Fixation Of Intraocular Lens Research Articles

Clinical Features, Risk Factors, and Outcomes Following Surgery for Late Intraocular Lens Decentration in the Dead Bag Syndrome.

To evaluate demographic profile, risk factors, and outcomes following intraocular lens (IOL) exchange surgery for late decentration of IOLs in dead bag syndrome DESIGN: Prospective, interventional case series METHODS: This was a study conducted at Raghudeep Eye Hospital, India. Explantation of the decentered/dislocated IOL along with pars plana vitrectomy and intrascleral fixation of a 3-piece foldable IOL using the Yamane technique was performed for all eyes. A total of 46 eyes (43 patients) with late decentration/dislocation of IOLs and spontaneous posterior capsule rupture in a clear and relatively intact capsular bag were treated. None of the eyes had significant zonular weakness. The main outcome measures were demographic profile, associated risk factors, visual outcomes and postoperative complications following IOL exchange in dead bag syndrome. A total of 30 eyes had in-the-bag IOL decentration and 16 had total dislocation of the IOL into the vitreous cavity. The mean (SD) age was 68.7 ± 8.9 years, and 91% patients were male. Of the patients, 36 had unilateral IOL disease, whereas 7 had bilateral dead bag syndrome, with or without clinically significant IOL decentration. The mean duration from primary cataract surgery to re-operation was 16.8 years. More than 50% eyes had axial myopia (axial length >24 mm). Only 4 eyes (9.3%) had associated pseudoexfoliation. Mean (SD) follow-up after IOL exchange surgery was 10.9 ± 9.8 months. The single-piece hydrophobic acrylic IOL was the most commonly explanted IOL. Intraoperatively, a Soemmering ring was seen in 71.7% (31) eyes. Of the eyes, 87% had an improvement in corrected-distance visual acuity (CDVA) following surgery, with 95% of eyes having a CDVA of ≤0.3 logMAR. Postoperative complications were a transient IOP spike in 8 (17%) eyes and cystoid macular edema in 6 eyes (13%). Three eyes had pre-existing glaucoma, which remained controlled at final follow-up. The major risk factors for dead bag syndrome were male sex, axial myopia, and duration of posterior capsule rupture event from the cataract surgery. Bilaterality and presence of the Soemmering ring in the majority of cases were new observations warranting further research. Outcomes following surgery were satisfactory.

Simplified Technique for Correcting Intraocular Lens Decentration in Scleral-Sutured Fixation Surgery.

To describe a simplified technique for correcting intraocular lens (IOL) decentration during scleral-sutured IOL fixation surgery. During surgery, Purkinje images were utilized to assess IOL positioning. A straightforward IOL decentration adjustment technique was employed when necessary. Patients in whom IOL position were corrected and who were followed up for at least three months after surgery were included in the study. From June 2023 to February 2024, six patients with noticeable IOL decentration were successfully treated using this technique. After a mean follow-up of 3.17 ± 0.37 months, there was a significant change in spherical equivalent (preoperative +10.55 ± 2.48 D, postoperative -1.58 ± 2.19 D). While the best-corrected visual acuity, refractive cylinder, intraocular pressure, and corneal endothelium density remained unchanged. Importantly, the IOL was well-centered in all six patients, with average horizontal and vertical IOL decentration of 0.21 ± 0.16 mm and 0.20 ± 0.15 mm, respectively. This simple IOL decentration correction technique demonstrated favorable results and may enhance IOL positioning in scleral fixation procedures.

Evaluation of a modified sutureless technique for scleral fixation of one-piece posterior chamber intraocular lens: a retrospective study.

