Fixation Of Posterior Chamber Intraocular Lens Research Articles

A novel custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses

PURPOSE: To describe a custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). METHODS: An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27G needle, and the needle tip was advanced into the eye from the IOL fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. RESULTS: The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. CONCLUSION: The curved needle-guided suture snare technique provides a simple minimally-invasive method of scleral suture fixation of PCIOL.

Supracapsular scleral sutured intraocular lens implantation in anterior segment dysgenesis patients with ectopia lentis.

To describe a new strategy to manage ectopia lentis in ASD patients assessing the visual outcomes and safety of supracapsular scleral sutured intraocular lens implantation and analyzing the accuracy of different intraocular lens (IOL) power calculation formulae. Eight patients with ASD (13 eyes) were underwent supracapsular scleral suture fixation of posterior chamber (PC) IOL without capsular extirpation. The preoperative and postoperative clinical features were compared. The prediction error values from four formulae (SRK/T, Holladay 1, Hoffer Q, Haigis), with or without Wang-Koch (WK) adjustment, were calculated for the cases. Zonulodialysis and premature cataracts could be the main reason for the decreased vision in patients with ASD. There was a significant improvement in best corrected visual acuity on 3-month follow-up after applying supracapsular scleral suture fixation of PC IOL. The prediction errors of the different formulae showed a slight tendency towards postoperative myopia. The Haigis formula with WK adjustment showed the best performance. Supracapsular scleral suture fixation of IOLs for retaining the capsule-zonule barrier is a good option for ASD patients. The Haigis formula is recommended for ASD patients treated with supracapsular scleral suture fixation of IOLs. The predicted IOL power should be reduced based on the effect of the new anatomic position of the IOL to achieve a satisfactory visual outcome.

Long-term Outcomes of Fibrin Glue-Assisted Intrascleral Haptic Fixation of Posterior Chamber Intraocular Lenses in Children.

To evaluate the long-term outcomes of intrascleral haptic fixation of posterior chamber intraocular lens (PCIOL) with fibrin glue in children. This is a retrospective case study conducted in a tertiary eye institute in North India. A total of 118 eyes of 82 children who underwent glued intrascleral haptic fixation of PCIOLs were retrospectively analyzed. Detailed analysis of the indication for surgery and ocular and systemic associations was performed. The outcome measures included intraoperative complications, final visual and refractive outcomes, and postoperative complications. The mean age of the patients was 10.16±3.94 years. Fifty-one patients (62.2%) were male and 31 (37.8%) were female. The mean follow-up period was 31.28±13.22 months. The mean preoperative corrected distance visual acuity was 1.18±0.63 Logarithm of Mean angle of resolution (logMAR) which improved to 0.60±0.58 logMAR postoperatively at 6 weeks (P<0.001). The mean preoperative and 6 weeks postoperative endothelial cell density were 3,176.08±318.6 and 2,936±289.9 cells/mm2, respectively (P=0.23). In the immediate postoperative period, corneal edema (19 eyes; 16.1%), decentered IOL/tilt (3 eyes; 2.54%), vitreous hemorrhage (3 eyes; 2.54%), optic capture (4 eyes; 3.38%), and hypotony (2 eyes; 1.69%) were seen. In the late postoperative period (>6 weeks), retinal detachment was observed in two eyes that had associated Marfan syndrome. Cystoid macular edema was seen in four eyes (3.38%), and glaucoma was seen in five eyes (4.23%). Fibrin glue-assisted intrascleral haptic fixation of a PCIOL is a safe and effective method to manage aphakia with inadequate capsular support in children.

Sutureless Intrascleral Posterior Chamber Intraocular Lens Fixation: Analysis of Clinical Outcomes and Postoperative Complications.

