Longterm outcome of combined vitrectomy and transscleral suture. Ninetyfour eyes of consecutive 94 patients who underwent scleralfixated iol implantation with zsuture technique were included in this prospective study. Surgical technique simple new technique for scleral. An acrylic singlepiece sa60at or 2 threepiece iols va60bbr.
Sutureless scleralfixated iol in children american. Results sutureless intrascleral iol fixation methods are newer and have been developed to eliminate the suturerelated complications of sutured scleral fixation methods such as sutureinduced inflammation or infection and iol dislocation or subluxation due to suture. I still perform all three modes of secondary iol implantation. If the capsular support is inadequate for the iol that is to be positioned in the posterior chamber of the eye, suture fixation of the iol to the scleral. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets.
Mark walsh has performed sutureless scleral tunnel iol fixation in 11 pediatric patients with a variety of lenticular disorders. A new technique of sutureless sf iol haptic is then held with the mvr forceps introduced through the upper right sclerotomy using a handshake technique and externalized fig. Fixation of intraocular lenses in cases of insufficient or no capsular support is challenging and requires a large armamentarium of techniques to resolve different situations. The cases of smooth vitreous hemorrhage resolved within 1 week without surgical intervention.
If, however, the patient is aphakic preoperatively, we plan for a scleralfixated iol using the method described above. Modified technique for transscleral fixation of posterior. Intermediate results of sutureless intrascleral posterior. Table 3 shows the postoperative complications, all of which occurred within the first 4 weeks after surgery. Dmek procedures were performed on a 49yearold woman with a preexisting sfiol case 1 and a 69yearold woman with a preexisting ifiol case 2 in order to treat secondary corneal edema due to. After a conjunctival peritomy is made, 2 partialthickness scleral tunnels 1. Scleralsutured lenses can have good results but require complex intraocular maneuvers. Sutureless, glueless, scleral fixation of singlepiece and. The disadvantage is that the iol is fixated into the iris tissue, and a too traumatic implantation may lead to an inflammation.
Som prasad and gabor scharioth present a strategy to achieve secure sutureless intrascleral haptic fixation. Abstractbackground in microspherophakia, abnormal laxity of the lenticular zonules leads to. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. This video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma. Longterm outcome of scleralfixated intraocular lens implantation. The purpose of this study is to assess the longterm outcome and complication profile of. Complications of scleralfixated intraocular lenses.
Cystoid macular oedema and irisfixated intraocular lens. The baseline characteristics and final visual outcomes in the sutured scleralfixated iol group n 52 and sutureless scleralfixated iol group n 59 were comparable. One month later, the right visual acuity was stable at 1010 snellen with 3. However, data on longterm functional outcome are limited. Purpose implantation of a scleralfixated intraocular lens sfiol for the surgical management of aphakia in the absence of capsular support is a safe procedure with a low risk of complications in the early postoperative period. The iol is inserted into the eye and positioned in the ciliary sulcus. Iol either to the iris or the sclera in the ciliary sulcus. Scharioth et al23 reported good intermediate results of sutureless surgery, with no cases of recurrent dislocation or retinal detachment at a median followup of 7months. The effect of intraocular lens tilt on visual outcomes in. The iol haptics provide an adequate fixation point for securing the lens to the peripheral iris.
The clear corneal wound is closed with a 100 nylon suture before the sutures of the iol are secured at the sclera. Yannek leiderman demonstrates his technique for a sutureless scleral fixation of a 3piece iol, a challenging procedure simplified by modifying haptic fixation within the scleral tunnel. Scleral fixation of posterior chamber intraocular lenses using. A modified technique of scleral fixated intraocular lenses. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus. Aphakia can be corrected with the use of anterior chamber lenses and iris fixation or scleral fixation of posterior chamber lenses. This postoperative inflammation with cellular proliferation of the iol is induced by. Pdf scleralfixated intraocular lenses researchgate. The insertion of a scleralfixated iol requires great surgical skill and lacks an anatomical safety net to prevent an insufficiently secured implant from sinking into the vitreous space.
Options for intraocular lens iol implantation in eyes with deficient or absent posterior capsule support include irisfixated iols, anterior chamber iols ac iols, and transscleral iol fixation. The free suture end is then tied around the side of the. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. Scleral fixated iol sutureless and glueless youtube. Intraocular lens iol implantation in an eye without sufficient capsular support has been accomplished by using an anterior chamber iol, an irisfixed iol, and a transscleralfixed posterior chamber pc iol through the ciliary sulcus or pars plana. Irisfixated surgical technique of an acrylic intraocular. Here the haptics of the 3 piece iol are grabbed through the respective sclerotomies using microvitreous forceps and exteriorised. Scharioth et al 23 reported good intermediate results of sutureless surgery, with no cases of recurrent dislocation or retinal detachment at a median followup of 7 months. All patients underwent abexterno scleral fixation of iol by the same surgeon. In cases of a dislocated iol in the vitreous, we plan for vitrectomy to retrieve the iol, followed by iris fixation. Post operative complications scleral fixation of iol, we noticed anterior uveitis in one eye which is comparable with the results of kwong et.
Iol power calculation using topok gave a significantly higher proportion of patients in whom. Optical rehabilitation of childhood aphakia, in the presence of an unstable capsulezonule complex, is one of the most challenging tasks faced by the ophthalmologists. Vrs technique no suture no glue scleral fixated iol. Surgical technique a new technique of sutureless sf iol. However, this technique is applied to singlepiece and toric lenses instead of 3piece lenses, allowing the advantage of the use of premium lenses in patients with poor capsular support. He has observed no complications so far, with a maximum followup of 4 years. Ab externo scleral fixation of iol be placed through incisions as small as. The technique for scleral tunnelglued iol was first described by gabor et al.