This study presents the one-year outcomes of a modified technique for transscleral suture fixation of a posterior chamber intraocular lens (PCIOL) in aphakic eyes. A retrospective chart review was conducted on 45 patients who underwent transscleral suture fixation of a foldable one-piece PCIOL through scleral pockets. Preoperative data and follow-up data for a minimum of 12 months were collected for all patients. The mean preoperative and postoperative uncorrected distance visual acuity (UDVA) in LogMAR was 2.49 ± 0.54 and 0.54 ± 0.25, respectively (p < 0.01). The mean preoperative and postoperative best-corrected visual acuity (BCVA) in LogMAR was 0.52 ± 0.22 and 0.45 ± 0.24, respectively (p < 0.01). The mean endothelial cell loss was 110.46 ± 11.5 cells/mm2. Postoperative complications included transient corneal edema (17.7%), transient elevated intraocular pressure (22.2%), and non-significant vitreous hemorrhage (11.1%). No severe complications were observed. The modified technique provides stable PCIOL placement in aphakic eyes with long-term follow-up.

Long-term outcomes of scleral fixated black diaphragm intraocular lens in eyes with combined aphakia and aniridia

Purpose To evaluate long-term anatomical and functional outcomes in eyes undergoing scleral fixation of aniridic black diaphragm intraocular lens (BDIOL). Methods Total 38 eyes that underwent scleral fixation of BDIOL for secondary aniridia following ocular trauma with aphakia with absent posterior capsule or primary congenital aniridia with subluxated lens were retrospectively analyzed. Final visual acuity, early and late complications were examined. Correlation analysis was done. Results The mean follow-up was 28 months (range 6 to 66 months). The mean preoperative visual acuity of 1.82 ± 0.90 logMAR improved to 0.69 ± 0.61 ( p = 0.00). The mean spherical equivalent refractive error of 7.88 ± 4.85 diopters improved to −0.69 ± 1.52( p = 0.00). Complications were seen in 9 eyes (23.6%). Early complications were raised intraocular pressure (IOP) in 2 eyes and one eye with suture site infection which were managed conservatively. Late complications were corneal decompensation 3eyes (7.8%), retinal detachment, hypotonic maculopathy and refractive surprise in 1 eye each (2.6%). None reported IOL tilt or dislocation. The patients noticed a significant reduction in glare disability and photophobia. No significant association was found between pre-operative factors such as prior surgical procedures, history of trauma and length of follow-up with surgical outcomes. Conclusions Scleral fixation of BDIOL is an effective option in eyes with aniridia and aphakia without capsular support that have undergone multiple previous surgeries. Despite severe damage, the BDIOL helps reconstruct the anterior segment and give a good quality of vision with minimal complications rate.

Modified Canabrava technique with a 4-closed loop intraocular lens injected into the anterior chamber

The goal of this study was to describe and assess the efficacy of a new modification for scleral fixation of a 4-eyelet foldable intraocular lens (IOL) using a previous IOL injector in the anterior chamber. An uncontrolled case series was used to investigate the efficacy of this new modification of the original Canabrava technique. Intraocular pressure and visual acuity data were obtained preoperatively and postoperatively. Surgeries were performed with the new modification of the Canabrava technique in 12 patients with implantation incisions as small as 2.2 mm (3.2 to 2.2 mm). The follow-up period ranged from 1 to 13 months. Corrected distance visual acuity improved significantly in all 12 patients, from 0.38 to 0.31 logMAR, whereas the cell count from specular microscopy decreased in average (preoperatively 2191 cells/mm2; postoperatively 1843 cells/mm2) and median (preoperatively 2225 cells/mm2; postoperatively 1902 cells/mm2). This current modification of the Canabrava technique greatly simplifies the procedure, making it easier and faster and with a shorter learning curve.

Anterior chamber and retropupillary iris-claw intar ocular lens fixation comparison of clinical outcomes: a systematic review

