± 1.31 (p=0.204)]. Sixteen eyes (72.7%) achieved complete success. The 3 commonest complications were bullous keratopathy, choroidal detachment, and displacement of intraocular lens. Conclusion and Relevance. This technique showed good success for intraocular pressure control and vision preservation. Postoperative complications were relatively common although most were self-limiting. Patients at increased risk of trabeculectomy failure may be suitable for this procedure.

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Intraocular pressure control after trans-scleral intraocular lens fixation in glaucoma patients

European Journal of Ophthalmology ◽

10.1177/1120672119840913 ◽

2019 ◽

Vol 30 (4) ◽

pp. 685-689

Author(s):

Avner Belkin ◽

Adi Einan-Lifshitz ◽

David J Mathew ◽

Nir Sorkin ◽

Yvonne M Buys ◽

...

Keyword(s):

Intraocular Pressure ◽

Intraocular Lens ◽

Pressure Control ◽

Secondary Outcome ◽

Medium Term ◽

Laser Trabeculoplasty ◽

Pressure Lowering ◽

Pressure Spike ◽

Topical Medications

Background: Intraocular lens fixation surgery is associated with fluctuations in intraocular pressure. This may be significantly relevant in glaucoma patients. Objectives: To assess short- and medium-term intraocular pressure control after trans-scleral intraocular lens fixation surgery in glaucoma patients. Methods: The charts of all glaucoma patients who underwent trans-scleral intraocular lens fixation surgery with at least 6 months follow-up by a single surgeon between the years 2004 and 2017 were reviewed. Primary outcomes were intraocular pressure at 1 day and 6 months after surgery. Secondary outcome measures were hypotensive medication use and the need for further intraocular pressure lowering interventions. Results: Eleven eyes of 10 patients were included in the analysis. Mean follow-up post intraocular lens fixation surgery was 54.6 months. Mean intraocular pressure before, 6 months, and last follow-up after intraocular lens fixation surgery was 15.8 ± 5.3 mmHg (range 10.6–25.3), 13.5 ± 3.8 mmHg (range 8–21, p = 0.2), and 11.8 ± 5.6 (range 6–21, p = 0.09) on a mean of 2.3 ± 1.6, 2 ± 1.6 (p = 0.23), and 1.7 ± 1.5 (p = 0.08) hypotensive medications, respectively. A pressure spike was noted in 5 of the 11 eyes on the first post-operative day (mean spike 15.2 mmHg, range 6–23). Four of 11 eyes in the study (36%) needed additional interventions to control intraocular pressure by the 6-month point. One eye required the addition of two classes of topical medications, one eye required laser trabeculoplasty, and two eyes required trabeculectomy. Conclusion: Over a third of glaucomatous eyes required a change in the management of their disease in the early post-operative period. Close follow-up of patients undergoing trans-scleral intraocular lens fixation surgery is warranted.

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Minimally Invasive Surgery for Intraocular Lens Removal and Intrascleral Intraocular Lens Fixation with Trabeculectomy in a Patient with Dislocated Intraocular Lens and Elevated Intraocular Pressure

Case Reports in Ophthalmology ◽

10.1159/000511593 ◽

2021 ◽

pp. 538-542

Author(s):

Yuko Mano ◽

Kei Mizobuchi ◽

Tomoyuki Watanabe ◽

Akira Watanabe ◽

Tadashi Nakano

Keyword(s):

Intraocular Pressure ◽

Intraocular Lens ◽

Combined Therapy ◽

Swept Source ◽

Needle Technique ◽

Elevated Intraocular Pressure ◽

Anterior Segments ◽

The Right ◽

End Stage

A 88-year-old female who was being treated for end-stage pseudoexfoliation syndrome was referred to our hospital for treatment of dislocated intraocular lens (IOL) and the elevated intraocular pressure (IOP) and in the right eye (RE). At the first visit to our hospital, best-corrected visual acuity (BCVA) was 0.2 in the RE and 0.02 in the left eye (LE). IOP was 47 mm Hg in the RE and 21 mm Hg in the LE. Slit-lamp examination showed no abnormalities in anterior segments and dislocated IOL in the RE. Fundus photograph showed optic disc pallor in both eyes. We performed the combined therapy of flanged intrascleral IOL fixation with the double-needle technique and trabeculectomy. Throughout the follow-up period, BCVA slightly improved from 0.2 to 0.4 in the RE. The angle of tilt of the IOL was 6.6, 7.9, and 8.7° as measured by swept-source optical coherence tomography at 1, 4, and 6 months after the surgery, respectively. The IOP remained less than 10 mm Hg without having to administer any other glaucoma medications. Furthermore, any complications associated with the surgery were not confirmed.

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Pigmentary Glaucoma After Cataract Surgery with Single-Piece Hydrophobic Intraocular Lens Implanted into the Ciliary Sulcus: Case Report

Journal of Ophthalmology & Clinical Research ◽

10.33140/jocr.05.01.02 ◽

2021 ◽

Vol 5 (1) ◽

Keyword(s):

Intraocular Pressure ◽

Intraocular Lens ◽

Corneal Endothelium ◽

Surgical Intervention ◽

Posterior Segment ◽

The Other ◽

Pigmentary Glaucoma ◽

Single Piece ◽

History Of ◽

Capsular Bag

A 59 years old man presented with a history of phacoemulsification with an hydrophobic intraocular lens implant in his left eye 4 years ago. The biomicroscopy revealed pigments in the corneal endothelium (Krukenberg’s spindle), peripheral transillumination of the iris and intraocular pressure of 52 mmHg in the left eye. Gonioscopy revealed hyperpigmentation of the posterior trabeculate. Posterior segment examination and visual field revealed a cup/disc 0.9 with significant field damage in strategy 10-2. Biomicroscopic ultrasonography showed asymmetric implantation of the IOL loops in the left eye (one loop in the ciliary sulcus and the other in the capsular bag). He underwent antiglaucomatous treatment with adequate control of intraocular pressure, with no need for surgical intervention.

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