Purpose To report a technique for performing sutureless intrascleral fixation of a posterior chamber intraocular lens (PC-IOL) and analyzing the clinical outcomes and postoperative complications. Study Design. 68 eyes of 66 patients who received the technique were studied retrospectively. Methods The best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), IOL tilt and decentration, corneal topography (K1 and K2), and postoperative complications were determined at 3 months. Results The mean preoperative BCVA was 1.63 ± 1.24 logMAR units, and the mean postoperative BCVA was 0.74 ± 0.59 logMAR units at 3 months (P < 0.05). The mean preoperative IOP was 21.9 ± 12.6 mmHg, and the mean postoperative IOP was 16.9 ± 4.5 mmHg at 3 months (P = 0.001). The mean preoperative corneal topography (K1 and K2) was K1 = 42.14 ± 1.91 and K2 = 43.54 ± 1.51; the mean postoperative corneal topography (K1 and K2) was K1 = 43.03 ± 2.18 and K2 = 43.40 ± 1.71 at 3 months (P = 0.678 and 0.468, respectively). The mean preoperative spherical equivalent was +11.00 ± 13.19 diopters (D), and the mean postoperative spherical equivalent was +0.06 ± 0.86 D (P < 0.005). The mean IOL tilt was 2.4 ± 1.7°, and the mean decentration was 0.35 ± 0.21 mm. The mean ACD was 4.31 ± 0.29 mm. Conclusions The 27-gauge sutureless intrascleral PC-IOL implantation technique minimizes intraoperative injury, simplifies procedure, and provides good PC-IOL fixation with few postoperative complications.

Sutured Scleral Fixation of Posterior Chamber Intraocular Lens in Children under the Age of 9 with Congenital Ectopia Lentis

Introduction: This study aimed to report the visual acuity outcomes and complications of sutured scleral fixation of posterior chamber intraocular lens (IOL) in children under 9 years old with congenital ectopia lentis. Methods: Twenty-six children (47 eyes) with congenital ectopia lentis were included in this study. The mean age at surgery was 61.6 ± 22.3 months (range, 32–94). Patients underwent lens extraction, anterior vitrectomy, and sutured scleral fixation of posterior chamber IOL. The implanted IOL included rigid polymethyl methacrylate (PMMA) IOL (CZ70BD, n = 36) and foldable IOL (SA60AT, n = 9, and LI61SE, n = 2). The outcome measures used to assess the benefits were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, intraocular pressure, and any associated complications. Median follow-up was 33.0 months (range, 4–129). Results: After surgery, the median UCVA (1.30 vs. 0.35 logMAR) and BCVA (0.82 vs. 0.15 logMAR) improved significantly (p < 0.001). The median absolute spherical values decreased considerably (9.00 vs. 0.75 D; p < 0.001). The median astigmatism was lower in foldable IOL compared to rigid PMMA IOL (1.0 vs. 2.5 D; p = 0.026), but neither the UCVA nor BCVA was significantly different. There was no intraoperative complication. Postoperative complications included pupillary capture in 4 eyes (9%), IOL decentration in 4 eyes (9%), choroid edema in 1 eye (2%), and subretinal hemorrhage in 1 eye (2%). The rate of secondary surgery was 9%, caused by IOL decentration of IOL haptics which was broken in 3 eyes and suture degradation in 1 eye. Conclusion: Sutured scleral fixation of posterior chamber IOL provided good visual outcomes in children under 9 years of age with congenital ectopia lentis. Although there were some risks of secondary surgery, the complications were acceptable.

Secondary Posterior Chamber Intraocular Lens Fixation Using Flanged Prolene Sutures as an Alternative to an Anterior Chamber Intraocular Lens Implantation.

