Prevention of suture knot exposure in posterior chamber intraocular lens implantation by 4-point scleral fixation technique.
ABSTRACT The results and complications of posterior chamber intraocular lens (IOL) implantation by a 4-point scleral fixation technique are described.
Fifty eyes of 47 patients who underwent scleral-fixated IOL implantation were retrospectively evaluated. Twenty-one (42%) eyes had a history of trauma and 29 (58%) eyes had previously undergone cataract surgery. In all cases, IOL implantation by 4-point scleral fixation was performed and the knots of fixation sutures were rotated and buried in the globe. The IOL position was adjusted by suture rotation for best centration.
The mean follow-up time was 7 +/- 4 months. Four (8%) eyes had minimal corneal edema preoperatively. Cystoid macular edema was noted in 2 (6.8%) eyes in the cataract surgery group and 8 (38%) eyes in the posttraumatic group. Two (9.5%) eyes in the posttraumatic group had atrophic macular changes and 1 (4.7%) had corneal scarring, which impaired vision. No complications such as knot exposure, tilting of the IOL, decentralization, or endophthalmitis were noted postoperatively. Postoperative mean corrected visual acuity was 0.4 +/- 0.3 in the posttraumatic group and 0.4 +/- 0.2 in the cataract surgery group.
The 4-point scleral fixation technique resulted in no serious postoperative complications such as suture exposure and endophthalmitis. Because the knot can be rotated and buried in the globe, knot exposure is less likely to occur. This procedure is more effective than other techniques regarding IOL centralization.
- SourceAvailable from: Martin Stephan Spitzer[show abstract] [hide abstract]
ABSTRACT: The presented Z-suture is a simple, rapid and safe knotless technique that facilitates transscleral suture fixation of various intraocular implants in the ciliary sulcus, such as sutured intraocular lenses, artificial iris prostheses and iris diaphragms. As the knotless approach reliably avoids suture erosion, external fixation can be performed without any protecting scleral flaps or lamellar grooves. The needle is simply passed through the sulcus and the emerging polypropylene suture is secured in the sclera using a zigzag-shaped intrascleral suture (Z-suture). Each pass starts directly adjacent to the exiting site. Five passes are sufficient to reliably fix the suture so that it resists even maximum tractive forces. Once this procedure is done, the suture can be cut without any knot. By avoiding suture knots, and hence the need for intrascleral flaps, this knotless approach may help to reduce suture-related complications such as scleral atrophy, suture erosion and infections.The British journal of ophthalmology 02/2010; 94(2):167-9. · 2.92 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: We describe a suture fixation technique for a single-piece foldable acrylic closed-loop intraocular lens (IOL) (C-flex, Rayner). In our experimental model analyzing the stability of acrylic haptics, we confirmed that the IOL could be in counterpoise without tilt using only a two-point fixation. This new surgical technique was performed in seven patients. The unique haptic design allows easy and secure suture fixation. The clinical outcomes were encouraging. It is conceivable that better stabilization can be achieved by the broad arc of distal haptic-tissue contact, in addition to suture fixation, using our surgical technique with the C-flex IOL.Korean Journal of Ophthalmology 01/2009; 22(4):205-9.
- [show abstract] [hide abstract]
ABSTRACT: To present a new surgical approach for the management of posteriorly dislocated lens by using a combination of 20-gauge (20G) and 23-gauge (23G) pars plana vitrectomy. An interventional case series This technique was performed on six patients (five men, one woman; mean age, 66.67 years; range, 66-72 years). Two 23G trans-conjunctival sclerotomy ports were created for infusion and illumination along with a 20G sclerotomy port for introducing the vitrectomy probe or fragmatome. This procedure was successfully performed on six eyes. On postoperative day one, the media were clear and the retina could be seen by indirect ophthalmoscopy. Hyphema developed in one eye and resolved within a week. There were no observed cases of retinal tear, wound leakage, hypotony, or endophthalmitis. The post-operative follow-up period ranged from three to twelve months (mean, 8.1 months). By the final visit, two patients had achieved a visual acuity of 20/40 or better, three patients, 20/70, and one patient, 20/200. The combination of 20G and 23G pars plana vitrectomy is an efficacious and safe procedure for management of posteriorly dislocated lens.Clinical Ophthalmology 01/2010; 4:625-8.