Flapless one-knot suture:a novel surgical technique for transscleral fixation of C-loop intraocular lenses

AIM:To describe a novel suture approach for transscleral fixation of C-loop intraocular lenses(IOL)and to compare the surgical outcomes with the four-haptics posterior chamber(PC)-IOL technique.METHODS:We retrospectively analyzed 16 eyes of 16 patients who underwent transscleral fixation of C-loop PCIOLs using a flapless one-knot suture technique,which were followed up for longer than 17mo.In this technique,the capsulorless IOL was suspended using a single suture for transscleral fixation of four feet.Then we compared its surgical outcomes and complications with the four-haptics PC-IOLs using the Student's t test and Chi-square test.RESULTS:Sixteen patients of 16 eyes with a mean age of 58.3±10.1y(42-76y)who received transscleral C-loop IOL implantation due to trauma,vitrectomy,or cataract surgery with inadequate capsule support showed improved visual acuity.The difference was not significant between two IOLs except the surgery time(P>0.05).The mean operation times of C-loop IOL surgery was 24.1±1.83min and 31.3±4.47min of the four-haptics PC-IOL method(P<0.0001).In the C-loop IOLs group,there was statistical difference between the preoperative and the postoperative UCVA(log MAR,1.20±0.50 vs 0.57±0.32,P=0.0003).There was no statistical difference between the preoperative and the postoperative BCVA(log MAR,0.66±0.46 vs 0.40±0.23,P=0.056).However,there was no statistically significant difference in postoperative UCVA and BCVA between the two IOLs(P>0.05).We did not detect any optic capture,IOL decentration or dislocation,suture exposed,or cystoid macular edema in patients underwent C-loop IOLs surgery.CONCLUSION:The novel flapless one-knot suture technique for transscleral fixation of C-loop IOL is a simple,reliable,and stable technique.

Novel transscleral sutureless subretinal fluid drainage using a 25-gauge trocar-cannula with a self-closing valve in patients with advanced Coats disease

AIM: To assess surgical outcomes of a novel method of transscleral drainage of subretinal fluid using a 25-gauge trocar-cannula with a self-closing valve(DTV) in patients with severe exudative retinal detachment(ERD) in Coats disease.METHODS: Retrospective consecutive cases of 20 patients(20 eyes) of severe ERD due to Coats disease(stage 3 B) in total 156 Coats patients between June 2015 and April 2019 were included in this study. The participants were aged 1 to 10 y with a mean age of 3.50±1.79 y. The mean follow-up time were 11.9 mo. Subretinal fluid was drained transsclerally using a novel method of DTV. The height of the retinal detachment and the regression of abnormal vessels including telangiectasias and aneurysms were observed. Complications including vitreoretinal fibrosis, tractional retinal detachments(TRD), endophthalmitis, retinal holes, and hemorrhages were evaluated.RESULTS: Following surgeries, the patients showed the replacement of ERD and regression of telangiectatic retinal vessels observed with binocular indirect ophthalmoscopy. Six patients received retinal cryotherapies and 12 patients received laser photocoagulations following first external subretinal fluid drainage using DTV. All patients underwent intravitreal anti-vascular endothelial growth factor therapies to induce residual subretinal fluid absorption. During followups, 8 patients underwent a second drainage operation, 17 patients received retinal laser photocoagulations and 7 patients received cryotherapies. Vitreoretinal fibrosis was found in 7 patients and 6 patients underwent microinvasive vitrectomies during the follow-up period. Severe TRD, iatrogenic retinal holes, and hemorrhages were not found.CONCLUSION: The authors present a new therapeutic approach that successfully drains subretinal fluid in advanced stage 3 B Coats disease with severe ERD. This is a simple, safe and less invasive approach when compared with traditional managements. However, it should be strictly selected for patients with high bullous ERD close to the central axis of the eye in order to avoid the complication of retinal holes.

