Flanged Intraocular Lens Research Articles

Repositioned versus exchanged flanged intraocular lens fixation for intraocular lens dislocation

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.

Double-Needle Haptic Repositioning: A Troubleshooting Technique for Flanged Intraocular Lens Fixation.

Haptic repositioning during flanged intraocular lens (IOL) fixation can be difficult, and the haptic requiring repositioning may be at increased risk of excessive bending or breakage. This study aimed to report double-needle haptic repositioning technique outcomes for the aforementioned difficulty during flanged IOL fixation. This retrospective case series included seven eyes requiring haptic repositioning during flanged IOL fixation. The method features reinsertion of an already externalized haptic into the needle lumen followed by a needle-haptic complex internalized through the original tract into the eyeball. Thus, an adequate configuration for contralateral haptic can be achieved for insertion into the needle lumen to create a double-needle condition before both haptics are successfully externalized. The median follow-up duration was 24 months (range, 4-24 months). Postoperatively, the IOL was well-centered, and corrected distance visual acuity improved from 20/320 (20/4,000-20/70) to 20/50 (20/250-20/20). No intraoperative or postoperative complications were noted. The technique produced encouraging results in patients undergoing haptic repositioning during flanged IOL fixation. This technique could potentially reduce haptic overbending risk and facilitate haptic adjustment. Further studies are needed to confirm the feasibility of the technique.

RISK FACTORS FOR PUPILLARY OPTIC CAPTURE FOLLOWING SUTURELESS FLANGED INTRAOCULAR LENS FIXATION FOR INTRAOCULAR LENS DISLOCATION.

To identify risk factors for pupillary optic capture after sutureless flanged intraocular lens (IOL) fixation for IOL dislocation. This retrospective comparative study enrolled consecutive patients who underwent flanged IOL fixation using 25-gauge pars plana vitrectomy. One hundred twenty-six eyes (126 patients) were divided into two groups according to the presence or absence of pupillary optic capture. A swept-source anterior segment optical coherence tomography and a rotating Scheimpflug camera were used to analyze and compare surgical parameters, including axial length, anterior chamber depth, differences in scleral tunnel angle and length, and IOL tilt and decentration, between the two groups. Compared with the nonpupillary optic capture group (106 eyes, 84.1%), the pupillary optic capture group (20 eyes, 15.9%) had larger differences in the nasal and temporal scleral tunnel angles and larger horizontal tilt (P < 0.05). Multivariate regression analysis demonstrated that these factors correlated with the occurrence of pupillary optic capture (P < 0.05). To prevent pupillary optic capture after flanged IOL fixation, surgeons should avoid asymmetry in the angles of the nasal and temporal scleral tunnels, which causes horizontal IOL tilt and subsequent pupillary capture.

SIMPLE REFIXATION OF A DISLOCATED HAPTIC OF FLANGED INTRAOCULAR LENS USING A 25-GAUGE NEEDLE.

To report the development of a novel, simple-to-use technique for the salvage of a haptic of dislocated flanged intraocular lens during a retinal detachment surgery. A 25-gauge regular-wall needle was prepared and threaded by the dislocated flanged haptic before the flanged haptic was heated and enlarged by low-temperature cautery. The dislocated flanged haptic was probably the result of too small of a diameter of the previously flanged haptic and was triggered by scleral indentation. The rescue technique required only a 25-gauge regular-wall needle to conduct the conventional procedure of flanged haptic intraocular lens fixation before being enlarged by low-temperature cautery. The intraocular lens remained centered and stable at a 3-month postoperative follow-up examination. The application of a 25-gauge needle in the salvage of a haptic of dislocated flanged intraocular lens is simple and effective without the need for trimming the flanged tip.