PurposeTo describe and evaluate the clinical outcomes of the Flanged Prolene Suture intraocular lens fixation (PIF) technique and compare it to anterior chamber IOL (ACIOL) implantation.DesignA retrospective comparative review.MethodsA retrospective comparative review of consecutive patients undergoing secondary IOL implantation was performed. A comparison between patients that had ACIOL and PIF technique was conducted. The main outcome measures were changes in best-corrected visual acuity (VA), IOL position and complications.ResultsIn the study period, fourteen eyes had ACIOL implantation and ten eyes had PIF surgery. VA acuity for both groups combined improved from 1.27 ± 0.65 logMAR preoperatively to 0.84 ± 0.65 logMAR (P<0.0001). Seventeen patients had VA measurements in the year before the IOL dislocation. In those seventeen patients, VA changed from a baseline of 0.90 ± 0.68 to 0.97 ± 0.61 logMAR in the PIF group (p=0.334) and from 0.54 ± 0.27 to 0.85 ± 0.65 logMAR in the ACIOL group (p=0.145). No intraoperative or early postoperative complications were documented in either group. Two (20%) patients in the PIF group developed CME and one patient developed corneal edema. In the ACIOL group, one patient developed significant CME and two patients developed visual significant corneal edema.ConclusionThe PIF technique seems to offer a simple, fast and safe way to fixate an IOL posteriorly. In our experience, the learning curve of the technique is short with a low complication rate and good visual outcomes.

Sutured Intrascleral Posterior Chamber Intraocular Lens Fixation with Ciliary Sulcus Location Guided by Ultrasonic Biological Microscopy: A Retrospective Analysis of Anatomical and Refractive Outcome.

Purpose To report the outcome of sutured intrascleral posterior chamber intraocular lens (PC IOL) fixation with ciliary sulcus location guided by ultrasonic biological microscopy (UBM). Methods Patients who underwent a sutured intrascleral PC IOL fixation were reviewed and divided into four groups. In group 1, the traditional sulcus fixation (2 mm from limbus) of IOL was performed. In groups 2, 3, and 4, UBM was performed before surgery to locate the position of the ciliary sulcus as the haptics insertion position. IOL power was selected by decreasing the calculated value of the IOL power by 1.0 D, 1.0 D, 0.5 D, and 0.0 D, respectively. Results Sixty-one patients (63 eyes) were included in the four groups. After 4.1 ± 3.0 months' follow-up, the postsurgery spherical equivalent (SE) was 0.73 ± 1.86, 0.71 ± 0.84, 1.14 ± 0.45, and 0.07 ± 0.89 diopters (D), respectively. Statistical significance was reached for the postsurgery SE with target refraction between group 1 (p = 0.027, <0.05), group 2 (p = 0.003, <0.01), and group 3 (p = 0.017, <0.05). No significant difference existed for the postsurgery SE with target refraction in group 4 (p = 0.779, >0.05), and the postsurgery SE in group 4 was the nearest to target refraction. Conclusion Intrascleral PC IOL fixation guided by UBM is helpful for locating the ciliary sulcus and satisfactory visual outcomes with a predictable IOL power calculation.

Outcomes and complications of iris-fixated intraocular lenses in cases with inadequate capsular support and complex ophthalmic history.

BackgroundTo report the indications, visual outcomes, and intra-operative and post-operative complications of iris-sutured posterior chamber intraocular lens (IOL) in eyes with inadequate capsular support and complex ocular history.MethodsA chart review and data analysis of eyes that underwent iris fixation of posterior chamber (PC) IOL for correction of aphakia, dislocated and subluxed IOLs, ectopia lentis, and IOL exchange. Data included clinical risk factors, associated eye conditions, previous surgeries, and concomitant procedures. The pre-operative and post-operative vision, manifest refraction, endothelial cell density, intraocular pressure (IOP), as well as intra-operative and post-operative complications were also recorded.ResultsOne hundred and seventeen eyes from 114 patients were examined with a mean follow-up of 22.4 months. The most common identifiable predisposing risk factor was high myopia in 23 eyes. A significant improvement in uncorrected and best corrected visual acuity compared with baseline was observed. The most common post-operative complications included recurrent IOL subluxation in 16 (13.7%) eyes, IOP spike in 7 (5.9%) eyes, cystoid macular oedema in 5 (4.3%) eyes, and epiretinal membrane formation in 4 (3.4%) eyes. There was one (0.85%) case of sterile endophthalmitis.ConclusionsIris suture fixation of PC IOLs is a good treatment option for eyes with inadequate capsular support and complex ocular history.

