Minimally invasive four-point scleral refixation for dislocated 4-haptic IOL by horizontal mattress sutures and Hoffman pockets.

The purpose of this study was to compare the surgical outcomes of intraocular lens (IOL) refixation with intraocular lens exchange using perfluorocarbon liquid (PFCL) and fibrin glue-assisted sutureless scleral fixation surgery in patients with dislocation of the IOL. Twenty-five eyes of 25 patients who underwent surgery for dislocated IOLs with PFCL and fibrin glue-assisted scleral fixation were studied; 13 eyes experienced IOL refixation (in-the-bag and out-of-the-bag), and 12 eyes experienced IOL exchange. Preoperative and postoperative clinical features from patient charts and 25 eyes with >6 months' follow-up information were reviewed and analyzed. At postoperative 6 months, best-corrected visual acuity (BCVA) and spherical equivalent of IOL refixation and exchange were significantly improved (P=0.042, P=0.001), and endothelial cell density was significantly decreased in the two groups with no significant difference between them. Surgically induced astigmatism of IOL refixation improved from 0.90±0.47 to 0.61±0.37 (P=0.012), and IOL exchange improved from 1.17±0.64 to 0.73±0.37 (P=0.037) at postoperative 6 months, with no significant difference between the two groups. Complications occurred in four eyes in the IOL refixation group and in three eyes in the IOL exchange group. PFCL and fibrin glue-assisted IOL sutureless scleral refixation or exchanged fixation was an effective surgical treatment for IOL dislocation. Also, because postoperative BCVA, surgical outcomes, and complications did not differ significantly between IOL refixation and exchange surgery, if IOL exchange surgery is not indicated, IOL refixation surgical techniques should be considered.

This Issue At A Glance

Indications and Outcomes of Intraocular Lens Exchange During a Recent 5-Year Period

Purpose: To evaluate the clinical features of high myopic eyes with cataracts implanted with negative power intraocular lenses (IOLs) at the time of cataract surgery. Methods: A retrospective chart review was conducted of 18 eyes of 14 patients who underwent cataract surgery with negative power IOLs and 10 eyes in 9 patients with low power IOLs. We investigated axial length, IOL power, preoperative and postoperative best-corrected visual acuity (BCVA) and preoperative and postoperative spherical equivalent (SE) refractive errors. Results: Mean BCVA showed significant improvement in both groups. We measured postoperative SE refraction and the difference between the mean intended and the mean achieved SE refractive errors in the negative power group (17 eyes) was +1.59 ± 1.34 D and +0.31 ± 0.50 D in the low power group. Conclusions: BCVA was significantly improved in the majority of eyes, although they had myopic macular degeneration or posterior staphyloma. However, the mean achieved postoperative SE refraction was more hyperopic than the predicted postoperative SE error. Additionally, hyperopic refractive error was greater in the negative power group than the low power group. Therefore, we recommend that postoperative hyperopic refractive error should be considered when performing cataract surgery in high myopic patients. J Korean Ophthalmol Soc 2016;57(6):898-904

To evaluate the visual outcome of intraocular lens (IOL) exchange for the management of myopic shift in pseudophakic children. The medical records of children who underwent IOL exchange for myopic shift were examined. The preoperative data, operative details and the postoperative outcome were analyzed. Twenty-one eyes (16 patients) were identified. Mean age at cataract extraction was 20 ± 26 months (range, 2-84 months). Twelve patients (6 unilateral, 6 bilateral) had primary IOL implantation. Mean age at IOL exchange was 7.3 ± 3.2 years. Mean spherical equivalent (SE) at IOL exchange was -14 ± 5 D (range, -7 to -21 D): Mean SE at IOL exchange was -13.64 ± 4.99 D, -12 ± 1.53 D, and -15.5 ± 4.7 D in unilaterally pseudophakic cases (8 patients), in the eye that underwent unilateral IOL exchange (3 patients) in bilaterally pseudophakic cases, and in bilateral IOL exchange cases (5 patients), respectively. Mean axial length at IOL exchange was 24 ± 1.3 mm (range, 23 to 27 mm). Following IOL exchange, mean SE was reduced to -2 ± 1.8 D (range, -4 to +2.5 D). An average of three logMAR line improvement in the best-corrected visual acuity was observed in 12/16 eyes of patients for whom pre- and post-exchange visual acuity were available, while visual acuity remained unchanged in 4 eyes. Mean logMAR visual acuity improvement was 0.35 and 0.49 in unilateral and bilateral pseudophakic cases, respectively. IOL exchange is a safe procedure that should be considered to improve visual rehabilitation in pseudophakic patients with myopic shift.

