Scleral Tunnel Fixated Intraocular Lens in Complicated  Cataract: A Case Series

When capsular support is inadequate in complicated cataract, scleral fixated IOL (SFIOL) has its advantage whereby it is nearer to physiological nodal point when compared to other types of IOL implantation. Scleral tunnel fixated intraocular lens (STFIOL) technique is gaining popularity due to its simplicity and ease of placement compared to sutured IOL. We report our experience with eight cases of STFIOL implantation from September 2016 to May 2018 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All patients had improvement of vision except one case who had unchanged vision. Mean post-operative BCVA was logMAR 0.57±1.13 (which is almost equivalent to 6/21) and improved to logMAR 0.37±0.43 (which is almost equivalent to 6/12) excluding one patient with chronic RRD with band keratopathy. Post-op complications include raised intraocular pressure, cystoid macular oedema, hyphaema, and wound leak. However, all complications were not severe and responded to topical eyedrops. In conclusion, STFIOL insertion technique is safe and works well to restore vision in majority of patients operated with this technique.

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Safety and efficacy of glued intraocular lens implantation in eyes with inadequate capsular support

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201335 ◽

2020 ◽

Vol 8 (4) ◽

pp. 1419

Author(s):

Payal P. Gonde ◽

Sagar Aghadate

Keyword(s):

Fibrin Glue ◽

Intraocular Lens ◽

Case Series ◽

Implantation Technique ◽

Posterior Chamber ◽

P Value ◽

Iol Implantation ◽

Significant Difference ◽

Feasible Option ◽

Capsular Support

Background: Aim of the study was to analyze the postoperative visual outcomes, complication rate of fibrin glue-assisted, suture-less posterior chamber (PC) intraocular lens (IOL) implantation technique in eyes with inadequate capsule support at a tertiary eye care hospital.Methods: This is a retrospective, nonrandomized case series. This study analyzes 50 eyes which underwent PC-IOL implantation by fibrin glue-assisted, suture-less technique. All patients who had IOL implants by the fibrin glue-assisted PC-IOL technique from 2017 to 2019 were included in the study. Intra- and post-operative complications were analyzed. The postoperative best corrected visual acuity (BCVA) was evaluated and recorded at the end of 6 months.Results: Mean age of distribution are 42.94 years in glued IOL implantation. Among 50 cases 30 are males and 20 are females. There is significant difference in BCVA between preoperatively and postoperatively, p value for pre-operative to post-operative vision in glued intraocular lens group is <0.0001 i.e. there is definite improvement in vision in glued intraocular group. BCVA ≥6/24 was 18 (48%) in Glued IOL subjects.Conclusions: Glued IOL implantation is a feasible option in rehabilitating patients with aphakia without adequate capsular support.

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Intraocular lens dislocation: a novel in-situ scleral refixation technique using a 25 Gauge trocar in the anterior chamber

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2018-000174 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000174

Author(s):

Fabrizio Giansanti ◽

Ruggero Tartaro ◽

Tomaso Caporossi ◽

Vittoria Murro ◽

Alfonso Savastano ◽

...

Keyword(s):

Anterior Chamber ◽

Intraocular Lens ◽

Case Series ◽

Cystoid Macular Oedema ◽

Closed Chamber ◽

Intraocular Lens Dislocation ◽

Case Series Study ◽

Single Piece ◽

Pars Plana ◽

Corneal Decompensation

ObjectiveIntraocular lens (IOL) repositioning using a closed-eye approach could be carried out in some selected cases. Our study focuses on the efficacy and safety of a IOL closed-eye repositioning technique using scleral suture, which is performed using a trocar as an intrastromal limbal guide.Methods and analysisThirty-one eyes of 31 patients with late IOL dislocation operated on between January 2015 and May 2017 were included in this retrospective non-comparative consecutive case series study. The patients had a single-piece in-the-bag dislocation or a 3-pieces in-the-bag or out-of-the-bag dislocation. The patients underwent an anterior vitrectomy and a scleral refixation in a closed chamber using a 10/0 polypropylene suture passed through a 25 Gauge trocar inserted in the anterior chamber.ResultsThe mean follow-up time was 19.54 months. Average preoperative best-corrected visual acuity (BCVA) was 0.73 LogMar (±0.21 SD); while average postoperative BCVA was 0.27 LogMar (±0.23 SD). Fifteen patients underwent anterior pars plana vitrectomy (PPV) while 16 patients did not; moreover, two patients underwent PPV. Six patients had an increase of postoperative intraocular pressure, two patients had postoperative decentration, two patients had postoperative cystoid macular oedema, none of the patients had major complications such as retinal detachment, choroidal detachment, malignant glaucoma, irreversible corneal decompensation and endophthalmitis.ConclusionWe can affirm that our technique may be safe and useful in the case of 3-piece in-the bag or out-of the bag dislocated IOLs and also in the case of in-the-bag single-piece dislocated IOLs.

