Aphakia after a cataract surgery could be attributed to many reasons, including lack of capsular support or insufficient surgical experience for scleral fixation. A quickacting surgical fibrin sealant derived from human blood plasma, with both hemostatic and adhesive properties is used. Original article visual outcome and complications in ab. Techniques involve fixation of iol haptics within partial thickness scleral flaps. Myriad techniques have been described for fixation of an. Scleral fixation lens are implanted inside the eyes with the help of scleral support. Positioning of scleralsutured posterior chamber iols. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. 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. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols.
At the retina world congress in february, shin yamane, md, of japan, presented his technique of flanged fixation. Sutureless scleral iol fixation american academy of. Scleral fixation of intraocular lens pakistan journal of. Sulcus fixation of foldable intraocular lenses guided by. Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. Cme was detected in cases with unexplained visual deterioration during follow up in 4% of cases in group a and 10% of cases in group b with no. 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. Modified technique for transscleral fixation of posterior. This video illustrates a modification of the scleralfixated io. Recently the yamane technique has also become popular and is being widely adopted as well. Our approach could be modified and used for other kinds of iol or intraocular devices that requires transscleral suture fixation. Intraocular lens iol dislocation develops after cataract surgery in the presence of insufficient capsule or zonular support. A redislocation such as in scleral fixated iols does not occur with irisclaw iols. Sutureless, glueless, scleral fixation of singlepiece and.
The iol haptics provide an adequate fixation point for securing the lens to the peripheral iris. It is known that iol tilt and decentration are more extensive in scleral fixated iols than in other methods of fixation. 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. Visual outcomes and complications of scleralfixated. This video demonstrates a modified method for scleral fixation of a 3piece iol. 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. Crsteurope sulcus fixation of an iol using scleral tunnels. Iol either to the iris or the sclera in the ciliary sulcus. We conceived and designed a knot ball scleral fixation technique for suture burial in a retrospective sample of 108. Pxf dislocated iol, iol exchange with gortex sutured iol. I need a code for a pars plana vitrectomy and removal of iol, and implantation of sclera fixation. Full text inandout technique for intraocular lens scleral fixation. Having an intraocular lens decenter or drop into the anterior vitreous, days or years after cataract surgery, is an infrequent but onerous complication for surgeons to deal with. Scleral fixated iols are indicated when there is no capsular or iris.
Pdf reverse pupillary block after implantation of a. 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. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79. The hydrophobic, aspheric monofocal iol incorporates a series of optimizations aimed at improving cataract surgical workflow and visual outcomes. If, however, the patient is aphakic preoperatively, we plan for a scleralfixated iol using the method described above. The disadvantage is that the iol is fixated into the iris tissue, and a too traumatic implantation may lead to an inflammation. Presented at the ascrs symposium on cataract, iol and refractive surgery, chicago, illinois, usa. Comparative evaluation of sutureassisted and fibrin glue. This technique simplifies scleral fixation of iols and potentially avoids some of the associated complications. In the absence of capsular support after cataract surgery or traumatic injuries, scleralfixated intraocular lens iol using goretex w. Therefore, reducing iol power by up to 1 d, as is commonly employed with sulcus fixation, should not be routinely practiced in scleralsutured posterior chamber iol cases to avoid postoperative. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon.
Posterior chamber intraocular lenses directly fixated to sclera have been used in a variety of situations such as planned secondary iol insertion and surgical. 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. This postoperative inflammation with cellular proliferation of the iol is induced by. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus.
