Posterior iris fixation of the iris-claw intraocular lens implantation through a scleral tunnel incision.
ABSTRACT To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction.
Noncomparative, interventional case series.
A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors' clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients.
BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was -0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was -1.08 D (SD, 0.55 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.1 D (SD, 0.81 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane.
Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.
Dataset: Air-assisted Descemet-stripping automated endothelial keratoplasty with posterior chamber iris-fixation of aphakic iris-claw intraocular lens[show abstract] [hide abstract]
ABSTRACT: We report a combination of surgical techniques during Descemet-stripping automated endoithelial keratoplasty and intraocular lens (IOL) exchange in patients with pseudophakic bullous keratop-athy and angle-supported anterior chamber IOLs. During this procedure, the anterior chamber IOL is exchanged for a posterior chamber iris-claw IOL enclavated to the posterior iris; the anterior chamber is kept filled with air using an air–fluid exchange machine during descemetorhexis and insertion of the donor endothelial disk. Descemet-stripping automated endothelial kerato-plasty (DSAEK), which replaces only the diseased layers of the donor, has become a popular alternative to penetrating keratoplasty in patients with corneal endothelial cell dysfunction. The advantages of DSAEK include faster visual recovery, minimal change in astigmatism, lower risk for wound dehis-cence, and a tectonically stable globe. In addition, the risk for intraoperative expulsive suprachoroidal hem-orrhage is reduced. The main disadvantages are a higher rate of graft dislocation and an increased rate of endothelial cell loss. In 1998, Melles et al. 1 presented a surgical technique in which partial corneal transplantation was performed for replacement of diseased endothelium. In 2000, Terry and Ousley 2 performed the first endo-thelial keratoplasty in the United States and called it deep lamellar endothelial keratoplasty. In 2006, Gorovoy 3 reported the use of a microkeratome instead of hand dissection to prepare the donor graft and called it Descemet-stripping automated endothelial keratoplasty (DSAEK). 4–7 Graft detachment is the most frequent early postop-erative complication after DSEK (10% to 35% of cases), particularly for surgeons who are new to the proce-dure. Various techniques to enhance graft attachment have been proposed. Meisler et al. 8 used an air–fluid exchange system to promote graft adhesion during DSAEK. They used a 30-gauge needle fixed to the recipient limbus to introduce air into the anterior cham-ber during the procedure. Mehta et al. 9 used an anterior chamber maintainer at the recipient limbus attached to a 3-way tap connected to the air syringe to keep the anterior chamber air filled during descemetorhexis. The surgical correction of aphakic eyes with corneal edema without adequate capsule support is controver-sial. Debate persists between selection of an angle-supported anterior chamber IOL, a sutured posterior chamber IOL, or, recently, an iris-claw IOL. 10 Angle-supported anterior chamber IOLs are associated with complications, such as bullous keratopathy, because of the presence of haptics in the iridocorneal angle and continuing endothelial cell loss. 11 The Artisan aphakia IOL (Ophtec BV), one of the latest versions of this type of iris-fixated IOL, is a single-piece poly(methyl methacrylate) (PMMA) IOL with haptics that are attached to the iris with clips on both
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ABSTRACT: To describe a new scleral fixation foldable intraocular lens (IOL): the Ultima. The novel IOL is a new scleral fixation acrylic hydrophilic foldable lens that offers a 360 degrees sulcus support due to its round geometry. It can be folded and inserted through a 4 mm clear cornea incision. Twenty-five eyes implanted with the Ultima lens were followed for 2 years. Twenty-two eyes showed visual improvement, two eyes had no functional improvement, and one eye had visual deterioration. The IOL remained well centered and showed no signs of tilting in all patients during the entire follow-up. The main advantages of the Ultima IOL include the lack of tilting and the minimum postoperative astigmatism. It also allows a clear retinal examination and provides an excellent barrier for silicone oil between vitreous cavity and anterior chamber.European journal of ophthalmology 18(6):895-902. · 0.96 Impact Factor