Full text inandout technique for intraocular lens scleral fixation. Sutureless intrascleral posterior chamber iol fixation. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol. To compare shortterm clinical outcomes between two different intraocular lens iol types in the flanged iol fixation technique. Reiss and adenwalla tie 60 vicryl suture to each haptic to facilitate haptic externalization. Specifically, the study found that iols fixated with the yamane method were tilted, on average. Herein, we describe a simplified and modified technique in which scleral fixation is performed together with temporary externalization of iol haptics through a small, superior clear corneal incision. Scleral fixation of dislocated intraocular lenses by. It is known that iol tilt and decentration are more extensive in scleral fixated iols than in other methods of fixation. Endoscopicassisted scleral fixated iol in the management of secondary aphakia in children.
This is a prospective study, whereas 40 aphakic eyes with absence of a good capsular support were implanted by endoscopyassisted sclera fixation technique. During the surgries, after cataract extraction scleral fixated iol was implantated. Modified 3piece scleralfixated iol american academy of. Cystoid macular edema and iol decentration was found in 3 8% eyes and 1 3% eye respectively. Iols can be fixated to the sclera using sutures or by tunneling the iol haptics into the sclera without sutures. Scleral fixation of intraocular lenses with goretex. Positioning of scleralsutured posterior chamber iols. To evaluate efficacy and safety of combined pars plana vitrectomy ppv and scleral fixated intraocular lens sfiol surgery as a single procedure. The procedure can be added to other various techniques of sclerafixated iol that use transscleral suture fixation, regardless of the suturing technique.
Complications of scleralfixated intraocular lenses. This study was a retrospective case series and included the patients who underwent flanged iol fixation between june 2017 and july 2018 at the hiroshima university hospital. Scleral fixation of iol is an effective but surgically demanding. If no capsular or iris support exists, the surgeon can fixate an iol to the sclera or the patient can remain aphakic. Medical records of consecutive patients who had scleral fixated iol surgery from january 1, 2010, to march 31, 2014, with more than 1 year of followup were. The effect of intraocular lens tilt on visual outcomes in. Conclusions scleralsutured posterior chamber iol in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Retrospective interventional case series done at a tertiary eye care center in northern india. Scleral fixation of intraocular lenses using goretex.
Original article visual outcome and early complications of sutureless. Combined 23gauge transconjunctival vitrectomy and scleral. 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 scleralsutured posterior chamber. The bagiol complex remained stable and well centered 12 months following transscleral suture fixation with good visual outcome. Several techniques have been employed for repositioning dislocated intraocular lenses iols. A modified technique of scleral fixated intraocular lenses.
We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. One haptic, scleral fixation, single loop, suture fixation. This article is from indian journal of ophthalmology, volume 62. Among them scleral fixated pc iol implant can provide minimum magnification of. Abstractbackground in microspherophakia, abnormal laxity of the lenticular zonules leads to. To investigate the longterm outcomes and complications of scleralfixated intraocular lens sfiol implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal. Reviewing complication trends over time, lens tilt and. Longterm outcome of scleralfixated intraocular lens. 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. Original article visual outcome and complications in abexterno scleral fixation iol in aphakia azizur rahman, israr ahmed bhutto, sadia bukhari, mazharul hassan, muhammad nasir bhatti. This video demonstrates a modified method for scleral fixation of a 3piece iol. Scleral fixation for intraocular lenses sciencedirect. 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 values of pre and postoperative 12th month uncorrected visual acuity ucva, cylindrical refractive error, bestcorrected visual acuity bcva. Endoscopicassisted scleral fixated iol in the management. Recently the yamane technique has also become popular and is being widely adopted as well. Scleral fixation of the pciol provides satisfactory visual outcomes. Original article visual outcome and complications in ab. Fifty eyes of 48 patients with sclerally fixated iol were included in the study. To report on the outcome of scleral fixated posterior chamber intraocular lens siol implantation in aphakic. Iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Outcomes of intraocular lens scleral fixation with the. Ninetyfour eyes of consecutive 94 patients who underwent scleralfixated iol implantation with zsuture technique were included in this prospective study. The implantation of the scleralfixated posterior chamber. The incidence of postoperative suture breakage in our series was similar as in previous studies in which the pciol was fixated with 100 polypropylene suture. Combined 23gauge transconjunctival vitrectomy and scleral fixation of iol without conjunctival dissection is effective and safe in managing a wide variety of lens complications, with good postoperative comfort and visual recovery.
For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. Because externalization of the haptic can be difficult at times using forceps alone, this method allows for easier externalization of the haptics even though it. Sutureless, glueless, scleral fixation of singlepiece and. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus. This technique can be used in any case of postoperative bagiol complex subluxation or dislocation to achieve stabilization.