Background: In cataract surgery, optimal intraocular lens (IOL) placement is typically within the capsular bag. However, in the absence of sufficient capsular support, alternative techniques such as scleral-sutured IOLs, anterior chamber IOLs, and iris-fixated IOLs either in the anterior chamber or retropupillary are employed. The choice between these methods depends on factors like surgeon expertise, patient-specific anatomy, and clinical circumstances, with anterior chamber iris-claw IOLs offering a more straightforward approach and retropupillary techniques potentially providing additional benefits requiring advanced skills. Objective: This systematic review aims to evaluate the clinical outcomes of anterior chamber versus retropupillary iris-claw IOLs fixation. Methods: Adhering to the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, a comprehensive literature search was conducted using PubMed, Cochrane Central, Scopus, and Web of Science databases until May 2024. These searches focused on specific terms related to the methods, and data were extracted using a standardized online sheet. Results: The review encompassed nine studies, including two randomized control trials (RCTs) and seven observational studies (Cohort and case controls). A total of 714 patients were evaluated, comprising 295 females (41.3%) and 419 males (58.7%), with a mean age of 60.11 years (SD = 10.22). Conclusion: The studies underscore the ongoing debate regarding the optimal surgical approach for IOL implantation in cases of insufficient capsular support. Both anterior chamber and retropupillary techniques demonstrates efficacy, with the latter offering potential advantages through retropupillary iris-claw IOL implantation via scleral approach. However, larger-scale studies with longer follow-up periods are still needed to definitively establish the relative merits of the different procedures.

Recent advances and current challenges in suture and sutureless scleral fixation techniques for intraocular lens: a comprehensive review

AbstractOver the past two decades, both suture and sutureless techniques for scleral fixation of intraocular lenses have seen significant advancement, driven by improvements in methodologies and instrumentation. Despite numerous reports demonstrating the effectiveness, safety, and superiority of these techniques, each approach carries with it its own drawbacks, including an elevated risk of certain postoperative complications. This article delves into various surgical techniques for scleral fixation of posterior chamber intraocular lenses, discussing their procedural nuances, benefits, drawbacks, postoperative complications, and outcomes. Furthermore, a comparative analysis between suture and sutureless fixation methods is presented, elucidating their respective limitations and associated factors. It is hoped that this comprehensive review will offer clinicians guidance on how to individualize procedural selection and mitigate surgical risks, and thus achieve optimal visual outcomes. This review will also endeavor to provide guidance for future advancements in intraocular lens fixation techniques.

Method of intraocular lens fixation in patients with compensated glaucoma and cataract complicated by zonular weakness

Method of intraocular lens fixation in patients with compensated glaucoma and cataract complicated by zonular weakness

Trans-iris vertical intrascleral haptic fixation of IOL: The bypass technique in eyes with megalocornea.

Intrascleral haptic fixation of intraocular lens (IOL) is an extremely useful technique to provide visual rehabilitation in eyes with inadequate capsular support. It requires exteriorization of haptics along with tucking of haptics in the scleral groove preferably and conventionally in the horizontal meridian. In eyes with large corneal diameter, there is difficulty in tucking enough length of the haptics into the intrascleral groove, carrying the risk of slippage of haptics and decentration of IOL. To exteriorize a larger segment of haptic for tucking, we describe a novel technique that involves creation of scleral groove at the posterior limbus and exteriorization of haptic through a small peripheral iridectomy through the posterior limbus. This provides a larger segment of haptic to tuck into the groove that might prevent slippage and decentration of IOL in eyes with megalocornea.

Comparison of Physical Properties of Polypropylene Sutures and Knot Method to Prevent the Slippage of Sutured Scleral Fixation