Evaluation of Flanged Haptics Intrascleral Sutureless Intraocular Lens Fixation

Background: successful intraocular lens (IOL) placement in patients undergoing cataract surgery has become synonymous with the IOL being placed in the capsular bag. Purpose: to evaluate the flanged haptic sutureless intrascleral intraocular lens fixation with double needle technique as a method of scleral fixation of posterior chamber IOL (PCIOL) as regard to its stability and safety as well as its complications. Patients and Methods: this is a prospective study, which included 20 eyes of 20 patients with aphakia with no adequate capsular support. Results: post-operatively the best corrected visual acuity (BCVA) was improved to reach up to 0.8 decimal unit. Intra-operatively, haptic breakage was reported in 3 cases where the IOLs were explanted and new IOLs were implanted and sclerally fixated. The post-operative complications included iris capture in 2 cases (10%), haptic deformation in 2 cases (10%), exposure in 5 cases (25%) and slippage in 2 cases (10%), corneal edema in 6 cases (30%), IOL decentration in 4 cases (20%) one of them was significantly decentered and needed for reoperation where one point fixation by a stitch of the slipped haptic , spontaneous IOL dislocation in 2 cases (10%) 1 month and 3 months post-operatively, both required re operation where the slipped IOL was explanted and new one is re implanted and sclerally fixated. There were no incidents of post-operative ciliary body injury, retinal tear or detachment or endophthalmitis. Conclusions: the flanged haptics intrascleral sutureless IOL fixation with double needle technique can be done for aphakic cases with no adequate capsular support.

Secondary intraocular lens implantation with absence of capsular support: Scleral versus iris fixation

To assess the outcomes of iris fixated (IF) posterior chamber (PC) intraocular lens (IOL) versus scleral-fixated (SF) PC IOL implantation, and compare them with the results reviewed from the literature. The study took place in the ophthalmology department of the Eye and Ear Hospital (Lebanon). This is a retrospective institutional study that collected the records of patients admitted for secondary IOL implantation between January 2007 and December 2016. A total of 28 eyes that underwent PC IOL fixation were included, 13 of which underwent trans-scleral PC IOL fixation and 15 of which underwent iris PC IOL fixation. Data were analyzed over a period of 3 years. Of the 28 patients, 18 (64.3%) were male and 10 (35.7%) were female (mean age at intervention 36.78±23.47 [standard deviation, SD] years). There were no significant intergroup differences with regard to baseline values and demographic characteristics. Trauma was the most common etiology for posterior capsule insufficiency (82.1%). The mean preoperative baseline BCVA was 0.58±0.27 logMAR for SF and 0.27±0.20 logMAR for IF (P=0.07). Both groups had significant improvement in vision during the follow up period. No significant differences were noted regarding early or late postoperative complications between the two groups. SF and IF techniques for PC IOL have similar outcomes and result in a significant improvement in BCVA. When compared to AC (anterior chamber) IOL, both techniques seem to yield fewer complications.

Scleral Fixation of Posterior Chamber Intraocular Lenses Using Gore-Tex Suture: Clinical Outcomes From a Single Institution

Purpose: The purpose of this article is to examine the clinical outcomes of scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture at our institution. Methods: A retrospective chart review was conducted of patients who underwent scleral fixation of an IOL with Gore-Tex suture with concurrent pars plana vitrectomy. Intraoperative and postoperative complications were assessed. Results: Seventy-four eyes of 74 patients were included with a mean follow-up interval of 210 days (range, 33–720 days). The mean best-corrected visual acuity improved from 20/480 (1.38 logarithm of the minimum angle of resolution [logMAR]) preoperatively to 20/78 (0.59 logMAR) postoperatively ( P &lt; .001). Indications included dislocated lens implant (42), aphakia without capsular support (18), and subluxation of crystalline lens (14). Bausch and Lomb Akreos AO60 IOL was implanted in 52 eyes, Alcon CZ70BD in 15, and Bausch and Lomb enVista MX60 in 6. Postoperative complications included temporary ocular hypertension in 9 eyes (12%), temporary hypotony in 7 (9%), cystoid macular edema in 3 eyes (4%), corneal decompensation in 2 eyes (3%), IOL dislocation requiring exchange in 1 case (1.4%), vitreous hemorrhage in 2 cases (3%), and retinal detachment in 2 cases (3%). There were no cases of postoperative suture breakage or erosion, endophthalmitis, or hyphema. Conclusions: The use of Gore-Tex suture in scleral fixation of posterior chamber IOLs was well tolerated at a mean follow-up interval of 210 days. There were no suture-related complications.

