Combined 23-gauge transconjunctival vitrectomy and scleral fixation of intraocular lens without conjunctival dissection in managing lens complications

Ling Yeung,Kuan-Jen Chen,Wei-Chi Wu,Nan-Kai Wang

doi:10.1186/s12886-018-0776-4

Abstract

BackgroundTo evaluate the safety and efficacy of combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of intraocular lens (IOL) without conjunctival dissection.MethodsA retrospective study in Chang Gung Memorial Hospital, Keelung and Taoyuan, Taiwan. Patients receiving combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of IOL without conjunctival dissection were enrolled. The ocular findings, causes of lens complication, surgical procedures, type of IOL used, and complications were documented.ResultsWe included 40 eyes from 39 patients (27 male, 12 female) with a mean age of 59.5 [standard deviation (±) 14.8] years old. The mean follow-up duration was 6.8 ± 5.4 months. The cause of lens complications was ocular trauma in 24 (60%) eyes, cataract surgery complications in 11 (28%) eyes, and spontaneous subluxation of crystalline lens in 5 (13%) eyes. The overall best corrected visual acuity (BCVA) (logMAR) improved from 1.359 ± 0.735 to 0.514 ± 0.582 (p < 0.001). The BCVA also improved significantly in each group with different causes of lens complications. Preoperative BCVA was the only factor associated with the postoperative visual outcome (p = 0.008). Most surgery-related complications were self-limited, including mild vitreous hemorrhage (5%), microhyphema (5%), transient elevated intraocular pressure (3%), and transient hypotony (3%). Cystoid macular edema and IOL decentration was found in 3 (8%) eyes and 1 (3%) eye respectively.ConclusionsCombined 23-gauge 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.Trial registrationRetrospective study, not applicable.

Highlights

To evaluate the safety and efficacy of combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of intraocular lens (IOL) without conjunctival dissection
The “reverse” scleral pocket was dissected outward from a clear cornea incision and conjunctival dissection was not required. This method was reported in the handling of other IOL complications [4, 5]. By combining this technique with the small gauge transconjunctival pars plana vitrectomy, a wide variety of lens complications can theoretically be managed by a single surgery with a more comfortable postoperative condition and faster visual recovery
The purpose of the current study is to evaluate the safety and efficacy of concurrent 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of IOL by a modified version of Hoffmann’s technique

Summary

Introduction

To evaluate the safety and efficacy of combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of intraocular lens (IOL) without conjunctival dissection. Yeung et al BMC Ophthalmology (2018) 18:108 sclerotomies, and omitting sutures required for sclerotomy and conjunctival wounds when compared with 20-gauge vitrectomies This improves the postoperative comfort in patients. The “reverse” scleral pocket was dissected outward from a clear cornea incision and conjunctival dissection was not required This method was reported in the handling of other IOL complications [4, 5]. By combining this technique with the small gauge transconjunctival pars plana vitrectomy, a wide variety of lens complications can theoretically be managed by a single surgery with a more comfortable postoperative condition and faster visual recovery. The efficacy and safety of these concurrent surgeries are unknown

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