Ciliary Sulcus Suture Fixation Research Articles

Long-term outcomes of transsclerally sutured intraocular lens correctly fixed in the ciliary sulcus

ObjectiveTo report the long-term postoperative outcomes of transsclerally sutured intraocular lenses (IOLs), in which the haptics were correctly fixated into the ciliary sulcus using an auxiliary device and endoscope.Methods and...

New device for ciliary sulcus suture fixation of intraocular lens Reply:

New device for ciliary sulcus suture fixation of intraocular lens Reply:

Efficacy of ciliary sulcus suture fixation of intraocular lens through reverse partial-thickness scleral flap

Efficacy of ciliary sulcus suture fixation of intraocular lens through reverse partial-thickness scleral flap

Ciliary sulcus suture fixation of intraocular lens using an auxiliary device

We developed an injector with a tip that matches the shape of the ciliary sulcus (Ciliary Sulcus Pad Injector) and is used in ciliary sulcus suture fixation of intraocular lenses. The injector is inserted through the corneal incisions and slid along the posterior surface of the iris to the opposite side. When the tip of injector is fitted in the ciliary sulcus, the plunger is pressed, causing the needle to pierce the ciliary sulcus. A suture is inserted in the ciliary sulcus without direct observation. In 91.4% of cases, the needle correctly pierced the ciliary sulcus in a single attempt. The difference between the preoperative expected refractive power and the postoperative spherical equivalent power was -0.63 diopter 6months after surgery.

The efficacy of surgery for removal of intraocular lens which prolapsed into vitreous

Objective To evaluate the surgical efficacy of surgery for removal of posterior chamber intraocular lens which prolapsed into the vitreous. Methods From Oct. 2012 to Oct. 2017, the data of 16 eyes of 16 patients with intraocular lens prolapsed into vitreous were analyzed restropectively. The cause was ocular contusion in 11 eyes, after cataract surgery without history of trauma in 5 eyes. The best corrected visual acuity before operation was CF-0.1. Vitrectomy was performed via the standard pars plana closed incision. The perfluorocarbon liquid of 0.5-3.5 ml was injected during operation, and intraocular lens was removed through the tunnel of the corneal limbus. All cases received IOL suture fixation in the ciliary sulcus.The postoperative visual acuity, intraocular pressure, intraocular lens position and complications were observed. Results The intraocular lens were successfully removed in 16 eyes. Thirteen eyes received the posterior chamber intraocular lens with ciliary sulcus suture fixation in one stage, and the visual acuity was improved. The best corrected visual acuity was 0.1-0.5. Postoperatively hypotony occurred in 1 eye, hypertension occurred in 3 eyes, and the intraocular pressure returned to normal after drug treatment. No complication such as intraocular lens decentration or dislocation, suture knot exposure or vitreous hemorrhage occurred. Conclusion Vitrectomy combined with intraocular lens removal and ciliary sulcus stature fixation for the treatment of the intraocular lens prolapsed into the vitreous can obviously improve visual acuity and prevent complications. Key words: Dislocation, lens, intraocular; Removal, lens, intraocular; Suture fixation; Ciliary groove

Anatomy of the ciliary sulcus and the optimum site of needle passage for intraocular lens suture fixation in the living eye

To determine the relationship of the anatomic position of tissue surrounding the ciliary sulcus using ultrasound biomicroscopy (UBM) for measurement of ciliary sulcus parameters and the surrounding tissue after intracapsular cataract extraction (ICCE) and determine the correct suture site for intraocular lens (IOL) suture fixation. Sugiura Eye Clinic, Asahi General Hospital, Shizouka-ken, Japan. Prospective case series. Using UBM, the angle of the ciliary sulcus and several areas of the tissue surrounding the ciliary sulcus were measured from 8 orientations in eyes after ICCE. These measurements and endoscopic observation of the ciliary sulcus indicated the optimum points of needle insertion and needle emergence on the sclera for IOL suture fixation. Endoscopic observation of the ciliary sulcus also showed its shape. The shape of the surrounding tissue of the ciliary sulcus was measured in 16 eyes after ICCE, and endoscopy was used to observe the ciliary sulcus during surgery in 150 eyes. For ab interno ciliary sulcus suture fixation, the correct point of needle emergence on the sclera was 2.5mm from the posterior surgical limbus when a straight needle was used. For ab externo pars plana suture fixation, the correct point of needle insertion on the sclera was 3.0mm from the posterior surgical limbus. Endoscopic observation showed that the lower surface of the ciliary sulcus was formed by the fusion of neighboring ciliary processes. Knowing the detailed shape of ciliary sulcus will allow for more precise IOL suture fixation.