A comparative study of transscleral sutured intraocular lens fixation and sutureless flanged intraocular lens fixation

BackgroundTo compare the intraocular lens (IOL) tilt and decentration and visual outcomes of transscleral sutured IOL fixation and sutureless flanged IOL fixation. To investigate the influence of IOL tilt and decentration on internal higher-order aberrations (HOAs) in these two techniques.MethodsPatients who received transscleral sutured or sutureless flanged IOL fixation procedures were included in this prospective, non-randomized, comparative study. Corrected distance visual acuity (CDVA) was measured at baseline and at every postoperative visit for 12 months. IOL tilt and decentration were measured using a second-generation anterior segment optical coherence tomography (Casia2) and internal HOAs were measured using iTrace Visual Function Analyzer at 3 months postoperatively.ResultsThe study included 27 eyes from the transscleral sutured IOL fixation group and 26 eyes from the sutureless flanged IOL fixation group. There was no significant difference in CDVA between the two groups at all time points. The two groups did not differ in refractive difference from the predicted value, corneal endothelial cell loss, IOL tilt, IOL decentration, internal astigmatism or internal HOAs. Vertical IOL decentration significantly correlated with total internal optical aberration (r = 0.288, P = 0.036), total internal HOA (r = 0.440, P = 0.001), internal coma (r = 0.348, P = 0.001), vertical internal coma (r = 0.388, P = 0.004), average height of modulation transfer function (r = − 0.364, P = 0.007) and Strehl ratio (r = − 0.297, P = 0.031). Horizontal IOL decentration significantly correlated with horizontal internal coma (r = 0.312, P = 0.023).ConclusionsTransscleral sutured IOL fixation and sutureless flanged IOL fixation had similar IOL positions and visual outcomes. IOL decentrations correlated with internal HOAs and thus should be avoided.

Scheimpflug imaging for evaluation of intraocular lens position in modified flanged scleral fixated intraocular lens.

Scleral fixation of intraocular lens (IOLs) is the most preferred technique for the management of aphakia and the techniques have evolved over the years. These methods have their advantages and disadvantages, however, the major concern being the position of the intraocular lens, its stability and complications. The final IOL position is the major determinant of the final visual acuity, and various imaging modalities have been used to quantify the IOL tilt. Use of Scheimpflug imaging to evaluate the IOL tilt in modified flanged scleral-fixated intraocular lens (MFSIOL). Retrospective chart review of 41 consecutive patients who underwent MFIOL. We conducted a retrospective chart review of 41 consecutive patients who underwent MFIOL. The baseline and final best-corrected visual acuity (BCVA), refractive error, and clinical examination findings were recorded. The vertical and horizontal tilts of the IOLs were calculated using the Scheimpflug image. The IOL tilt (in degrees) in the vertical and horizontal axes was the primary outcome and the BCVA, residual refractive error, intraocular pressure, and surgical complications were secondary outcome measures. The mean baseline BCVA was logMAR 0.49, which improved to logMAR 0.356 (p < .005) after the surgery. The mean IOL tilt in the vertical axis was 3.40° (range of 0.0°-8.5°, interquartile range: 1.21-5.66) and in the horizontal axis was 1.35° (range of 0.60°-4.620°, interquartile range: 0.44-1.86), respectively. There was no correlation between angle of IOL tilt and UCVA (r = 0.089, p = 0.580), BCVA (r = 0.109, p = 0.498), final spherical error (r = 0.081, p = 0.615), cylindrical error (r = 0.207, p = 0.195), axial length (r = 0.105, p = 0.514), and IOL power (r = -0.139, p = 0.388). Modified flanged IOL (MFIOL) is an alternative technique for intrascleral fixation of IOL resulting in good lens stability. The IOL tilt achieved by this technique is minimal and did not influence the final visual outcome or spectacle correction. Scheimpflug imaging is simple and non-invasive method to measure the IOL tilt. This study on 41 eyes was aimed to analyze the lens tilt using Scheimpflug imaging in cases of modified flanged scleral fixation of intraocular lens (MFSFIOL), which is a novel technique to minimize the complications and simplify the procedure. The intraocular lens (IOL) remained stable with an acceptable range of vertical and horizontal tilt. There was no significant effect of IOL tilt on the final best-corrected visual acuity (BCVA) or spectacle correction. Scheimpflug imaging is an accurate and non-invasive technique for assessment of lens position in the patients with intrascleral fixation of IOL.