Purpose: This study compared the physical properties of 9-0 and 10-0 polypropylene sutures used in scleral-sutured posterior chamber intraocular lens (PCIOL) fixation, with a focus on knot security and methods to prevent slippage.Methods: Tensile strength measurements were performed on 10-0 and 9-0 polypropylene sutures (Prolene™) using a material testing machine (Instron 5966 Load Frame, Model 2701-065 controller; Instron Corp., Norwood, MA). Various knotting techniques were evaluated, including a single fisherman’s knot and one, three, and five overhand knots tied around the haptic of a three-piece IOL. Knot thickness and area of the surgeon’s Knot were measured using microscopy and Image J® software, with statistical analysis conducted to compare the differences between the two suture types.Results: The 9-0 polypropylene sutures exhibited a significantly higher maximum tensile strength than the 10-0 sutures, particularly with a single fisherman’s knot (0.47 N vs. 0.52 N, p = 0.007; 0.27 N vs. 0.50 N, p &lt; 0.001). However, when multiple overhand knots were tied around the haptic, the 10-0 sutures showed increased tensile strength with more knots (0.11 N, 0.23 N, 0.33 N, p &lt; 0.05), whereas the 9-0 sutures did not (0.06 N, 0.31 N, 0.19 N). Notably, three overhand knots provided better stability than five knots (p &lt; 0.05). The knot area and thickness of the surgeon’s knot were significantly larger in the 9-0 sutures than in the 10-0 sutures (21,062.4 μm2 vs. 41,188.5 μm2, p &lt; 0.001; 160.1 μm vs. 195.6 μm, p = 0.021).Conclusions: Overhand knots increased friction between the suture and IOL haptic, enhancing knot security. However, in the 9-0 sutures, the higher rigidity caused the knots to loosen more easily, decreasing the tensile strength with more knots. This study suggests that three overhand knots are optimal for securing IOL haptics using both 9-0 and 10-0 sutures.

Scleral fixated intraocular lens techniques for the vitreoretinal surgeon: an update.

To describe recent evidence regarding surgical techniques for secondary scleral fixation of intraocular lenses (IOLs), with attention to information most relevant to the surgical practice of vitreoretinal surgeons. Recent studies have reported favorable outcomes in patients treated with scleral fixation of IOLs using Gore-Tex suture and flanged intrascleral haptic fixation (ISHF). ISHF can be achieved using trocar-cannulas or double needle-based techniques. Recent data has focused on refractive outcomes data, as well as postoperative complications related to specific IOL choices, including haptic breakage, rotation/ tilt, and opacification. Studies directly comparing Gore-Tex sutured and ISHF techniques offer additional insights. Favorable refractive and surgical outcomes can be achieved using both sutured and sutureless scleral fixation techniques. These techniques can be combined effectively with pars plana vitrectomy (PPV) and are thus well suited for the skillset of a vitreoretinal surgeon. Future studies on iris-based fixation techniques and IOL types not yet available in the United States will be of interest. As these techniques are more widely used, prospective data as well as longer term outcomes will continue to clarify their risk/benefit profile.

Postoperative complications of intrascleral intraocular lens fixation: A systematic review and meta-analysis.

Our systematic review and meta-analysis elucidates the postoperative complication rates associated with 3 major surgical approaches, including the scleral tunnel, glued, and flanged techniques, for sutureless intrascleral intraocular lens (IOL) fixation. An online search was performed for articles published in PubMed and EMBASE between January 1, 1975, and January 7, 2023. Original studies reporting postoperative complications of sutureless intrascleral IOL fixation were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The initial search yielded 1854 articles, from which 1797 were excluded; 57 and 51 were included in the qualitative synthesis and meta-analysis, respectively. Based on the meta-analysis, the postoperative complication rates of cystoid macular edema (5.7 %), retinal detachment (3.5 %), vitreous hemorrhage (8.8 %), and hypotony (5.5 %) were highest with the scleral tunnel technique. The glued technique had the highest complication rate for corneal edema (14.2 %). The rates of temporarily elevated intraocular pressure (9.9 %), iris capture (5.4 %), haptic exposure (6.5 %), and IOL decentration (7.3 %) were the highest with the flanged technique. The flanged technique had a significantly shorter operative time (median, 17.1 min) compared with the scleral tunnel (42.7 min) and glued (56.5 min) techniques. Postoperative best-corrected visual acuity with the flanged technique was significantly better than that with the other techniques (P = 0.017). This meta-analysis identified high postoperative complication rates related to the impact of surgical manipulations with the scleral tunnel technique and IOL placement stability with the flanged technique. These findings enable surgeons to minimize postoperative complications in high-risk patients.

The Etiology of Intraocular Lens Dislocation and Changes in Intraocular Pressure After Intrascleral Intraocular Lens Fixation Surgery.