The efficacy of different methodes of surgery for traumatic luxation of lens

Objective To observe clinical efficacy of different surgical treatment for traumatic luxation of lens. Methods The data of 39 eyes of 35 cases with traumatic luxation of lens were selected, including lens subluxation 18 eyes of 16 cases, lens complete dislocation 21 eyes of 19 cases. Some cases combined with retinal detachment, vitreous opacity or secondary glaucoma. For the patients with subluxation of lens and the dislocation range ≥180°, without retinal detachment, received three channel vitrectomy and lensectomy, combinded with ciliary sulcus suture fixation of intraocular lens implantation. Phacoemulsification and intraocular lens implantation were performed in paitents with the incomplete dislocation range <180°. For the patients with complete dislocation of the lens, the intracapsular extraction were performed. During the following period, the clinical treatment efficacy was observed. Results All patients underwent operation successfully. The intraocular pressure was (32.5±3.7) mmHg before surgery, >21 mmHg in 28 cases. The visual acuity was 1.4±0.2 (logMAR) in preoperative. One month after surgery, the IOP was (17.3±2.6) mmHg and the visual acuity was (0.2±0.1), IOP>21 mmHg in 4 cases. The difference in intraocular pressure and visual acuity were statistically sinificant (P<0.05). Followed up for 3-6 months, no obvious complication happened. Conclusion Targeted surgical treatment for traumatic luxation of lens is helpful to reduce the intraocular pressure, and improve visual acuity. Key words: Luxdtion, lens, traumatic; Treatment; Surgery

The comparison of two surgical methods for the treatment of traumatic complete luxation of lens

Objective To compare the efficacy between the two surgical methods for the treatment of traumatic complete luxation of lens into vitreous. Methods The data of 53 eyes of 53 cases with traumatic lens luxation fallen into vitreous cavity treated by different ways of surgery were collected.The patients were randomly divided into two groups. In group A, the patients underwent vitrectomy combined with lens extracted through limbus of cornea, intraocular lens ciliary sulcus suture fixation at the second stage. In group B, the patients underwent vitrectomy combined with the ultrasonic phacoemulsification and implantation of intraocular lens.Complication after surgery, vision after surgery, intraocular pressure were analyzed. The follow-up period was 3 months to 2 years. Results Of 24 cases in group A, 14 cases were effective, with visual acuity≥0.2 (58.33%). 10 cases (41.67%) had visual acuity≤0.1. Of 29 cases in group B, 27 cases were effective(93.10%). The comparison of significant therapeutic effect and therapeutic effect between two goupes had statistical significance(χ2=9.06, P=0.003). The intraoperative and postoperative complications were observed in 14 cases(58.33%) in group A and 6 eyes(20.69%) In group B. The difference between the two groupes in complications as statistically significant(χ2=7.92, P=0.049). Conclusion The vitrectomy combined with the ultrasonication of crystalline lens may be more safe and effective for traumatic lens dislocation. The patients can have good final vision after surgery. Key words: Luxation of lens, complete, traumatic; Vitrectomy; Phacoemulsification, ultrasonic; Lens, intraocular, sutural fixing

Clinical research of different surgical modes for the treatment of severe capsule contraction syndrome

