Fixation Of Foldable Intraocular Lens Research Articles

A retrospective analysis of surgical outcome in sutureless glueless scleral fixation of foldable intraocular lens.

Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts. This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India. The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon's experience in influencing outcomes has been evaluated. The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.

Sulcus Fixation of Foldable Intraocular Lenses Guided by Ultrasound Biomicroscopy.

Background. To evaluate the clinical efficacy of suture fixation of foldable intraocular lens (IOL) in ciliary sulcus guided by ultrasound biomicroscopy (UBM). Methods. Thirty-five eyes of 32 cases needing suture fixation of foldable IOL in ciliary sulcus in our hospital were collected and divided into two groups: group A and group B. In group A, UBM was performed on 19 eyes of 17 cases before surgery to locate the projection position of ciliary sulcus in iris surface. In group B, the traditional sulcus fixation of IOL was performed on 16 eyes of 15 cases. The inserting position of needles, the haptics position of IOL and the IOL tilt, and decentration were observed by UBM examination 3 months after the surgery. Meanwhile, the vision and contrast sensitivity were analysed. Results. The differences in inserting position of the needle, the IOL tilt and decentration, the ratio of IOL haptics in sulcus, and uncorrected visual acuity were statistically significant (P < 0.05). The differences in best corrected visual acuity (BCVA) and contrast sensitivity were not statistically significant (P > 0.05). Conclusions. Sulcus fixation of foldable IOL aided by UBM can increase the accuracy of IOL haptics implanted into ciliary sulcus and reduce the IOL tilt and decentration.

Transscleral fixation of a single-piece hydrophilic foldable acrylic intraocular lens.

To evaluate the results of transscleral fixation of foldable hydrophilic acrylic intraocular lenses (IOLs). Twenty eyes of 16 patients, aphakic after phacoemulsification (PE) surgery and with at least 6 months follow-up, were included in the study. All eyes were implanted with single-piece hydrophilic foldable acrylic lenses by transscleral fixation, either with PE surgery (2 eyes) or secondarily. Follow-up was 11.6 months (SD 4.85, range 6-20 mo). Age was 62.3 years (SD 12.95, range 18-78 y); 10 patients were women. Preoperative best corrected visual acuity (BCVA) was 0.20 (SD 0.14, range 0.1-0.3) in eyes with primary IOL implantation and 0.53 (SD 0.12, range 0.3-0.7) in secondary implantation. Astigmatism was 1.4 D (SD 1.19, range 0.25 to 5.0 D). Postoperatively, transient corneal edema developed in 6 eyes (30%) and transient IOP elevation in 2 eyes (10%). BCVA was 0.69 (SD 0.15, range 0.4-0.9), astigmatism was 0.84 D (SD 0.80, range 0.25 to 3.0 D), both p < 0.01. Spherical refractive error was -0.38 D (SD 0.47, range +0.75 to -1.25 D). Cystoid macular edema was observed in 2 eyes (10%). No IOL decentration was observed on biomicroscopy in any eye with undilated pupil; IOL decentration with no effect on vision was observed in 3 eyes (15%) after pupil dilation. No IOL tilt, retinal detachment, suture exposure, or endophthalmitis was observed. Scleral fixation of foldable IOLs may be preferred in eyes with insufficient zonular and capsular support. This technique reduces surgery time and complications, and it provides early visual rehabilitation.

Secondary Intraocular Lens Implantation for Pediatric Aphakia

We sought to report the outcome of secondary intraocular lens (IOL) implantation in children. This was a retrospective case review. A total of 77 eyes were identified. An average age at secondary implantation was 7.8 +/- 5.0 years, whereas the average age at primary cataract surgery was 1.5 +/- 2.6 years. Average follow-up was 2.7 +/- 1.9 years. Thirty eyes received a hydrophobic acrylic IOL implantation whereas 47 eyes received a PMMA IOL. The sites of fixation for implanted IOLs were as follows: anterior-chamber (n = 6), sulcus (n = 42), in-the-bag (n = 14), optic-capture (n = 6), piggyback (n = 4), and sutured (n = 5). Complications included clinically significant decentration, 4 (5.2%); visual axis opacification, 4 (5.2%); dislocation of the IOL, 2 (2.6%); and pupillary capture requiring repositioning of IOL, 1 (1.3%). Clinically significant decentration requiring surgical intervention was noted only in eyes with sulcus-fixated foldable IOLs (28.6%; 4/14). None of the 29 eyes with sulcus-fixated PMMA IOL implantation developed decentration. All the decentrations were in an inferior direction and occurred in eyes of male patients (P = 0.03). Eyes with an axial length of >23 mm were 4 times more likely to develop decentration if implanted with a sulcus-fixated foldable IOL when compared with eyes measuring <23 mm (P = 0.03). Postoperative geometric mean visual acuity was significantly better than preoperative visual acuity (P < 0.001). Secondary IOL implantation can be safely achieved in pediatric eyes. In-the-bag fixation of foldable IOLs is associated with a low rate of complications. Foldable lenses appear to have a higher rate of decentration than PMMA lenses when placed in the sulcus in eyes of myopic male patients.

Transscleral fixation of foldable intraocular lens after pars plana lensectomy in eyes with a subluxated lens

Two patients had a subluxated crystalline lens: one with Marfan’s syndrome and the other with traumatic cataract. A pars plana lensectomy with transscleral fixation of a foldable silicone intraocular lens rather than a conventional poly(methyl methacrylate) lens was performed. Excellent, rapid visual rehabilitation was obtained using this small incision technique.