Objectives This study aimed to identify the etiology and the direction of dislocation of the natural crystalline lens or intraocular lens (IOL) in IOL intrascleral fixation surgery and to determine the change in intraocular pressure (IOP) after surgery. Methods We retrospectively investigated the diagnosis, direction of lens and IOL dislocation, and IOP before and after surgery (preoperatively and one day, one week, and one month postoperatively) in 236 eyes from 228 patients who underwent IOL intrascleral fixation at Chiba University Hospital between February 2015 and September 2020. Results IOL intrascleral fixation was performed in 48 (20.3%) patients with long eye axis, 44 (18.6%) with pseudoexfoliation (PEX), 42 (17.8%) with intraoperative problems such as ciliary zonule rupture or posterior capsule rupture, 40 (16.9%) with a history of trauma, 34 (14.4%) with a history of vitrectomy, 21 (8.9%) with atopic dermatitis, six (2.5%) with genetic diseases such as Marfan syndrome, four (1.7%) with retinitis pigmentosa, and 58 (24.6%) with unknown causes. Downward IOL dislocation was the most common (52 cases), while IOL falling into the vitreous cavity was seen in 46 cases, aphakic eye in 31 cases, and anterior lens dislocation in 16 cases. In general, IOP was significantly lower at onemonth postoperatively than preoperatively. Specifically, in the trauma, PEX, and unknown causes groups, as well as the groups with anterior lens deviation, IOL fell into the vitreous cavity, and with IOL downward deviation, IOP was significantly lower. Conclusion IOP was significantly lower one month postoperatively than preoperatively after IOL intrascleral fixation. Patients who underwent IOL intrascleral fixation surgery were most commonly found to have long eye axis, PEX, and intraoperative problems. Downward deviation of the IOL or IOL falling into the vitreous cavity was most common. IOP was significantly lower one month postoperatively than preoperatively after IOL intrascleral fixation.

Simple ab externo lens capsule removal in intraocular lens reuse and intrascleral fixation for intracapsular lens dislocation: A case report.

This study aimed to report and recall a simple method to remove the lens capsule ab externo when performing intrascleral fixation of an intracapsular intraocular lens (IOL) dislocation with reuse of the IOL. A 43-year-old Japanese male patient underwent pars plana vitrectomy, phacoemulsification, and IOL fixation for rhegmatogenous retinal detachment in the right eye 10 years prior. A 3-piece IOL was intraocularly fixed during the initial procedure. In December 2023, the patient presented with intracapsular IOL dislocation in his right eye, causing the IOL to descend into the vitreous cavity enveloped by its entire capsule. During surgery, an intravitreal dislocated IOL was placed over the iris with the entire capsule. The haptics on 1 side of the IOL were placed outside the eye through the corneoscleral wound. Subsequently, the lens capsule and Soemmerring's ring surrounding the haptics were removed. After the haptics were placed back over the iris, the same extraction procedure was performed for the remaining haptics. The IOL was intrasclerally fixed using a flange technique through the intrascleral tunnel at the 4 and 10 o'clock positions. One week postsurgery, the best-corrected visual acuity of the right eye was 20/16, and the corneal endothelial cell density was recorded as 2923 cells/mm2 (preoperative: 1650 cells/mm2). In cases of 3-piece IOL dislocation, employing the ab externo technique for lens capsule extraction has been proven to be a straightforward and efficient method. This approach facilitates the removal of the lens capsule around the IOL. If subsequent damage to the IOL is identified, it allows for easy conversion to replacement.

Visual and refractive outcomes of trocar-assisted intrascleral three-piece intraocular lens fixation.