Purpose:To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia.Methods:In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant.Results:Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability.Conclusion:We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Possible Predisposing Factors for In-the-Bag and Out-of-the-Bag Intraocular Lens Dislocation and Outcomes of Intraocular Lens Exchange Surgery

To investigate the changes in choroidal thickness (CT) in high myopic eyes after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery or central hole implantable collamer lens (ICL V4c) implantation using swept-source optical coherence tomography (SS-OCT). We examined the right eyes of 116 patients with high myopia who were candidates for FS-LASIK surgery and ICL implantation. Sixty eyes underwent ICL V4c implantation and 56 eyes were subjected to FS-LASIK surgery. The CT was measured with SS-OCT. All data were recorded preoperatively and 2h, 1wk, 1 and 3mo postoperatively. Other demographic information was collected, including age, sex, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP) and axial length (AL). The UCVA improved in both groups and showed no significant differences between groups. There also were no significant differences between the two groups in postoperative BCVA and SE (P=0.581 and 0.203, respectively). The foveal CTs, inner nasal and outer nasal CTs were significantly thicker at 2h postoperatively in both groups (P<0.05) but returned to baseline levels in 1wk; after 1mo, no significant differences were found relative to the preoperative values. At 3mo in each group, nine regions showed variations in the CT as compared with preoperative thickening, but only the foveal and nasal area CTs preoperative differences were statistically significant (P<0.05). In addition, there was no significant difference in 9 regions of CT between the two groups at all follow-up times (P>0.05). The CTs after ICL implantation and FS-LASIK surgery are significantly thicker than those before operation, especially in the foveal and nasal areas, but there is no significant difference between the two methods.

Lacquer crack formation after LASIK

Purpose: We evaluated the difference in clinical outcome according to the use of double-needle stabilizer in flanged intrascleral fixation of intraocular lens (IOL).Method: We retrospectively analyzed the medical records of 44 patients (44 eyes) who underwent flanged intrascleral fixation of IOL. Groups 1 and 2 (respectively) underwent surgery that did not and did employ a double-needle stabilizer. We evaluated the best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent (SE), refractive prediction error (RPE), IOL tilt and decentration, and other complications.Results: The postoperative BCVA, SE, and RPE did not differ between the two groups (&lt;i&gt;p&lt;/i&gt; = 0.672, &lt;i&gt;p&lt;/i&gt; = 0.131, &lt;i&gt;p&lt;/i&gt; = 0.247). IOL tilt was significantly less in group 2 than in group 1 (&lt;i&gt;p&lt;/i&gt; = 0.038, &lt;i&gt;p&lt;/i&gt; = 0.015 [horizontal and vertical]) (3.96 ± 2.01° horizontally and 4.17 ± 2.07° vertically in group 1; 2.59 ± 2.02° horizontally and 2.50 ± 1.92° vertically in group 2). IOL decentration was also significantly less in group 2 than in group 1 (&lt;i&gt;p&lt;/i&gt; = 0.001, &lt;i&gt;p&lt;/i&gt; = 0.004 [horizontal and vertical]) (0.44 ± 0.21 mm horizontally and 0.45 ± 0.20 mm vertically in group 1; 0.25 ± 0.09 mm horizontally and 0.27 ± 0.13 mm vertically in group 2).Conclusions: Use of a double-needle stabilizer during flanged intrascleral fixation of IOL significantly reduced postoperative IOL tilt and decentration, and may thus improve postoperative visual quality.

To present the visual outcome and postoperative complications of pars plana vitrectomy and intraocular lenses (IOL) removal with or without IOL exchange of late in-the-bag IOL dislocation after uneventful cataract surgery. Retrospective analysis of a consecutive series of 83 eyes with late in-the-bag dislocated IOL treated with pars plana vitrectomy and anterior chamber IOL (25 eyes), transscleral suture-fixated posterior chamber IOL (38 eyes), or aphakia (20 eyes). High myopia was the major predisposing factor (40%). The interval between cataract surgery and the dislocation was 10.9 years. The complication rate after the second surgery was 43%; being transient hypotony (19%) and hypertension (15%) the most frequent. Postoperative best-corrected visual acuity improvement was statistically significant (P < 0.001), with a mean of 3 Snellen lines. This improvement was also significant in 2 subgroups, patients with sutured posterior chamber IOL (20/80-20/40; P < 0.001) and in patients with anterior chamber IOL (20/125-20/40; P < 0.001). However, best-corrected visual acuity did not improve in aphakic patients (20/63-20/63; P = 0.13). Postoperative astigmatism increased significantly (P < 0.001), with a mean of -1 D. Mean follow-up was 24 months. The major predisposing factor for late in-the-bag IOL dislocation is myopia. Despite a complication rate of 43%, mostly minor and transient, IOL exchange surgery is an effective procedure with a good visual outcome (mean 3 Snellen lines improvement). There were no statistically significant differences in the final best-corrected visual acuity or complication rate between anterior chamber IOL and sutured posterior chamber IOL, thus, both surgical techniques may be considered to treat this condition.