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Intraocular lens (IOL) implantation in the absence of capsular support

Journal of Cataract & Refractive Surgery ◽

10.1097/j.jcrs.0000000000000529 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Matteo Forlini ◽

Raman Bedi

Keyword(s):

Intraocular Lens ◽

Iol Implantation ◽

Capsular Support

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Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

10.21203/rs.3.rs-37812/v3 ◽

2020 ◽

Author(s):

Takahiko Hayashi ◽

Yasutsugu Ida ◽

Toshiki Shimizu ◽

Tsubasa Kuroki ◽

Yuji Kobashigawa ◽

...

Keyword(s):

Graft Survival ◽

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Penetrating Keratoplasty ◽

Case Series ◽

Glaucoma Surgery ◽

Bullous Keratopathy ◽

Spherical Equivalent ◽

Iol Implantation ◽

Pars Plana

Abstract Background The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes.Methods In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. Results This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively.Conclusion The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.

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STUDY OF VISUAL OUTCOME IN PATIENTS AFTER AC-IOL (ANTERIOR CHAMBER INTRA-OCULAR LENS) IMPLANTATION DURING CATARACT SURGERY

10.36106/gjra/3405219 ◽

2021 ◽

pp. 17-19

Author(s):

Shilpa Bhatt ◽

Mittal Kuchhadiya ◽

Chirag D. Odedara ◽

Vimal J Vyas ◽

Mariam Mansuri ◽

...

Keyword(s):

Cataract Surgery ◽

Anterior Chamber ◽

Intraocular Lens ◽

Visual Outcome ◽

Cystoid Macular Oedema ◽

Consecutive Series ◽

Ocular Lens ◽

Co Morbidity ◽

Lens Implantation ◽

Capsular Support

Background: Following posterior capsular rupture (PCR) and vitreous loss during cataract surgery, sometimes there is inadequate support for implanting a conventional intra-ocular lens (IOL) in the capsular bag. Flexible openloop anterior chamber intraocular lens, trans-sclerally sutured posterior chamber intraocular lens and iris-claw lenses are the most acceptable alternatives in such a scenario. Objective: To review our experience with primary anterior chamber intraocular lens implantation at a District Hospital in Rajkot. Methods: Analysis of medical records of a consecutive series of primary anterior chamber intraocular lens implantations carried out at the G.T. Sheth Eye Hospital at Rajkot, from September 2011 to April 2013. Eyes with complicated or traumatic cataracts, ocular co-morbidity and cases of combined surgery were excluded from the analysis of visual outcome. Results: There were 70 cases of primary anterior chamber intraocular lens implantations during the study period. Posterior capsule rupture and resultant inadequate capsular support was the commonest indication for implanting the anterior chamber intraocular lens. Postoperatively 82.85% had a best corrected visual acuity of 6/12 or better. The commonest postoperative complications were cystoid macular oedema, recurrent iritis and persistent elevated intra-ocular pressure (IOP). Conclusion: Our results indicate a satisfactory visual outcome with primary implantation of anterior chamber intraocular lenses. Caution should be exercised when implanting an anterior chamber intraocular lens following complicated cataract surgery, particularly in the absence of appropriate capsular support.

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Cystoid macular oedema and iris-fixated intraocular lens treated with intraocular lens exchange: A case series and review

Journal of International Medical Research ◽

10.1177/0300060518799004 ◽

2018 ◽

Vol 47 (1) ◽

pp. 188-195 ◽

Cited By ~ 2

Author(s):

Horace F. Massa ◽

Iona Gobej ◽

Paul Jacquier ◽

Christian Jonescu-Cuypers ◽

Olivier Le Quoy

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Macular Oedema ◽

Case Reports ◽

Case Series ◽

Cell Loss ◽

Cystoid Macular Oedema ◽

Posterior Fixation ◽

Ocular Coherence Tomography ◽

Iol Exchange

This series of case reports describes six eyes from five patients that underwent intraocular lens (IOL) exchange with scleral-fixated IOLs for cystoid macular oedema associated with iris-fixated IOLs between 2005 and 2015. Macular oedema was assessed using ocular coherence tomography (OCT). The six eyes in this series were treated by IOL removal and implantation of a scleral -sutured IOL with four points of fixation in the sulcus. Visual acuity improved in all six eyes. On OCT, macular oedema resolved after 3 months in all eyes. There were no surgical complications from the IOL exchange. One eye had a pupilloplasty and another had a diaphragm IOL to treat a major iris impairment from prior surgeries. The cause of cystoid macular oedema in these cases remains controversial but has been well recognized in eyes with iris-sutured IOLs. The absence of sutures with posterior fixation of an iris claw IOL prevents progressive corneal endothelial cell loss but does not prevent macular oedema, even in vitrectomized eyes. In conclusion, macular oedema resolved and visual acuity improved after implant exchange with a secondary scleral-fixated IOL in these cases. This procedure should be considered as a solution to persistent symptomatic cystoid macular oedema from an iris-fixated implant.

