Prevention of suture knot exposure in posterior chamber intraocular lens implantation by 4-point scleral fixation technique
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.
Available from: Pipat Kongsap
- "Increasing the infusion pressure from 35 mmHg to 50 mmHg ensured the prevention of intraoperative hypotony. Modified 4-point scleral fixation of intraocular lenses (IOLs)6–7 was also performed on five eyes with trauma. Plugs were placed in the cannula, which was removed at the end of the surgery by applying gentle traction with the help of forceps. "
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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.
Available from: Muhittin Taskapili
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ABSTRACT: To evaluate the results of transscleral fixation of foldable hydrophilic acrylic intraocular lenses (IOLs).
Twenty eyes of 16 patients, aphakic after phacoemulsification (PE) surgery and with at least 6 months follow-up, were included in the study. All eyes were implanted with single-piece hydrophilic foldable acrylic lenses by transscleral fixation, either with PE surgery (2 eyes) or secondarily.
Follow-up was 11.6 months (SD 4.85, range 6-20 mo). Age was 62.3 years (SD 12.95, range 18-78 y); 10 patients were women. Preoperative best corrected visual acuity (BCVA) was 0.20 (SD 0.14, range 0.1-0.3) in eyes with primary IOL implantation and 0.53 (SD 0.12, range 0.3-0.7) in secondary implantation. Astigmatism was 1.4 D (SD 1.19, range 0.25 to 5.0 D). Postoperatively, transient corneal edema developed in 6 eyes (30%) and transient IOP elevation in 2 eyes (10%). BCVA was 0.69 (SD 0.15, range 0.4-0.9), astigmatism was 0.84 D (SD 0.80, range 0.25 to 3.0 D), both p < 0.01. Spherical refractive error was -0.38 D (SD 0.47, range +0.75 to -1.25 D). Cystoid macular edema was observed in 2 eyes (10%). No IOL decentration was observed on biomicroscopy in any eye with undilated pupil; IOL decentration with no effect on vision was observed in 3 eyes (15%) after pupil dilation. No IOL tilt, retinal detachment, suture exposure, or endophthalmitis was observed.
Scleral fixation of foldable IOLs may be preferred in eyes with insufficient zonular and capsular support. This technique reduces surgery time and complications, and it provides early visual rehabilitation.
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ABSTRACT: The goals of canine cataract and lens instability surgery should be to ensure a small incision, minimal tissue trauma, shortened surgical time, maintenance of the anterior chamber, and restoration of emmetropia through the use of a stable intraocular lens specifically designed for the canine eye. While this is usually the case with routine phacoemulsification and in-the-bag intraocular lens implantation, it is often not the case with lens instability, lens luxation or large posterior capsular ruptures. In such cases the incisions are often larger, surgical time and tissue trauma are excessive, and the patient is often left aphakic. The goal of this paper is to present a modified ab externo technique designed to allow removal of the lens and placement of a ciliary sulcus sutured IOL through a small incision, with minimal trauma and shortened surgical time. Use of this technique may allow more canine patients to be emmetropic postoperatively. In addition, the ease of this procedure may encourage earlier removal of an unstable lens and decrease the risk of secondary glaucoma and retinal detachment that occur in association with lens luxation.
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