Flanged intraocular lens (IOL) implantation with scleral pockets - A modification of flanged IOL technique (E-Flanged IOL) for secondary lens implantation.

The current technique for implanting flanged intraocular lens (IOL) suffers from complications like haptic exposure and tilting of the implanted IOL. We describe a modification of the currently described technique to obviate its shortcomings. Five eyes of five patients with a minimum of 1 year of follow-up were included. In this technique, two scleral pockets were made nasal and temporal to embed the flanged haptics. The primary outcome measure was the improvement in visual acuity (VA) postoperatively and the secondary outcome measures were postoperative complications. The primary objective of this current modification is to simplify the surgical technique for secondary IOL implantation and make it more replicable and predictive. The mean age of the patients was 19.44 years. The mean preoperative VA was 0.44 logMAR which improved to 0.26 logMAR at the 6-week postoperative visit. The mean follow-up was 496+/- 80 days. The maximum follow-up was 647 days. There were no postoperative complications such as haptic exposure, hypotony, or IOL tilt in any cases. The new E-flanged IOL technique has good visual outcomes and does not have postoperative complications. It has less intraoperative manipulation and complications.

Intraocular lens implantation with flattened flanged intrascleral fixation technique in pediatric aphakia

To evaluate the clinical outcomes of flattened flanged intrascleral fixation of the intraocular lens (IOL) in cases of pediatric aphakia without adequate capsular support. The medical records of children who underwent flattened flanged intrascleral IOL implantation for aphakia with insufficient capsular support, subluxated cataract, ectopia lentis, and dislocated IOL were reviewed retrospectively. Best-corrected visual acuity, astigmatism, corneal endothelial cell loss, IOL tilt, and intra- and postoperative complications were evaluated. A total of 21 eyes of 16 patients were included. Mean patient age at time of surgery was 7.1 ± 3.8 years (range, 2-15). Mean follow-up time after surgery was 2.0 years. The mean pre- and postoperative best-corrected visual acuities were 1.03 ± 0.49 logMAR and 0.33 ±0.44 logMAR, respectively (P < 0.001). The mean preoperative astigmatism was 2.2 ± 0.9 D; and the mean postoperative astigmatism, 1.8 ± 0.8 D. The mean IOL tilt was 3.2° ± 3.1° (range, 0°-10°). The mean endothelial loss was 4.8%. Postoperatively, one of the haptics was partially visible in the scleral tunnel in one eye of a patient with Marfan syndrome. In our study cohort, the flattened flanged IOL fixation technique provided good IOL fixation, with firm haptic fixation, without use of sutures or glue.

Outcomes of flanged IOL fixation combined with microhook trabeculotomy.

To evaluate the outcomes of flanged intraocular lens fixation combined with microhook trabeculotomy. This study was a retrospective case series and included nine eyes of nine exfoliation glaucoma patients with subluxated lens or intraocular lens who underwent flanged intraocular lens fixation combined with microhook trabeculotomy between May 2019 and February 2020 at the Kochi University Hospital. The mean best-corrected visual acuity, intraocular pressure, and number of antiglaucoma medications were compared before and after surgery. The mean follow-up period was 5.67 ± 2.50months. The mean best-corrected visual acuity improved significantly from 0.83 ± 0.72 preoperatively to 0.22 ± 0.34 at the last visit (p = 0.015). The mean intraocular pressure had significantly reduced from 27.1 ± 8.12mmHg preoperatively to 13.2 ± 3.73 at the last visit (p = 0.008). The mean number of antiglaucoma medications decreased significantly from 4.56 ± 1.88 to 2.0 ± 1.0 at the last visit (p = 0.008). Postoperative intraocular pressure control to 21mmHg or lower was achieved or maintained in all patients. Postoperative vitreous hemorrhage was observed in six eyes (66.7%), two of which needed reoperation. This study showed that flanged intraocular lens fixation combined with microhook trabeculotomy might be effective for exfoliation glaucoma with subluxated lens or intraocular lens.

