scholarly journals Scleral Fixation Using a Hydrophilic Four-haptic Lens and Polytetrafluoroethylene Suture: A Phase I Clinical Trial

Author(s):  
Natacha Junqueira ◽  
Leandro Chaves ◽  
Omero Poli-Neto ◽  
Ingrid Scott ◽  
Rodrigo Jorge

Abstract Purpose: To assess the safety of scleral fixation using Akreos AO60 IOL and Gore-Tex suture. Methods: Prospective evaluation of 20 patients who underwent scleral fixation of Akreos AO60 with Gore-Tex. Patients presenting with aphakia or dislocated IOL without capsular support were enrolled in the study. Main outcome measures included visual acuity, endothelial cell density, and postoperative complications over 6 months of follow-up.Results: Mean ± SD uncorrected logMAR visual acuity improved from 1.92 ± 0.23 (20/1600 Snellen equivalent) preoperatively to 0.80 ± 0.56 (20/125) post-surgery (p < 0.001). Mean ± SD BCVA logMAR was 0.43 ± 0.23 preoperatively and 0.37 ± 0.24 (20/50) post-surgery (p = 0.312). Exposure of suture occurred in 8/20 (40%) eyes over the 6 months of follow-up. The mean ± SD endothelial cell density was 1,740.50 ± 522.92 cells/mm2 and 1,187.19 ± 493.00 cells/mm2 (p < 0.001) pre and postoperatively, respectively. Mean ± SD postoperative spherical equivalent was -1.12 ± 1.50D. Postoperative complications included hypotony in 15% of the patients, ocular hypertension and transient vitreous hemorrhage in 10%, and retinal detachment and transient lens opacification in 5%. Conclusion: Scleral fixation with an Akreos AO60 and Gore-Tex appears safe. However, caution must be taken regarding suture exposure, and scleral flaps can be a technique to reduce the risk of this complication. Phase II studies are needed.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Natacha B. Junqueira ◽  
Leandro J. Chaves ◽  
Omero Poli-Neto ◽  
Ingrid U. Scott ◽  
Rodrigo Jorge

AbstractTo assess the safety of scleral fixation using the Akreos AO60 intraocular lens (IOL) and Gore-Tex suture. Prospective evaluation of 20 patients who underwent scleral fixation of an Akreos AO60 with Gore-Tex. Patients presenting with aphakia or dislocated IOL without capsular support were enrolled in the study. Main outcome measures included visual acuity, endothelial cell density, and postoperative complications over 6 months of follow-up. Mean ± standard deviation (SD) uncorrected logMAR visual acuity improved from 1.92 ± 0.23 (20/1600 Snellen equivalent) preoperatively to 0.80 ± 0.56 (20/125) at 6 months postoperatively (p < 0.001). Mean ± SD best-corrected visual acuity (BCVA) logMAR was 0.43 ± 0.23 preoperatively and 0.37 ± 0.24 (20/50) at 3–6 months postoperatively (p = 0.312). The mean ± SD endothelial cell density was 1740.50 ± 522.92 cells/mm2 and 1187.19 ± 493.00 cells/mm2 (p < 0.001) pre and postoperatively, respectively. Mean ± SD postoperative spherical equivalent was − 1.12 ± 1.50D. Postoperative complications included exposure of suture in 40% of the patients, hypotony in 15%, ocular hypertension in 10%, transient vitreous hemorrhage in 10%, retinal detachment in 5%, and transient lens opacification in 5%. Scleral fixation with an Akreos AO60 and Gore-Tex appears generally safe. However, given the high incidence of suture erosion observed, the use of scleral flaps or rotating and burying the knots is recommended in order to reduce the risk of this complication.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tatsuya Jujo ◽  
Jiro Kogo ◽  
Hiroki Sasaki ◽  
Reio Sekine ◽  
Keiji Sato ◽  
...  

Abstract Backgrounds However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was − 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred. Conclusions IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.


2020 ◽  
Author(s):  
Tatsuya Jujo ◽  
Jiro Kogo ◽  
Hiroki Sasaki ◽  
Reio Sekine ◽  
Keiji Sato ◽  
...  

Abstract Backgrounds: However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was − 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred. Conclusions IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.


2020 ◽  
Vol 40 (12) ◽  
pp. 3403-3412
Author(s):  
Carlo Cagini ◽  
F. Riccitelli ◽  
M. Messina ◽  
F. Piccinelli ◽  
G. Torroni ◽  
...  

Abstract Purpose To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients. Methods In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400 µm, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100 µm thick and of 8.5 mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Results CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379–414 µm, mean 387.6 µm. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91 ± 1.9 and 50.75 ± 2.93, respectively, and at 12 months mean K1 was 47.36 ± 2.66 and mean K2 50.53 ± 3.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283 µm and 267 µm, respectively) and in some cases at 6 months. Reduced keratocyte density and stromal oedema were observed immediately up to 1 month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6 months. Conclusion This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.