Sulcus fixation of foldable intraocular lenses guided by. Crandall, md we describe an ab externo technique that facilitates iol scleral fixation and reduces the risk associated with previous ab externo scleral fixation techniques. Ab externo scleral fixation of intraocular lens pdf free. Eleven patients who underwent combined ppv and sfiol surgery were included and analyzed retrospectively. Acm in yshaped intrascleral fixated iol group while in retropupillary iol group was treated by repeated injection of ophthalmic viscosurgical devices ovd e. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. To report refractive outcomes of scleralfixated intraocular lens iol implantation with goretex w. However, this procedure is associated with a considerable risk of postoperative complications.
Yshaped intrascleral fixated lens versus retropupillary. Scleral fixation of a pc iol is an effective but surgically demanding technique. Scleralfixated posterior chamber intraocular lenses in. Intrascleral haptic fixation as an alternative to sutures. It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. If you continue browsing the site, you agree to the use of cookies on this website. Outcomes and complications of concurrent pars plana. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. The purpose of this study was to compare a new intraocular lens iol scleral fixation technique scleral incision with the scleral flap surgical. Modified technique for transscleral fixation of posterior. All patients underwent abexterno scleral fixation of iol by the same surgeon.
Clinical outcomes of 4point scleral fixated 1piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture nimesh a patel, parth shah, nicolas a yannuzzi, zubair ansari, jill s zaveri, nidhi relhan, basil k williams jr, ajay e kuriyan, christopher r henry, jayanth sridhar, luis haddock, jorge a fortun, thomas a albini, janet l davis, harry w flynn jrdepartment of. Scleral fixated intra ocular lens implantation is a procedure of recent origin which is more advancing such that even sutureless technique with foldable iol has achieved. Although we made a secondary enlargement of the clear corneal incision for iol insertion without using iol injector in our case, the inandout suture technique can be applied to methods. Longterm outcome of scleralfixated intraocular lens implantation. Technique ab externo scleral fixation of intraocular lens d. Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. Comparison of different iol types in the flanged 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. Post op results are quite good and comparable to other kinds of implantations. When lack of capsular and zonular support prevents placement of an intraocular lens iol in the posterior chamber, some surgeons turn to sutureless intrascleral fixation of a 3piece, posterior chamber iol pciol as the solution. Sutureless intrascleral fixation using different three.
Iol, iris fixated iol and sutured scleral fixated intraocular lens sfiol implantation have been performed for many years. Placement of iol in the posterior chamber rather than anterior or. Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot iol scleral fixation technique by a single surgeon. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. The author has been using and refining these techniques for more than last one and a half decade. Scleral fixation of iol is an effective but surgically demanding technique. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets. 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 wall becomes a good alternative. Myopic shift of sulcus suturefixated posterior chamber intraocular. Scleral fixation of posterior chamber intraocular lens. Scleral fixated posterior chamber intraocular lenses in nonvitrectomised eyes. In general these eyes were lacking adequate posterior. A literature search in pubmed for several terms, including scleral intraocular lens complication, yielded 17 relevant articles.
Inandout technique for intraocular lens scleral fixation. 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 wall becomes a. Visual outcomes and complications of scleralfixated posterior chamber intraocular lenses. Backgroundaims to report the shortterm safety profile and clinical outcomes of scleral fixation of intraocular lenses iols using goretex suture. Dislocation of a scleralfixated, hydrophobic, single. Scleral fixation of intraocular lens zia ul mazhri, wasif m qadri. Scleral fixation of intraocular lens ophthalmology. Scleral fixation of iols became popular, originally with sutured scleral fixated iols and later the scharioth technique of intrascleral haptic fixation. Implanting a scleralfixated iol in cases with absent capsular support helps in separating the anterior chamber from the. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. Twenty eyes from 16 patients with sulcus suturefixated pc iols were included in the study. Scleralfixated posterior chamber intraocular lenses in nonvitrectomised eyes. Understanding the evolution of complications after scleralfixated lens placement demonstrates advantageous surgical techniques and suitable candidates. To evaluate the shortterm postoperative outcomes in endoscopicassisted sclera fixation intraocular lens iol for the management of secondary aphakia in children.
To assess the visual outcome and complications in patients after. Sutureless, glueless, scleral fixation of singlepiece and toric. Clinical outcomes of 4point scleral fixated 1piece. Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. Because of the variability in lens positioning after implantation of scleralsutured posterior chamber iols, one presenter suggested that the common practice of reducing iol power by up to 1 d.
This work and the related pdf file are licensed under a creative commons attribution 4. Combined pars plana vitrectomy and suture less scleral. This was further developed as the glued iol technique which enjoys widespread adoption all over the world. Haptics can be externalized using 25gauge forceps or hollow needle. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. Scleral iol suture fixation techniques were used in all 65 procedures. Without capsular support, scleralfixated iol placement is effective when pars plana vitrectomy ppv is also necessary to resolve additional complications such as retained lens material, dislocated iol, or posteriorly subluxated crystalline lens. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. To investigate the effect of scleralfixated intraocular lens iol tilt on visual outcomes. Iol rescue via sutureless scleral fixation eyetube. Aphakia after a cataract surgery could be attributed to many reasons, including lack of capsular support or insufficient surgical experience for scleral fixation.
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