Long-term Outcome of Pars Plana Vitrectomy and Sutured Scleral-Fixated Posterior Chamber Intraocular Lens Implantation or Repositioning

To assess the long-term stability of sutured scleral-fixated posterior chamber intraocular lenses (PCIOLs) performed in combination with pars plana vitrectomy. Retrospective, consecutive, interventional case series. Retrospective single-surgeon study of 118 eyes of 111 patients seen at Retina Consultants of Hawaii, who underwent sutured scleral fixation of at least 1 haptic of a posterior chamber intraocular lens with 10-0 polypropylene combined with a pars plana vitrectomy. The fixation knot-tying technique required 2 separate 10-0 polypropylene sutures tied into 1 combined knot-1 suture closed the fixation sclerotomy and created the scleral fixation, and 1 suture looped together around the haptic of the PCIOL, securing the haptic to the scleral fixation site. The primary outcomes were position of the PCIOL at last follow-up, dislocation of either 1 or both haptics of the PCIOL, and breakage of the 10-0 polypropylene fixation suture. PCIOLs remained well stabilized and positioned at last follow-up in 116 of 118 eyes (98.3%), with a mean follow-up of 6.0 years. The maximum stable follow-up with 2 intact fixation sutures was 24.75 years. There were 4 cases of redislocation (3.4%), but 2 cases were owing to unstable residual capsular support. There was 1 case of suture breakage in 214 fixation sutures (0.47%) and 1 case of haptic breakage. Scleral fixation sutures with 10-0 polypropylene provide excellent long-term fixation of PCIOLs, with a less than 0.5% incidence of suture breakage and documented suture stability for up to 24+ years.

Visual outcome following scleral fixated intraocular lens implantation

Introduction: Scleral fixated intraocular lens(SFIOL) implantation to correct aphakia offers superior visual rehabilitation in comparison to aphakic spectacles or contact lens. This study was done to evaluate a simplified technique of scleral fixation of posterior chamber intra-ocular lens (IOL) in terms of visual outcome and complications.Methods: This was a prospective study enrolling 23 eyes of 23 patients who underwent anterior vitrectomy followed by ab-externo sclera fixation of posterior chamber IOL using 10.0 polypropylene sutures from January 2016 to February 2017 in Nepal Eye Hospital.Scleral flap was made at 3 and 9'o clock meridian to cover the knots which prevent erosion of the knots through conjunctiva. Main outcome measures were post-operative best corrected visual acuity and post-operative complications.Result: Best corrected visual acuity were 6/6 - 6/18 in 86.9% (n=20), 6/24 - 6/60 in 8.7% (n=2) and worse than 6/60 in 4.3% (n=1)at six months followup. The mean spherical equivalent before surgery was +10.60 diopter and -1.14 diopter post-surgery. The common indicationsfor scleral fixated intraocular lens weretrauma in 60.86% (n=14), surgical aphakia in21.73% (n=5), spontaneous posterior dislocation of lens in 13.0% (n=3) and subluxated intraocular lens in 4.34% (n=1). The common complications were astigmatism in 91.30% (n=21), decentered IOL in 4.34% (n=1) and uveitis in 4.35% (n=1).Conclusion: Ab-externosclerated fixated intraocular lens is a safe and effective method for visual rehabilitation with low post-operative risk.