2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Dilek Yaşa ◽  
Alper Ağca

Purpose. To compare refractive stability, central endothelial cell density (ECD), and complications between Verisyse (Abbott Medical Optics, Netherlands) and Veriflex (Abbott Medical Optics, Netherlands) phakic intraocular lenses (pIOL) over five years.Methods. We retrospectively reviewed the medical records of patients who underwent Verisyse or Veriflex pIOL implantation for surgical correction of myopia. Patients with a 5-year follow-up period were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent of manifest refraction (SE), and ECD were compared between the groups preoperatively and 1, 3, and 5 years postoperatively.Results. The study included 47 eyes in the Verisyse group and 50 eyes in the Veriflex group. There was no significant difference in mean SE, UDVA, CDVA, and ECD preoperatively or postoperatively. In both groups, there was a statistically significant myopic shift between 1-year and 5-year visits (−0.25 ± 0.30 D and −0.23 ± 0.48 D in the Verisyse and Veriflex groups, respectively). There was no significant difference between the groups in terms of efficacy and safety indexes at 5 years. ECD loss was highest during the first year (3.9% loss in the Verisyse group and 3.9% loss in the Veriflex group,p=0.670). At 5 years, the mean cumulative ECD losses in the Verisyse and Veriflex groups were 7.42% and 7.64%, respectively (p=0.709). Cataracts developed in 2.1% of the eyes in the Verisyse group and in 2.0% of those in the Veriflex group. No sight-threatening complications were observed.Conclusion. Verisyse and Veriflex pIOLs are highly effective for treating high myopia up to 5 years after surgery. Longitudinal studies with longer follow-up periods are necessary to determine the endothelial safety profile.


2020 ◽  
Author(s):  
Tatsuya Jujo ◽  
Jiro Kogo ◽  
Hiroki Sasaki ◽  
Reio Sekine ◽  
Keiji Sato ◽  
...  

Abstract Backgrounds: However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods: Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results: The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p<0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p=0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm 2 at 1 month (p=0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p>0.05). The mean prediction error of the target refraction was –0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.Conclusions: IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.


2020 ◽  
Author(s):  
Tatsuya Jujo ◽  
Jiro Kogo ◽  
Hiroki Sasaki ◽  
Reio Sekine ◽  
Keiji Sato ◽  
...  

Abstract Backgrounds: However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar.Methods: Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications.Results: The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p<0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p=0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p=0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p>0.05). The mean prediction error of the target refraction was –0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.Conclusions: IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.


Author(s):  
Julia M. Weller ◽  
Friedrich E. Kruse ◽  
Theofilos Tourtas

Abstract Purpose This study aimed to evaluate the clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK). Methods In this retrospective, consecutive, single-center case series the medical files of eyes which have received DMEK between 2009 and 2012 for the treatment of endothelial dysfunction was evaluated regarding follow-up time and clinical outcomes. Annual examinations of best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT) of 66 eyes which fulfilled the criterion of a minimum of 8 years follow-up were analyzed. Results BCVA improved from 0.55 ± 0.37 logMAR (n = 54) to 0.15 ± 0.11 (n = 47) in eyes without ocular comorbidities one year after DMEK (p < 0.001), and remained stable up to 10 years after DMEK. Mean ECD decreased to 744 ± 207 cells/mm2 (n = 39) after 9 years, and to 729 ± 167 cells/mm2 (n = 21) after 10 years, respectively. CCT decreased from 650 ± 67 μm before DMEK to 525 ± 40 μm (n = 56) after 1 year, increasing slowly to 563 ± 40 µm (n = 39) after 9 years, and to 570 ± 42 µm (n = 21) after 10 years, respectively. Graft failure occurred in 4 of 66 eyes after year 8. These 4 eyes required repeat DMEK after 101–127 months. Conclusion This study shows the long-term outcomes in a small subset of DMEK grafts. Visual acuity remained stable in spite of slowly increasing corneal thickness and diminishing endothelial cell density during the 10-year period after DMEK.


Author(s):  
Firman Setya Wardhana ◽  
Dhimas Hari Sakti ◽  
Supanji Supanji ◽  
Muhammad Bayu Sasongko ◽  
Tri Wahyu Widayanti ◽  
...  

Introduction: IOL-capsular bag complex dislocation is a rare but serious complication of phacoemulsification surgery. Technique to repair this complication should be based on various clinical parameters including quality of corneal endothelial cells and the type of dislocated IOL. Case Presentation: We present a case of a 67-year-old male with left eye spontaneous one-piece foldable IOL-capsular bag complex dislocation to vitreous cavity 4 years after phacoemulsification surgery.  Visual acuity of the left eye was 1/60, pupil was round with 3 mm diameter and IOP was 15 mmHg. Noncontact specular microscopy examination showed that the corneal endothelial cell density was 1100 cells/mm2. It was managed with 23-gauge posterior vitrectomy, IOL evacuation to anterior chamber, releasing the capsular bag and repositioning the IOL into posterior chamber by sutured scleral fixation. Result: Follow-up at 6thmonth, best corrected visual acuity of the left eye achieved 6/6, IOL at central position and the last corneal endothelial cell density was 1076 cells/mm2. Conclusions: Late spontaneous IOL-capsular bag complex dislocation with low corneal endothelial cell density can be safely managed with proper surgical technique. Vitrectomy and sutured scleral fixation of the previously dislocated IOL were effective in managing such case. Longer follow-up should be done to assure the stability of IOL position and the quality of corneal endothelial cells.


2020 ◽  
Author(s):  
Tatsuya Jujo ◽  
Jiro Kogo ◽  
Hiroki Sasaki ◽  
Reio Sekine ◽  
Keiji Sato ◽  
...  

Abstract Backgrounds: However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods: Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results: The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p<0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p=0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm 2 at 1 month (p=0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p>0.05). The mean prediction error of the target refraction was –0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred. Conclusions: IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.


Sign in / Sign up

Export Citation Format

Share Document