Inthebag placement of an iol maximizes the chances of optimal. Michael patterson, do, shares the case of a gentleman who presented with a dislocated iol and bag complex with vitreous into the anterior chamber. Sulcus fixation of foldable intraocular lenses guided by ultrasound biomicroscopy shasha gao,1 tingyu qin,1 shengnan wang,2 and yong lu1 1department of ophthalmology, the first affiliated hospital of zhengzhou university, zhengzhou 450052, china 2department of ophthalmology, beijing ditan hospital, capital medical university, beijing, china received 29 july 2015. Recently, iol implantation via sutureless intrascleral fixation has been performed in children with no lens dislocations after six months of. This eliminates the need to make large incisions to explant the iol for exchange with a new lens. Haptic extrusion occurred in 4% of intra scleral fixated iols group group b, however kumar da et al. After discussing various treatment options available with the patient, written informed consent was obtained, and righteye cataract extraction with a scleralfixated singlepiece iol, in view of poor capsular support, followed later by the left eye, was planned. Scleral fixation of iols became popular, originally with sutured scleral fixated iols and later the scharioth technique of intrascleral haptic fixation. 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. Lente carlevale a fissazione sclerale senza punti di sutura, intervento dott, carlo carlevale roma carlevale lens. Scleral fixation of posterior chamber hydrophobic acrylic. Among them scleral fixated pc iol implant can provide minimum magnification of image as compared to other options. When performed with pars plana vitrectomy ppv, the outcomes are favorable.
It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. Keywords secondary iol implantation, sutureless intrascleral fixation, aphakia, scleral fixation. Scleralsutured lenses can have good results but require complex intraocular maneuvers. 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. How much of a difference can a few small changes make. A common complication of scleral fixated iol implantation is erosion of sutureknots through sclera.
Scleral fixated iol this video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma. Cystoid macular edema and iol decentration was found in 3 8% eyes and 1 3% eye respectively. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. This was further developed as the glued iol technique which enjoys widespread adoption all over the world. At the 5th annual vitbuckle society meeting in april, mark walsh, md, of tucson, az, presented his method. Methods a series of 19 patients n24 eyes were split into two groups according to the degree of zonular abnormality as follows. Scleralfixated intraocular lenses madanagopalan v g, sen p. Late iol dislocation or tilt is also a potential concern with scleral fixation techniques 8, 11, 15, 26, 35. Scleral fixated iol sutureless and glueless youtube. In this study, 30 eyes of 30 patients were included. Reiss and adenwalla tie 60 vicryl suture to each haptic to facilitate haptic externalization. The efficacy of lens removal plus iol implantation for the. For a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says.
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 new minimally invasive technique for fixation of an intraocular lens iol was presented at two recent retina conferences. We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. Phoebe lin, md, phd, and sharon fekrat, md, facs, present the case of a 51yearold male with a traumatic dislocated crystalline lens associated with a superior 180 degree iridodialysis. 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. Pdf on nov 10, 2019, simonadelia nicoara and others published. Scleralfixated iol using 25gauge needle scleral tunnel. Haptics can be externalized using 25gauge forceps or hollow needle. Modified 3piece scleralfixated iol american academy of.
To assess the feasibility of scleralfixated intraocular lens iol implantation as an alternative form of optical correction in aphakic children intolerant of. According to our data, covering the suture ends with scleral pockets is an alternative way to avoid suture exposure in scleralfixated iol implantation. For scleral fixation implantation, use 6725067255 for posterior sclera fixation and 6622066225 for anterior sclera fixation accordingly. 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 sub. Placement of iol in the posterior chamber rather than anterior or. Aims to evaluate the efficacy of lens removal plus intraocular lens iol implantation for spherophakia with secondary glaucoma. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. Her iol power as calculated with autokeratometry and manual ascan immersion method was %plus.
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. And its familiar cloop design means you dont need to make significant modifications to your surgical technique. Combined 23gauge transconjunctival vitrectomy and scleral. How to put an iol in its place experienced implant surgeons share their best techniques for refixating malpositioned lenses. Yshaped intrascleral fixated lens versus retropupillary. In cases of a dislocated iol in the vitreous, we plan for vitrectomy to retrieve the iol, followed by iris fixation. Glued iol or glued intraocular lens is a new surgical technique for implantation of a posterior chamber iol with the use of biological glue in eyes with deficient or absent posterior capsules fig 1. Cataract surgery with implantation of an intraocular lens iol within the capsular bag, although ideal, does not always happen. Cover story sulcus fixation of an iol using scleral tunnels. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. Intraoperative steps of yshaped intrascleral fixated iol implantation. Sutureless scleral fixation requires sclerotomy and externalization of haptics through uveal tissue, which may induce intraocular hemorrhage 6, 14.
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