Clinical observation on the modified one-haptic fixation of posterior chamber intraocular lens implantation

Objective To observe the clinical efficacy of one-haptic fixation of posterior chamber intraocular lens (PCIOL) through modified scleral tunnel. Methods The data of 11 eyes of 11 cases with incomplete posterior capsular after cataract surgery or subluxation of lens were collected. They underwent one-haptic fixation of PCIOL through shaped scleral tunnel perpendicular to the limbus . All patients were followed up for 3-18 months.The surgical efficacy was observed. Results The range of BCVA was 0.25-1.0.The visual acuity was 0.6-1.0 in 7 eyes (63.64%), 0.3-0.5 in 3 eyes (27.27%), and 0.25 in 1 eye (9.09%). After surgery posterior capsule opacification occurred in 1 eye, and intraocular hypertension in 1 eye. No IOL dislocation happened. Conclusion One-haptic fixation of PCIOL through modified shaped scleral tunnel is a safe and viable option, with less complications. Key words: Lens, intraocular; Scleral tunnel, modified; Fixation, one-haptic

Long-term outcome of combined vitrectomy and transscleral suture fixation of posterior chamber intraocular lenses in the management of posteriorly dislocated lenses

BackgroundThere is no general consensus on the optimal choice of intraocular lenses (IOLs) or fixation methods in eyes with inadequate capsular support. The purpose of this study was to determine the long-term safety, efficacy and refractive status of combined vitrectomy and transscleral suture fixation of posterior chamber (PC) IOLs in the management of posteriorly dislocated lenses in Taiwan. MethodsWe conducted a retrospective interventional study at our medical facility. The posteriorly dislocated crystalline lenses (or dislocated IOL) were removed with pars plana vitrectomy followed by transscleral suture fixation of PC IOLs at the same setting. Additionally, preexisting ocular condition, postoperative visual acuity (VA) and refraction were recorded. ResultsFifteen patients were enrolled for analysis, including traumatic posteriorly dislocated IOLs in seven cases, and traumatic posteriorly dislocated crystalline lenses or retained lens nuclei after cataract surgery in eight cases. The end result of our study showed that best-corrected VA of 6/12 or better was achieved in 13 patients (87%) after a mean 45 months follow-up. The mean VA significantly improved from 0.98 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.14 logMAR at last follow-up (p < 0.01). The refractive status after suture fixation of PC IOL revealed a mean myopic shift of −1.18 ± 1.47 D from the predicted spherical equivalent. Overall, most complications were minor. Ciliary body hemorrhage occurred during operation in one case and was cleared without visual compromise. Erosion of prolene suture through conjunctiva was noted in three patients. Elevated intraocular pressure was well controlled by topical antiglaucoma medications in three cases. No suture breakage or IOL dislocation was noted in any of the patients. There were no serious adverse events of retinal detachment, corneal compromise, or endophthalmitis in any of the patients. ConclusionOur data showed that use of combined vitrectomy and transscleral suture fixation of PC IOLs is a safe and efficient technique to correct aphakia in eyes without adequate capsular support. Our study demonstrated good long-term visual outcome with only minor complications. Furthermore, we recommend that the IOL power should be adjusted 1.00 D less for transscleral suture fixation.

A knotless, one-haptic fixation of posterior chamber intraocular lenses: one-year results.

To assess the results of a modified technique for scleral fixation of a posterior chamber intraocular lens (IOL) in eyes which had deficient of posterior capsular support. This retrospective study was comprised of ten patients with deficient posterior capsular support who underwent one-haptic fixation of posterior chamber IOLs, between February 2010 and October 2011. IOL as implanted with one haptic supported on the capsular remnant and the other haptic drawn into the sulcus by anchoring suture without a knot. All patients were evaluated for pre- and postoperative visual acuity, lens centration, intra-and postoperative complications. A knotless, one-haptic fixation of posterior chamber IOLs has successfully been performed on ten eyes. All cases had inadequate capsular support (i.e. a capsular tear ranged from 5 to 7 clock hours). The average age was 74.25±8.87y (SD). The average postoperative uncorrected visual acuity was 0.51 logMAR. Complications included hyphema in one eye, a mild inflammatory reaction in the anterior chamber in two eyes, and a transient rise in IOP in one eye. Neither IOL tilt nor dislocation was observed and there were no later complications. In the presence of insufficient capsular support, a knotless, one-haptic fixation of posterior chamber IOLs is a safe and viable option which reduces the operation time, and minimizes postoperative suture-related complications.

