Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Transcapsular scleral fixation of the standard capsular tension ring and in-the-bag intraocular lens implantation for severely subluxated lenses

AIM:To present a technique of transcapsular scleral fixation of the standard capsular tension ring(CTR)through equatorial capsulotomy and in-the-bag intraocular lens(IOL)implantation in subluxated lenses.METHODS:This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction,transcapsular scleral fixation of the standard CTR through equatorial capsulotomy,in-the-bag IOL implantation and with at least 6mo follow-up.Preoperative and postoperative best corrected visual acuity(BCVA),intraocular pressure(IOP),complications,and postoperative IOL tilt and decentration were recorded.RESULTS:Nine eyes of 7 patients with a mean followup of 11.0±3.7mo were included in this study.The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively(P<0.001).The IOP was within the normal range postoperatively.The mean tilt of the IOL was 4.30°±2.31°(range,1.0°to 8.9°)and the mean decentration of the IOL was 0.37±0.12 mm(range,0.14 to 0.50 mm).No visually threatened intraoperative and postoperative complications were detected during the follow-up period.CONCLUSION:This is a safe and effective surgical technique for managing patients with severely subluxated lenses.It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.

New two-point scleral-fixation technique for foldable intraocular lenses with four hollow haptics

The study was to report a new two-point scleralfixation technique for foldable intraocular lenses with four haptics.Lenses were slid into the anterior chamber from a 2.8 mm corneal incision and fixed under two sclera flaps at two opposite points.The postoperative best-corrected visual acuities（BCVAs） of all patients were significantly better than their preoperative BCVA.The results demonstrate that two-point,scleral fixations of foldable,intraocular lenses might be practicable and effective.

High speed small gauge anterior vitrectomy cutter for scleral fixated intraocular lens implantation

AIM： To report the outcomes of anterior vitrectomy using high speed cutter for scleral fixated intraocular lens （SFIOL） implantation in patients with posterior capsular rupture .METHODS： Medical records of 51 patients with posterior capsular rupture who received high speed cutter anterior vitrectomy via limbal incision with SFIOL implantation from June 2011 to December 2013 were reviewed retrospectively for visual outcomes and complications.RESULTS： Totally 51 eyes of 51 patients were identified （23 males and 28 females）. Mean age at surgery was 67.2±15y （range 27-91y）, with mean follow-up of 23±8.2mo （range 12-40mo）. The 49 （96.1%） eyes had improvement or unchanged of final postoperative visual acuity. The most common complication was vitreous haemorrhage （5.9%） and transient rise in intraocular pressure （5.9%） which all spontaneously resolved CONCLUSION： High speed cutter anterior vitrectomy via limbal incision is a safe and effective method for those with posterior capsular rupture for SFIOL implantation.

Toric markers-assisted implantation of the scleral-fixated intraocular lens

AIM：To evaluate the efficacy of toric intraocular lens markers-assisted implantation of the scleral-fixated intraocular lens（SFIOL）.METHODS：From October 2010 to December 2013,all patients who had undergone secondary SFIOL implantation were assigned to group 1 and 2,in group 1SFIOL was performed with the assist of radial keratotomy（RK）-marker,and in group 2 SFIOL was performed with the assisted of toric intraocular lens markers（T-and axis markers）.Patients＇ demographic data and information on baseline preoperative visual acuity,indication for surgery and latest postoperative visual acuity were collected and analyzed.The haptic and optic positions were determined by ultrasound biomicroscopy.The optic tilt angle and decentration distance were measured.RESULTS：The study evaluated 43 eyes of 43 patients ranging in age from 3 to 66 y.Group 1 comprised 24 eyes（24 patients） and group 2,19 eyes（19 patients）.Uncorrected reoperative acuity was improved on all the eyes postoperatively.The improved postoperative acuity was significantly more in group 2 than that in group 1（1.11 ±0.38 vs 0.82 ±0.45 logMAR;F=4.85,P=0.03）.Ultrasonic biomicrograph examination showed that the rate of haptic asymmetry was significantly higher in group 1（42%,10/24） than that in group 2（11%;2/19）（Chi square=3.68,P=0.04）.The mean tilted degree in group 1was significantly higher than that in group 2（P=0.04）.Mean decentration distance in group 1 was greater than that in group 2（P=0.03）.CONCLUSION：During SFIOL the toric markers help the surgeon identify the placement of fixation more precisely than that with the use of RK marker.

A knotless, one-haptic fixation of posterior chamber intraocular lenses: one-year results

AIM: To assess the results of a modified technique for scleral fixation of a posterior chamber intraocular lens(IOL) in eyes which had deficient of posterior capsular support.METHODS: This retrospective study was comprised of ten patients with deficient posterior capsular support who underwent one-haptic fixation of posterior chamber IOLs, between February 2010 and October 2011. IOL as implanted with one haptic supported on the capsular remnant and the other haptic drawn into the sulcus by anchoring suture without a knot. All patients were evaluated for pre- and postoperative visual acuity, lens centration, intra-and postoperative complications.RESULTS: A knotless, one-haptic fixation of posterior chamber IOLs has successfully been performed on ten eyes. All cases had inadequate capsular support(i.e. a capsular tear ranged from 5 to 7 clock hours). The average age was 74.25 ±8.87y(SD). The average postoperative uncorrected visual acuity was 0.51 log MAR.Complications included hyphema in one eye, a mild inflammatory reaction in the anterior chamber in two eyes, and a transient rise in IOP in one eye. Neither IOL tilt nor dislocation was observed and there were no later complications.CONCLUSION: In the presence of insufficient capsular support, a knotless, one-haptic fixation of posterior chamber IOLs is a safe and viable option which reduces the operation time, and minimizes postoperative suture-related complications.

Evaluation of functional outcome and stability of sutureless scleral tunnel fixated IOLs in children with ectopia lentis

AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.

A case study of blast eye injury at work place

This case report aims at investigating whether two consecutive surgical settings would be beneficial in achieving postoperative success for the patient with blast eye injury. A 45-year-old male patient admitted on 17th October 2011 with history of blast eye injury. Right eye examination revealed central corneal laceration with incarceration of lens matter, multiple foreign bodies also seen embedded in the eyelid margins and in the left cornea. Computed ocular tomography showed a retained intraocular foreign body (IOFB) in the right eye. Simultaneous corneal laceration repair and extraction of the ruptured lens performed as primary procedure under general anesthesia. Intraoperative posterior capsule loss was noticed with vitreous presentation. Anterior vitrectomy with removal of the IOFB was done. Foreign bodies were also removed from the left cornea. Penetrating keratoplasty (PK) with scleral fixated intraocular lens implantation executed 4 months later as secondary procedure. Visual acuity maintained at 6/24 in 2 years follow-up. In conclusion, two consecutive surgical settings has the advantage of calculating the intra ocular lens power.