Two double flanged versus four flanged in scleral fixated IOL: A descriptive study

Aims: To describe a new method for scleral fixated intraocular lens (IOL) and to report its long-term follow-up. This study also shows the comparison of the new method with the current popular method that is four flanged scleral fixated IOL. Method: Six patients who underwent the new method (two double flanged IOL) and 6 patients underwent four flanged scleral fixated IOL. Postoperative data was collected and recorded, such as visual acuity, intraocular pressure, anterior chamber activity, sign of IOL decentration/tilting and subjective complaints from the patients. Follow-up was done for 4–8 weeks. Result: Among the first group (two double flanged IOL) the mean visual acuity are 0.28 and 0.34 [uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA)]. The second group (four flanged IOL) the mean visual acuity are 0.29 and 0.35 (UCVA and BCVA). There is no (0%) IOL decentration of both the groups during the follow-up period. No significant anterior chamber reaction was found in both groups. Conclusion: The two double flanged IOL can be used as alternative method for intrascleral IOL fixation. It provides good long-term stabilization, no need for specific IOL, or any hard to obtain material.

Flanged fixation: Yamane technique and its application.

To review variations of flanged intraocular lens fixation (Yamane technique) and their outcomes. Sutureless intrascleral IOL fixation has become popular, and many techniques have been reported. Among them, the Yamane technique has been widely used in recent years, and there are many variations. However, there are no reports that systematically compare them. There are variations of the Yamane technique, such as those used to create a scleral tunnel or to dock needles and haptics. Although few reports have directly compared each technique, small scleral wounds appear to be beneficial for long-term stability of the IOL. A method of fixing a capsule tension segment or iris using a flange has also been reported, demonstrating the diverse range of uses of the flange.

A 1-Year Prospective Comparative Study of Sutureless Flanged Intraocular Lens Fixation and Conventional Sutured Scleral Fixation in Intraocular Lens Dislocation

Purpose: To compare surgical outcomes of sutureless flanged intraocular lens (IOL) fixation and conventional sutured scleral fixation (SF) for secondary IOL implantation in patients with IOL dislocation. Methods: This is a prospective, comparative cohort study on 103 consecutive patients (103 eyes) with IOL dislocation who underwent vitrectomy with IOL removal and sutured SF (53 eyes) or flanged IOL fixation (50 eyes). Operating time, best-corrected visual acuity (BCVA), refractive difference, IOL tilt and decentration using swept-source anterior segment OCT, and postoperative complications were measured for 12 months. Results: Operating time was significantly shorter for the flanged IOL fixation than for sutured SF (19.4 ± 4.6 vs. 48.9 ± 5.2 min, p < 0.001). BCVA in both groups improved at 1, 3, 6, and 12 months postoperatively (p < 0.05). BCVA in the 2 groups was similar during the 12 months of observation. The refractive difference, IOL tilt, IOL decentration, and incidence of postoperative complications were also not different in the 2 groups. Conclusion: Sutured SF and flanged IOL fixation had similar visual outcomes and IOL stability in patients with IOL dislocation. However, the operating time for flanged IOL fixation was less than half that of the sutured SF. This technique is an efficient alternative for treating IOL dislocation.

Comparison of Different IOL Types in the Flanged IOL Fixation Technique.

Purpose To compare short-term clinical outcomes between two different intraocular lens (IOL) types in the flanged IOL fixation technique. Methods This study was a retrospective case series and included the patients who underwent flanged IOL fixation between June 2017 and July 2018 at the Hiroshima University Hospital. Two different 3-piece IOLs (NX-70 and PN6A) were used. Recipients of NX-70 and PN6A IOLs were classed into groups 1 (15 eyes) and 2 (25 eyes), respectively. Patient characteristics, surgical results, and postoperative complications were analyzed. We excluded patients with a postoperative follow-up of <1 month. Results The mean follow-up period was 13.3 ± 11.7 weeks. The postoperative best corrected visual acuity, in logarithm of the minimum angle of resolution (logMAR), was 0.10 ± 0.33 in group 1 and 0.26 ± 0.42 in group 2. The mean operation times for groups 1 and 2 were 11.2 ± 4.54 minutes and 7.00 ± 2.20 minutes, respectively (p=0.0024). Detachment of the IOL haptic from the optic during surgery occurred in four eyes in group 2 (16%), but did not occur in group 1. Iris capture of the optic was observed in 3 of the 13 eyes (23%) without a peripheral iridotomy in group 2. No peripheral iridotomies were performed on group-1 eyes, but iris capture did not occur in that group. Conclusions There was a trend to fewer intraoperative and postoperative complications when using NX-70 IOLs. On the other hand, PN6A IOLs was easy to maneuver within the anterior chamber, and the operation time was shorter when using PN6A IOLs. Selection of optimal IOLs for flanged IOL fixation necessitates an understanding of their characteristics in terms of intraoperative and postoperative complications.