Review of Surgical Techniques for Posterior Chamber Intraocular Lens Fixation in the Absence of Capsular Lens Support

This is a review of surgical options for posterior chamber intraocular lens (IOL) fixation in the absence of adequate capsular support. The indications, techniques, and outcomes for posterior chamber iris-sutured and scleral-fixated IOLs, including trans-scleral sutured and trans-scleral tunnel glued fixation, are reviewed. Iris-sutured IOL fixation may be appropriate in cases in which small corneal incisions with a foldable IOL are desired, but are only possible in cases of adequate iris tissue, and may be complicated by pupil ovaling and iris trauma, which can lead to prolonged inflammation in some studies. Scleral-sutured IOL fixation does not require robust iris tissue and decreases the risk for iris trauma, but is technically more demanding, may require larger incisions, and poses potentially more posterior segment complications. There are also ongoing concerns for suture exposure, erosion, and late suture breakage and IOL dislocation. Scleral tunnel-glued IOL fixation is a more recent innovation that avoids sutures and concerns for suture-related complications, and can be completed through smaller incisions with a foldable IOL. However, long-term studies are pending.

Evaluation of pars plana sclera fixation of posterior chamber intraocular lens.

Purpose:The purpose of this study was to evaluate the clinical efficacy and safety of modified posterior chamber intraocular lens (PCIOL) implantation with transscleral fixation.Design and Setting:This is a study, which is conducted at Department of Ophthalmology, Jinan Eye Hospital, Jinan Second People's Hospital.Materials and Methods:A total of 82 patients who were scheduled for sutured PCIOL were divided randomly into modified and conventional groups. The former underwent PCIOL through pars plana fixation with knot buried and without scleral flap and the latter underwent transscleral fixation of PCIOL in the ciliary sulcus. The main outcome measures included operative time, postoperative visual acuity, and postoperative complications.Results:The mean operative time of the modified group was 39.95 ± 5.87 min, which was significantly less than that of the conventional group (45.77 ± 5.21 min; P < 0.05). No difference was found in postoperative visual acuity between the two groups. There were no significant postoperative complications, including knot exposure, endophthalmitis, and retinal detachment in either group. The optical clamping of PCIOL was prone to occur in the conventional group.Conclusion:Modified sutured PCIOL implantation is a safe, effective, and feasible technique for the correction of aphakia in eyes without adequate posterior capsular support.

Fibrin Glue–Assisted Fixation of Decentered Posterior Chamber Intraocular Lens

To report the feasibility and outcome of the technique of glue-assisted fixation of decentered posterior chamber intraocular lens (PCIOL) in the posterior chamber using the same IOL. The procedure was performed in three eyes having decentered PCIOL with inadequate capsular rim to support the IOL. The haptics were exteriorized under a partial thickness scleral flap at 1.5 mm behind the limbus and placed into a partial thickness scleral pocket and fixed with fibrin glue. No suture was placed at any site. On day 1 and at 6 weeks, the IOLs were well centered. There was no significant anterior or posterior segment inflammation, and the intraocular pressure was normal. Fibrin glue-assisted fixation of PCIOL is a feasible technique with good outcome in eyes with decentered IOL with inadequate capsular support.

Fijación de lente intraocular en sulcus mediante inserción de hápticos en túneles esclerales: resultados a un año

Methods We included seven eyes in which sutureless intrascleral posterior chamber intraocular lens (IOL) fixation was performed. Pre- and post-surgical best-corrected visual acuity (LogMAR) and refraction changes were analyzed. There was a one year follow-up period Conclusions Sutureless intrascleral posterior chamber intraocular lens fixation is, in our experience, a safe technique that allows locating the IOL in the posterior chamber when no capsular support is present. Visual and refractive outcomes were satisfactory.