Objectives:To define a haptic modification technique to increase the overall length of the intraocular lens (IOL) and evaluate the postoperative outcomes of patients in whom this technique was applied.Materials and Methods:The preoperative and postoperative characteristics of patients who underwent modified IOL implantation into the sulcus between May 2019 and December 2019 were evaluated. Modified Sensar AR40e lenses with hydrophobic acrylic optic and polymethylmethacrylate haptics were implanted to all eyes. Before implanting the IOL, the haptics were grasped with two toothless forceps and bent to elongate the total diameter of the IOL from 13.0 mm to 14.5 mm.Results:The study included 11 eyes of 11 patients who underwent modified three-piece IOL implantation into the sulcus due to insufficient capsular support. The mean age of the patients was 53.9±12.2 years. The mean axial length was 24.13±1.93 mm. Sulcus implantation was required due to aphakia in 9 eyes and IOL dislocation in 2 eyes. No haptic breakage occurred during the IOL modification technique or implantation. The mean preoperative best corrected visual acuity (BCVA) was 0.88±1.1 logMAR, while postoperative BCVA was 0.28±0.30 logMAR. No IOL dislocation or decentration was observed during 6-month postoperative follow-up.Conclusion:The larger diameter lenses obtained with this inexpensive and easily applicable technique may allow a more stable sulcus implantation in eyes with inadequate capsular support.

To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005. The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared. Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562+/-0.279 and 0.627+/-0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test). The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.

This study aimed to compare the outcomes of flanged intraocular lens (IOL) fixation with new IOL exchange after dislocated IOL removal and repositioned dislocated IOL in patients with IOL dislocation. Eighty-nine eyes that underwent flanged IOL fixation were retrospectively included, with 51 eyes in the exchanged IOL group and 38 eyes in the repositioned IOL group. In both groups, best-corrected visual acuity (BCVA) improved at 1, 3, 6, and 12 months postoperatively and did not differ between the two groups at any of these time points. However, at 1 week postoperatively, BCVA in the repositioned IOL group improved compared with baseline, whereas that in the exchanged IOL group did not. Moreover, there were lesser changes in the corneal endothelial cell density (ECD) and corneal astigmatism in the repositioned IOL group than in the exchanged IOL group. The IOL positions, including IOL tilt and IOL decentration, were not different between the groups. Flanged IOL fixation with new IOL exchange and with repositioned dislocated IOL for patients with IOL dislocation had similar visual outcomes and IOL position. However, the latter had a smaller corneal ECD decrease and astigmatic change. This technique was effective in treating IOL dislocation while minimizing corneal injury.

To report the indications and outcomes of intraocular lens (IOL) exchange at a tertiary referral center in northern China over a period of 8 years. Setting: Ophthalmology departments of Hebei Eye Hospital, Hebei, China. Design: Retrospective cross-sectional study. In this retrospective study, the medical records of 233 patients with a history of IOL exchange were reviewed between 2016 and 2024. These cases were reviewed to determine surgical indications, the type of intraocular lens removed, the type of intraocular lens implanted, the time between operations, surgical complications, and visual outcomes. All postoperative data were analyzed at least six months after follow-up. The mean age of our participants was 50.05 ± 21.76 years (range 5–82 years), with a male percentage of 65.67%. The mean time between primary surgery and IOL exchange was 6.64 ± 6.16years (range 0.01–30 year). The main indications of IOL exchange were IOL dislocation (63.37%) and IOL opacification (21.81%). The most common ophthalmic comorbidity was high myopia. Procedures for secondary IOL implantation were scleral fixated IOL with sutures (34.16%), IOL in ciliary sulcus (26.75%), in-the-bag IOL (26.31%) and Iris fixation IOL (7.82%). The mean postoperative corrected distance visual acuity (CDVA) was significantly higher compared to the mean preoperative CDVA (p = 0.00). The mean preoperative and postoperative IOP were 16.23 ± 4.92 and 14.84 ± 3.05 mmHg, respectively (p = 0.00). No serious complications ware observed. IOL dislocation is the most common indication of intraocular lens implantation, followed by IOL opacification. Simultaneous scleral-sutured fixation after IOL replacement is the most common procedure in secondary IOL implantation.