Flanged intraocular lens fixation via 27-gauge trocars using a double-needle technique decreases surgical wounds without losing its therapeutic effect.

PurposeIntraocular lens (IOL) fixation using a sutureless 27‐gauge needle intrascleral IOL implantation technique requires six surgical wounds. We developed a modified technique using two 27‐gauge trocars for vitrectomy and indwelling flanged IOL haptics to reduce the number of surgical wounds.SettingDepartment of Ophthalmology, Hyogo College of Medicine.DesignThis retrospective study enrolled 54 patients who had undergone IOL scleral fixation between January 2016 and April 2019.MethodsPatients who underwent IOL scleral fixation and were observed for >12 weeks were analysed using medical record data. Before October 2017, patients underwent normal flanged IOL scleral fixation. Between November 2017 and April 2019, patients underwent the modified method (flanged IOL via 27‐gauge trocars with double‐needle technique). Primary end‐point was superiority or non‐inferiority of modified IOL scleral fixation compared with normal IOL scleral fixation for visual acuity (VA). Changes in corneal endothelium cell number, refractivity, astigmatisms and surgery‐related complications, were secondary end‐points.ResultsThere were no significant differences in baseline characteristics between groups. Raw VA and best collected VA (BCVA) were significantly improved in all eyes (p−). There were no statistical significances in raw VA, BCVA and surgery‐related complications between groups.ConclusionsResults of the modified technique were not inferior compared with the original technique although it was less invasive. Therefore, flanged IOL fixation via trocars using a double‐needle technique is a useful technique for IOL implantation.

Gentamicin-induced macular toxicity following flanged intraocular lens fixation

Gentamicin-induced macular toxicity following flanged intraocular lens fixation

Flanged Intrascleral Intraocular Lens Fixation with Double-Needle Technique

To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL). Prospective, noncomparative, interventional case series. One hundred eyes of 97 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied. Two angled incisions parallel to the limbus were made by 30-gauge thin-wall needles. Haptics of an IOL were externalized with the needles and cauterized to make a flange of the haptics. The flange of the haptics were pushed back and fixed into the scleral tunnels. Best-corrected visual acuity (VA), corneal endothelial cell density, IOL tilt, and complications were determined. The IOLs were fixed with exact centration and axial stability. The mean preoperative best-corrected VA was 0.25 logarithm of the minimum angle of resolution (logMAR) units; after surgery, it improved significantly to 0.11 logMAR, 0.09 logMAR, 0.12 logMAR, and 0.04 logMAR at 6, 12, 24, and 36 months, respectively (P<0.01, P < 0.01, P= 0.03, and P= 0.10, respectively). The mean corneal endothelial cell density decreased from 2341 cells/mm2 before surgery to 2313 cells/mm2, 2240 cells/mm2, 2189 cells/mm2, and 2244 cells/mm2 at 6, 12, 24, and 36 months, respectively (P < 0.01, P < 0.01, P < 0.01, and P= 0.17, respectively). The mean IOL tilt was 3.4°±2.5°. The postoperative complications included iris capture by the IOL in 8 eyes (8%), vitreous hemorrhage in 5 eyes (5%), and cystoid macular edema in 1 eye (1%). There were no incidents of postoperative retinal detachment, endophthalmitis, or IOL dislocation. We have developed a new technique for intrascleral IOL fixation. The flanged IOL fixation technique is a simple and minimally invasive method for achieving good IOL fixation with firm haptic fixation.