Objective To observe the clinical effect of different surgical methods for the treatment of severe capsule contraction syndrome. Methods Twenty-three eyes of 23 cases of severe capsule contraction syndrome were treated with operation. According to the condition of patients, 12 eyes underwent anterior capsulotomy with intraocular lens(IOL) adjustion in the capsule, 6 eyes underwent anterior capsulotomy with IOL ciliary sulcus fixation, and 5 eyes underwent IOL removal with vitrectomy and IOL ciliary sulcus suture fixation. The follow-up time was 3 months, and the visual acuity, anterior chamber reaction, position of intraocular lens, condition of the anterior and posterior capsule were measured respectively. Results The visual acuity improved postoperatively in all eyes. The size of the transparent area of the capsularhexis holes which underwent anterior capsulotomy significantly increased comparing with that before surgery. The complications such as glare and monocular diplopia in 6 cases disappeared after Nd: YAG laser posterior capsulotomy 1 month after the operation. Among the three different kinds of surgery procedures, postoperative best corrected visual acuity were all improved evidently one month after the surgery. The differences were statistically significant when compared with that of preoperation (P 0.05). Anterior chamber reaction of IOL ciliary sulcus suture fixation cases was the most obvious one, and it returned to normal within a week after appropriate treatment. The IOL were all centered in the capsule, and no other complication was observed during the follow-up of 3 months after operation. Conclusion Various surgical methods for severe capsular contraction syndrome are effective, satisfactory and safe.The right operation methods should be chosen according to the patients' condition. Key words: Cataract; Capsule contraction syndrome; Treatment, surgical

Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

Severe ocular trauma requires emergency surgery, and a fresh corneal graft may not always be available. We describe a case of perforating eye injury with corneal opacity, suspected endophthalmitis, and an intraocular foreign body. The patient was successfully treated with a two-step procedure comprising endoscopy-guided vitrectomy followed by corneal transplantation. This surgical technique offers a good option to vitrectomy with simultaneous keratoplasty in emergency cases where no graft is immediately available and there is the possibility of infection due to the presence of a foreign body. A 55-year-old Japanese woman was referred to our hospital with a perforating corneal and lens injury sustained with a muddy ferrous rod. Primary corneal sutures and lensectomy were performed immediately. Vitreoretinal surgery was required due to suspected endophthalmitis, vitreous hemorrhage, retinal detachment, dialysis and necrosis of the peripheral retina. Instead of conventional vitrectomy, endoscopy-guided vitreous surgery was performed with the Solid Fiber Catheter AS-611 (FiberTech, Tokyo, Japan) due to the presence of corneal opacity and the unavailability of a donor cornea. The retina was successfully attached with the aid of a silicon oil tamponade. Following removal of the silicon oil at 3 months after surgery, penetrating keratoplasty and intraocular lens implantation with ciliary sulcus suture fixation were performed. At 6 months after penetrating keratoplasty, the graft remained clear and visual acuity was 20/40. Primary endoscopic surgery for vitreoretinal complications in eyes with perforating injury performed prior to penetrating keratoplasty appears to be advantageous in terms of avoiding damage to the corneal endothelium.

Two techniques of posterior chamber intraocular lens (IOL) implantation by a 4-point ciliary sulcus suture fixation technique combined with vitrectomy

To observe the results of two techniques of posterior chamber intraocular lens (IOL) implantation by a 4-point ciliary sulcus suture fixation combined with vitrectomy. Lensectomy and vitrectomy combined with posterior chamber IOL implantation by a 4-point scleral fixation was performed in 23 cases with complicated ocular trauma, including 9 eyes had eyeball rupture, vitreous hemorrhage, retinal contusion and traumatic cataract; 6 eyes having eyeball rupture, vitreous hemorrhage, retinal contusion, intraocular foreign body and traumatic cataract; 8 eyes having ocular blunt trauma, vitreous hemorrhage, traumatic cataract and lens dislocation. Two techniques of IOL were randomly assigned: Alcon CZ70BD PMMA suspensory IOL was performed in 12 cases (Group I); Bausch & Lomb Akreos Adapt four-haptic hydrophilic acrylic foldable IOL was performed in 11 cases (Group II). After completed vitrectomy, removed intraocular foreign body and (or) cataract extracted, one-stage IOL implantation by 4-point scleral fixation was performed and the knots of fixation sutures were rotated and buried under the sclera for all patients. The IOL position was adjusted by suture for the best centration. The mean follow-up time was (12.4 +/-1.7) months. The postoperative best-corrected visual acuity (BCVA) was improved in 11 cases (91.7%) of Group I; and BCVA was > or =0.5 in 3 patients(25.0 %). The postoperative BCVA was improved in 11 cases (100 %) of Group II; and BCVA was > or =0.5 in 4 eyes (36.4%). There was no IOL decentration or tilting in two groups. Lensectomy and vitrectomy combined with posterior chamber IOL implantation by a 4-point scleral fixation technique is a good method to treat complicated ocular trauma. Two techniques of posterior chamber IOL have both advantages and disadvantages, and can be used accordingly.