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The Balanced Two-String Technique for Sulcus Intraocular Lens Implantation in the Absence of Capsular Support

Journal of Ophthalmology ◽

10.1155/2015/153963 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Hesham A. Ibrahim ◽

Heba Nabil Sabry

Keyword(s):

Intraocular Lens ◽

Wound Closure ◽

Anterior Segment ◽

Iol Implantation ◽

Corrected Visual Acuity ◽

Alternative Approach ◽

Secondary Implantation ◽

The Stability ◽

Capsular Support

Purpose. To describe and explore an alternative approach for sulcus intraocular lens (IOL) implantation in the absence of capsular support.Methods. The commonly available one-piece poly(methyl methacrylate) (PMMA) lens is stabilized in the sulcus by two intraocular horizontal strings of 10/0 polypropylene suture passed through the lens dialing holes in opposite directions to achieve a mechanical balance. The horizontal strings of 10/0 polypropylene work as a rail track for the IOL optics, allowing some side to side lens adjustment even following wound closure. The stability of the IOL was tested in vitro. Six aphakic patients underwent in-sulcus IOL secondary implantation using the balanced two-string technique. Patients were followed up for a minimum of six months. Best spectacle corrected vision was assessed. Lens centration and lens tilt were measured by anterior segment optical coherence tomography (AS-OCT).Results. All patients had successful lens insertion. Best spectacle corrected visual acuity (BSCVA) improved in all patients. Lens decentration ranged between 0.21 mm and 0.9 mm (average 0.53 mm). Lens tilt ranged between 1.2° and 2.8° (average 2.17°).Conclusion. The mechanically balanced two-string technique is an alternative option for sulcus IOL implantation in absence of capsular support, allowing lens centration adjustment with no additional risks.

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Clinical Evaluation of Toric Intraocular Lens Implantation Based on iTrace Wavefront Keratometric Astigmatism

10.21203/rs.2.24137/v2 ◽

2020 ◽

Author(s):

Zhe Zhang ◽

Hui Li ◽

Jing Zhou ◽

Yaqin Zhang ◽

Suhua Zhang

Keyword(s):

Intraocular Lens ◽

Case Series ◽

Standard Technique ◽

Rotational Stability ◽

Toric Intraocular Lens ◽

Vector Method ◽

Toric Iol ◽

Iol Implantation ◽

Wavefront Aberrometry ◽

Prospective Case Series

Abstract Background: There was no standard technique for measuring corneal astigmatism. The iTrace wavefront aberrometry of cornea calculated steep power and axis based on the best Zernike mathematical fit from all topo data within 4 mm circle. It was supposed to be more accurate than iTrace simulated keratometry which was calculated based on only 4 points on the circle of 3 mm. This study evaluated visual outcomes, rotational stability after performing toric intraocular lens (IOL) implantation planning based on the wavefront aberrometry of the cornea with iTrace. Setting: Single site in China, Shanxi Eye Hospital, Shanxi, China.Design: Prospective case series.Methods: The study included 85 eyes of 63 patients undergoing phacoemulsification and toric IOL implantation. The IOL power and cylinders were chosen with the help of the iTrace toric planning program using wavefront keratometric astigmatism. Over a 3-month follow-up period, astigmatic changes were assessed using the Alpins vector method. Results: Preoperative mean corneal topographic astigmatism was 1.91 diopters (D) ± 0.69 (standard deviation). Postoperative mean refractive astigmatism decreased significantly to 0.48 D ± 0.34. Surgical induced astigmatism was 1.73 D ± 0.77 and the mean correction index was 0.89 ± 0.22, showing a slight undercorrection. The proportion of astigmatism ≤ 0.50 D increased from 0 to 71.8% postoperatively.Conclusions: This is the first study evaluating the clinical outcomes of using iTrace wavefront keratometric readings to plan a toric IOL implantation. The findings show that the iTrace built-in toric calculator with wavefront keratometric astigmatism for toric IOL planning is safe and effective.Trial registration: Current Controlled Trials ISRCTN94956424, Retrospectively registered (Date of registration: 05 February 2020). http://www.isrctn.com/ISRCTN94956424.