Simple transscleral fixation of IOL technique without tying up haptics

AIM: To introduce a novel technique for transscleral fixation of the posterior chamber intraocular lens(PC-IOL) that requires no sutures on the IOL haptics.METHODS: Instead of suturing polypropylene onto the IOL haptics, the method simply winds the thread on the haptics. Fifteen eyes of 15 patients underwent this technique and were followed up for more than 18 mo. Surgical outcomes and post-operative complications were evaluated and compared with those of the conventional transscleral fixation method.RESULTS: Postoperative cylinder was significantly lower in the thread winding group than in the conventional transscleral fixation method group(-1.02±0.46 diopters vs-1.57±0.77 diopters;P=0.01). Further, no postoperative complications, such as optic capture, IOL dislocation, and hyphema, were detected in the thread winding group.CONCLUSION: We believe that our thread winding technique is better than previously reported methods because it is simple, mechanically stable, and free from suture-related complications.

Efficacy of scleral-fixated 3-looped haptics intraocular lens implantation for surgical management of microspherophakia

AIM:To evaluate the safety and efficacy of scleral-fixated 3-looped haptics intraocular lens(IOL)implantation for surgical management of microspherophakia.METHODS:A retrospective case series include 10 microspherophakic patients(15 eyes)who underwent lens removal plus a modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation.The primary outcomes involved visual acuity,intraocular pressure(IOP).Secondary outcomes were spherical equivalent(SE),anterior chamber depth(ACD),corneal endothelial cell density and postoperative complications.RESULTS:After a postoperative follow-up of 17.60±15.44mo,improved visual outcomes can be observed.The uncorrected distance visual acuity(UCVA)log MAR improved from 1.54±0.59 preoperatively to 0.51±0.35 postoperatively(P=0.001),and best corrected visual acuity(BCVA)log MAR improved from 0.97±0.91 preoperatively to 0.24±0.23 postoperatively(P=0.003).Moreover,the SE decreased from-9.58±7.47D preoperatively to-0.65±2.21 D postoperatively(P<0.001).In terms of safety profile,the average IOP decreased from 21.10±12.94 mm Hg preoperatively to 14.03±3.57 mm Hg postoperatively(P=0.044),and the previously elevated IOP of three eyes decreased to the normal range.The ACD increased from 2.25±1.45 mm preoperatively to 3.35±0.39 mm postoperatively(P=0.017).The density of corneal endothelial cells did not change significantly after surgery(P=0.140).The posterior chamber IOLs were well centered and no severe complications were found.CONCLUSION:Lens removal plus the modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation can help in improvement of visual acuity,which can be regarded as a relative safe method for the surgical management of microspherophakia.

Micropulse diode laser therapy in refractory glaucoma

Purpose:Description of safety and efficacy of micropulse lYanssderal cydophotocoagulation as a treatment option for refractory glaucoma.Mahods:This is a prospective study including 39 eyes of 31 patients foil owed for refractory glaucoma,who benefited from transsderal cyclophotocoagulation using a mic topi used laser.The main indication for tire pro­cedure was increased ocular pressure refractory to quadri therapy in various types of glaucoma.Ihe patients were tieated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm.The pa­rameter for tire procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an eneigy of 180 J.Both tire upper and lower hemispheres were treated in tire same procedure,sparing tire 3 o'clock and 9 o'clock meridians,and aD tire patients benefited from a single treatment session.The following parameters were evaluated;ocular pain and overall tolerance;visual acuity;and tire evolution of IOP postoperatively up to 9 months.Results:The glaucoma subtypes treated are as follows:primaty open-angle glaucoma(n=05),chronic angle-closure glaucoma(n=13),neovascular glaucoma(n=07),aphakic glaucoma(n=06),malignant glaucoma(n=04),post-traumatic angle recession(n=02),and inflammatoiy glaucoma(n=02).The mean pre-operative intraocular pressure was 42.3±5.2 mmHg and tire mean post operative intraocular pressure at 9 months was 16.9±1.9 mmHg The reduction in IOP was 49.9%.The average number of intraocular pressure-lowering medications used prior to surgery was four,and tire average number of medications used at tire 9-month post­operative visit was 2.0±1.2(703%of patients were on dual therapy).The overall success rate was 60.9%.Conclusions:Micropulse transsderal cydophotocoagulation appears to be a safe and effident treatment for re­fractory glaucoma.Its indications should therefore be broadened and proposed early in various situations.