Ab externo scleral fixation of intraocular lens pdf free. To investigate the effect of scleralfixated intraocular lens iol tilt on visual outcomes. Article information, pdf download for scleral fixation of posterior. It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. Polymethyl methacrylate pmma scleral fixated iol with eyelets in the haptics were used. This is a modification of the gabors technique of intrascleral fixation of iol haptics. Aim to determine the higherorder aberrations of intraocular lenses iols that are extended and fixed intrasclerally. Iol rescue via sutureless scleral fixation eyetube.
This article is from indian journal of ophthalmology, volume 62. Iols can be fixated to the sclera using sutures or by tunneling the iol haptics into the sclera without sutures. Maggisutureless scleral fixation of intraocular lenses. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Average value of iol power to be implanted results. Afterwards, the free end with the needle and the other end. To secure the haptics, 27gauge scleral tunnels are created.
Scleral fixated intra ocular lens implantation is a procedure of recent origin which is more advancing. The presented novel sutureless scleral iol fixation technique may provide minimal trauma to the surrounding tissues, good iol stabilization decreasing the incidence of iol tilt along with shorter. Crsteurope sulcus fixation of an iol using scleral tunnels. To report the intermediate multicenter results of a technique of sutureless intrascleral fixation of a standard 3piece posterior chamber intraocular lens pc iol in the ciliary sulcus. Methods a computeraided design system was used to calculate the length of an iol when it was fixed to the sclera 2 mm posterior to the limbus in a gullstrand eye model. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79. Iol power for scleral fixated iol was kept same as for pciol pmma lens with aconstant of 118. K values used were the flattest k on corneal topography escrs calculator. She underwent replacement of the binkhorst iol with a 28 dioptre scleralsutured iol and vitrectomy.
Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol. Longterm outcome of scleralfixated intraocular lens. Scleral fixated intraocular lens,pciol posterior chamber intraocular lens. We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. To examine the safety and efficacy of a modified scleral fixated intraocular lens sfiol technique combining a scleral tunnel for intraocular lens iol insertion, horizontal passage of sutures. The technique allows permanent scleral fixation of the polypropylene haptics of a 3piece iol directly into the sclera to achieve a position in the ciliary sulcus, thus obviating the need for suturing. Prior art keywords haptic lens eye sutureless sclera prior art date 20306 application number pcttr2014000056 other languages french fr inventor bilak semsettin.
Sulcus implantation without fixation requires capsular support and an iol that is appropriate for the sulcus. Glued scleral fixation for subluxated mature cataract and. Scleral fixation lens are implanted inside the eyes with the help of scleral support. In sutureless scleral fixation3,4 and glued iol techniques5, intraocular bimanual handshake technique6 is used.
A new intrascleral fixation technique for a standard 3piece posterior chamber intraocular lens pc iol using a simple guide is described. K used were the one derived from iol master topography. Pdf sutureless intrascleral fixated intraocular lens. A step by step guide for doing a sutureless and glueless scleral fixation of the intraocular lens in cases of aphakia without capsular support, traumatic subluxation, pseudoexfoliation. Sutureless scleral iol fixation american academy of. The values of pre and postoperative 12th month uncorrected visual acuity ucva, cylindrical refractive error, bestcorrected visual acuity bcva. Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case.
Scleral fixated posterior chamber intraocular lens sfiol, anterior chamber intraocular lenses aciol, irisfixed iol, are alternative options to. Descemet membrane endothelial keratoplasty in cases with. Patients were followed up on 1st day, 1st week, 1st month, 2nd month and 3rd month. Article information, pdf download for outcomes and complications. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol.
Because specially made lenses for iris suturing do not fold, many retina surgeons prefer to use traditional threepiece iols that can be folded and inserted through a small scleral incision. A redislocation such as in scleral fixated iols does not occur with irisclaw iols. Sutureless scleralfixated posterior chamber intraocular. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. Sutureless intrascleral posterior chamber iol fixation. To report two cases of descemet membrane endothelial keratoplasty dmek in patients with existing scleralfixated and irisfixated intraocular lenses sfiol and ifiol, respectively. For a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. I believe a backup lens should be available for every cataract procedure. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. To present the followup outcomes of a modified technique of transscleral suture fixation of posterior chamber intraocular lens pciol in eyes. No inflammation was visible in the anterior chamber. The two haptics were tied at 3 and 9 oclock position 1 mm posterior to.
Outcomes and complications of concurrent pars plana vitrectomy. Inandout technique for intraocular lens scleral fixation. In case of iol flip during the process of insertion, the. Her iol had one loop fixated to the iris with a prolene suture standard fixation technique and was tilting. Review of surgical techniques for posterior chamber. Posterior chamber intraocular lenses directly fixated to sclera have been used in a variety of situations such as planned secondary iol insertion and surgical complications at the time of primary cataract surgery.
No onepiece iol should ever be placed in the sulcus. This eliminates the need to make large incisions to explant the iol for exchange with a new lens. Care should be taken to hold the haptics at the very tip to avoid kinking or fracture of the haptic. Sutureless intrascleral intraocular lens fixation with. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. Hovanesian described sutureless intrascleral iol fixation as safer and easier than suturing a lens into the scleral flap. Flapless and sutureless intrascleral fixation of posterior. It is known that iol tilt and decentration are more extensive in scleral fixated iols than in other methods of fixation. There are several advantages to this technique, dr. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years.
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