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Clinical Evaluation of Toric Intraocular Lens Implantation Based on iTrace Wavefront Keratometric Astigmatism

10.21203/rs.2.24137/v1 ◽

2020 ◽

Author(s):

Zhe Zhang ◽

Hui Li ◽

Jing Zhou ◽

Yaqin Zhang ◽

Suhua Zhang

Keyword(s):

Intraocular Lens ◽

Case Series ◽

Standard Technique ◽

Rotational Stability ◽

Toric Intraocular Lens ◽

Vector Method ◽

Toric Iol ◽

Iol Implantation ◽

Wavefront Aberrometry ◽

Prospective Case Series

Abstract Background: There was no standard technique for measuring corneal astigmatism. The iTrace wavefront aberrometry of cornea calculated steep power and axis based on the best Zernike mathematical fit from all topo data within 4 mm circle. It was supposed to be more accurate than iTrace simulated keratometry which was calculated based on only 4 points on the circle of 3 mm. This study evaluated visual outcomes, rotational stability after performing toric intraocular lens (IOL) implantation planning based on the wavefront aberrometry of the cornea with iTrace. Setting: Single site in China, Shanxi Eye Hospital, Shanxi, China. Design: Prospective case series. Methods ： The study included 85 eyes of 63 patients undergoing phacoemulsification and toric IOL implantation. The IOL power and cylinders were chosen with the help of the iTrace toric planning program using wavefront keratometric astigmatism. Over a 3-month follow-up period, astigmatic changes were assessed using the Alpins vector method. Results ： Preoperative mean corneal topographic astigmatism was 1.91 diopters (D) ± 0.69 (standard deviation). Postoperative mean refractive astigmatism decreased significantly to 0.48 D ± 0.34. Surgical induced astigmatism was 1.73 D ± 0.77 and the mean correction index was 0.89 ± 0.22, showing a slight undercorrection. The proportion of astigmatism ≤ 0.50 D increased from 0 to 71.8% postoperatively. Conclusions ： This is the first study evaluating the clinical outcomes of using iTrace wavefront keratometric readings to plan a toric IOL implantation. The findings show that the iTrace built-in toric calculator with wavefront keratometric astigmatism for toric IOL planning is safe and effective.

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Sutureless scleral-fixated intraocular lens: long-term outcomes

Medical Hypothesis, Discovery & Innovation in Optometry ◽

10.51329/mehdioptometry108 ◽

2021 ◽

Vol 1 (2) ◽

pp. 52-56

Author(s):

Vinaya Felcida ◽

Anand Chawla ◽

Dimitrios Kalogeropoulos ◽

Ajai K Tyagi

Keyword(s):

Visual Acuity ◽

Standard Deviation ◽

Cataract Surgery ◽

Intraocular Lens ◽

Long Term Outcomes ◽

Complicated Cataract ◽

Corneal Decompensation ◽

Capsular Support ◽

Scleral Fixated Intraocular Lens

Background: The purpose of this study was to evaluate the long-term outcomes of sutureless scleral-fixated intraocular lens (SFIOL) implantation at a tertiary referral center. Methods: This retrospective observational study included 50 eyes of 43 consecutive patients who underwent sutureless SFIOL implantation by a single surgeon from January 2009 to December 2015. Indications for surgery were aphakia, dislocated intraocular lens (IOL), complicated cataract surgery (posterior capsule rupture, zonular dialysis, dropped nucleus), iris-clipped IOL with corneal decompensation, and lens with poor capsular support. Indication for surgery, visual acuity, ocular history, ocular comorbidities, intraoperative and postoperative complications, and the need for further surgery were analyzed. Results: The analysis conducted on 50 eyes from 43 patients with a mean ± standard deviation (SD) follow-up of 16.64 ± 9.34 months. Patients were 27 (63%) men and 16 (37%) women with a mean ± standard deviation (SD) age of 53.36 ± 22.45 years (range 8–90 years). Final visual acuity was 6/18 or better in 39 eyes. SFIOL was stable and well centered in 48 eyes. SFIOL dislocation was noted in 2 eyes, retinal detachment in 1 eye, and worsening of diabetic cystoid macular edema in 1 eye. Two patients with pre-existing corneal decompensation from complicated cataract surgery had worsening of their condition Conclusions: Sutureless SFIOL could be considered as a long-term option for the management of aphakia, dislocated IOL, and lens with poor capsular support. However, future studies with more subjects, longer follow-ups, and robust study design are needed to confirm the results of the present study.

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