To report the visual and refractive outcomes of trocar-assisted sutureless intrascleral three-piece intraocular lens (IOL) fixation, and to compare the accuracy of different IOL power formulas in this setting. Twenty eyes of 20 patients who underwent trocar-assisted sutureless three-piece IOL scleral fixation were included. Two trocar-cannula systems were placed at 3 and 9 o'clock position creating 2.5 mm scleral tunnels. The haptics of a three-piece IOL were grasped with serrated retinal forceps, externalized through the scleral tunnels and fixed by making a flange. Prediction error (PE) was calculated as the actual postoperative spherical equivalent (SE) refraction minus the SE predicted refraction. The predicted SE was calculated using the Barret Universal II, Emmetropia Verifying Optical (EVO), Hoffer Q, Holladay 1, Holladay II, and SRK/T. At 6 months after surgery, corrected distance visual acuity improved from 0.66 ± 0.36 to 0.17 ± 0.13 logMAR (p < .001). The lowest median absolute PE was obtained by the Barrett formula (0.73D), followed by the EVO (0.81D), Holladay 1 (0.94D), SRK/T (0.98D), Hoffer Q (1.05D) and Haigis (1.64D) formulas. The highest percentage of eyes within ±1.00 D were obtained with the Barrett (60.0%), and EVO (55.0%) formulas. Although trocar-assisted intrascleral three-piece IOL fixation yields good visual results, the predictability of refractive outcomes is lower than in standard cataract surgery. All formulas showed a slight tendency towards a hyperopic refractive surprise.

Double-Suture Scleral-Fixated Intraocular Lens With 2 Polypropylene Sutures.

We present a modified technique in performing scleral fixation of a posterior chamber intraocular lens (IOL) using 2 pairs of double-armed 9-O polypropylene sutures and an ab-externo technique, in 2 patients with surgical aphakia after complicated cataract surgery. Two eyes of 2 patients underwent this modified technique by an experienced cataract surgeon (A.L.Y.) in 2022. We evaluated pre- and postoperative best-corrected visual acuity, perioperative complications, corneal endothelial cell density by specular microscopy, and IOL position by anterior segment optical coherence tomography and ultrasound biomicroscopy. Both patients achieved an improvement in best-corrected visual acuity from 20/50 to 20/30 and 20/80 to 20/50, respectively. There was a loss in endothelial cell count in both cases (8% and 23%, respectively). No complications were noted in both cases, and postoperative anterior segment optical coherence tomography and ultrasound biomicroscopy showed a stable scleral fixation of IOL at more than 20 months postoperatively. The utilization of 2 pairs of double-armed 9-O Prolene suture may provide a stronger alternative than conventional scleral fixation of IOL with single suture.

Refractive Outcome, Lens Power Calculation, and Surgically Induced Astigmatism After Four-Flanged Intrascleral Intraocular Lens Fixation.

To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulas in patients who underwent intrascleral IOL fixation using the four-flanged technique. This prospective, longitudinal, single-site, single-surgeon study's setting was the Department for Ophthalmology and Optometry, Medical University of Vienna, Austria. Patients who received IOL implantation via the four-flanged technique were followed up to 3 months after the operation. Refraction was measured using the Early Treatment of Diabetic Retinopathy Study visual acuity test at 4 m. Lens decentration, tilt, and aqueous anterior chamber depth were evaluated using anterior segment optical coherence tomography. The SRKT, Holladay 1, and Hoffer-Q formulas were used to assess prediction error (PE) and absolute error (AE). Correlations between axial length, keratometry, and white-to-white distance were subsequently evaluated. A total of 28 eyes of 28 patients were examined in this study. The application of all formulas resulted in a hyperopic PE (SRKT: 0.35 ± 0.86 diopters [D], Holladay 1: 0.36 ± 0.78 D and Hoffer-Q: 0.37 ± 0.73 D). There was no variation between the PE of different formulas discovered (P > .05). The AE was within 0.50 D in 54% to 61% and within 1.00 D in 79% of eyes, depending on the formula used. Furthermore, Cochrane's Q test detected no significant distinctions between formulas (P > .05). The PE of each formula demonstrated a significant correlation to the axial length of the eyes (P < .05). The correlation estimates ranged from -0.25 D/mm to -0.39 D/mm, subject to the applied formula. This study demonstrates that the four-flanged technique for scleral IOL fixation yields reliable outcomes. PE was closest to zero using the Hoffer-Q formula, although there was no statistically significant difference compared to the other formulas. Axial length emerged as the most pertinent factor for PE. Short eyes resulted in a more hyperopic outcome, whereas longer eyes resulted in a more myopic outcome than intended. This myopic and hyperopic shift was due to the standardized surgical technique with an externalization of the haptics 2.5 mm behind the limbus resulting in a consistent aqueous anterior chamber depth across all eye lengths, coupled with a reduction or increase in the distance from the IOL to the macula, which is dependent on the length of the eye. [J Refract Surg. 2024;40(12):e985-e993.].

