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