Микрореконструктивные технологии подшивания интраокулярной линзы к радужке с полным сохранением ее функций

Today, implantation of an intraocular lens (IOL) into the capsular bag is the standard approach to surgical treatment of cataracts and aphakia of various origins. However, there are several reasons and conditions that disallow this operation or increase the risk of instability of the implanted lens, such reasons and conditions including weakness of the lens ligaments; degradation of Zinn's zonule, including dislocation of the IOL‒capsular bag complex post-surgery; damage to or removal of capsular bag during surgery; lack of capsular bag or its destruction during implantation in aphakia cases. To date, problems associated with fixation and centralization of IOL in non-standard cases involving weak or inexistent capsular support remain unresolved. This study aimed to develop techniques allowing to stitch IOL to the iris without compromising its functions in various situations when it is unfeasible or impossible to fix and center lens in the capsular bag. The patients (n = 12; 12 eyes), depending on the clinical situation, were divided into groups: group 1 — dislocations of the IOL–capsular bag complex (6 eyes); group 2 — complete lack of capsular support (3 eyes); group 3 — weakness of capsular support (3 eyes). A special stitching technique was developed for each of these situations. The results of the treatment were good from clinical and functional perspectives: the IOL was fixed securely and centered properly, and the iris's performance and cosmetic aspects were not compromised.

DYNAMICS OF CHANGES IN THE ANATOMICAL PARAMETERS OF THE ANTERIOR CHAMBER OF THE EYE WITH VARIOUS TYPES OF APHAKIA CORRECTION IN PATIENTS WITH SILICONE TAMPONADE OF THE VITREAL CAVITY

Rationale: In case of combined pathology, in particular aphakia and regmatogenic retinal detachment, an important point is the leveling of changes in the iridocrustal apparatus. When analyzing the morphoanatomic parameters of the angle and depth of the anterior chamber using optical coherence tomography, distinctive features were revealed in patients with various methods of correcting the defect of the iridohrustal barrier.Objective: of the study was to evaluate anatomical changes in the angle and depth of the anterior chamber in patients with various types of intraocular correction of the defect of the capsule-binding apparatus under conditions of tamponade of the vitreal cavity with silicone oil.Methods: Studies were conducted on 74 eyes of patients aged 56 to 75 years with various methods of correction of aphakia and silicone tamponade of the vitreal cavity.Results: There was a significant decrease in the anterior chamber angle in various sectors in patients with aphakia, in contrast to patients with anterior chamber and transclerally fixed intraocular lenses. A similar trend is observed in patients with anterocameral intraocular lenses, relative to the group of patients with artifacia. A decrease in the depth of the anterior chamber was revealed in patients with anterior chamber lenses relative to patients with transcleral fixation and articulation was revealed in the upper sector. In the temporal sector, there is a decrease in this indicator in patients with aphakia relative to patients with artifakia.Conclusion: In the conditions of silicone tamponade of the vitreal cavity, the technique of transcleral fixation of intraocular lenses provides the most physiological indicators of the anterior chamber angle comparable to single-format indicators of patients with artifacia.

Efficacy of Sutureless Scleral Fixation of One-Piece T-Shaped Haptic Intraocular Lens in Maintaining Anterior Chamber Stability During Descemet Membrane Endothelial Keratoplasty in Vitrectomized Eyes: Leak Test and Iris Diaphragm Reconstruction.

Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from -1.00 to -0.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 μm (range: 651 to 701) at baseline visit and 541.5 μm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction.