Flanged Intrascleral Intraocular Lens Research Articles

Comparison of Refractive Prediction Error by Axial Length in Flanged Intrascleral Intraocular Lens Fixation.

To evaluate the refractive prediction error in flanged intrascleral intraocular lens (IOL) fixation using the SRK/T formula and compare the axial length using a single IOL. Seventy-six eyes from 70 patients (45 males and 25 females) were included in this study. The mean age at the time of surgery was 73.4 ±12.3 years. The patients underwent flanged IOL fixation using a PN6A (Kowa). All surgeries were performed by two surgeons (Y. K. and T. O.) between Jan 2020 and Dec 2022 at Jikei University Daisan Hospital. IOL power was calculated using the SRK/T formula with IOL Master 700 (Carl Zeiss) as the bag power. The recommended value of 119.0 was used for the A-constant. The actual refractive spherical equivalent was calculated and compared with preoperative predictions. Refractive prediction errors were defined as the deviation of the actual postoperative spherical equivalent refraction in diopters from the predicted preoperative spherical equivalent refraction. The patients were divided into three groups according to axial length: <22.0 mm (short eyes), 22.0-24.5 mm (medium eyes), and >24.5 mm (long eyes), and the refractive prediction errors and mean absolute errors were compared. The mean refractive prediction error was -0.20 ± 0.52D. The mean absolute error was 0.44 ± 0.33D. The mean refractive prediction errors were not significantly different between the 22.0-24.5 mm (medium eyes) and >24.5 mm (long eyes) groups. (P=0.06) The mean absolute errors were not significantly different between the two groups (P=0.10). The SRK/T formula worked well regardless of whether the eyes were medium or long according to the axial length in the flanged intrascleral IOL fixation.

Long-term functional outcome between Yamane technique and retropupillary iris-claw technique in a large study cohort.

To evaluate which secondary intraocular lens (IOL) implantation technique was more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw IOL (ICIOL) and flanged intrascleral IOL (FIIOL) fixation with the Yamane technique. Eye Clinic of the University of Trieste, Trieste, Italy. Retrospective observational study. 116 eyes of 110 patients who underwent ICIOL or FIIOL were analyzed. Patients with follow-up shorter than 6 months or with incomplete clinical data were excluded. Collected data included demographics, ocular comorbidity, indication of surgery, intraocular pressure, early (≤1 month) and late (>1 month) postoperative complications, corrected distance visual acuity (CDVA), and manifest refraction at the last follow-up visit. 50% (n = 58) of eyes underwent FIIOL and 50% (n = 58) ICIOL implantation for aphakia (n = 44, 38%) and IOL dislocation (n = 72, 62%). No statistically significant differences in demographics, comorbidity, follow-up duration, postoperative complications, and surgical indications were found. The refractive prediction error (RPE) was 0.69 ± 0.94 diopter (D) in the FIIOL group and 0.21 ± 0.75 D in the ICIOL group ( P = .03), indicating residual hyperopia after both techniques. RPE, mean absolute error, and median absolute error were higher in the FIIOL group ( P = .003). ICIOL implantation was more successful in obtaining a RPE between -0.50 D and +0.50 D (52% of ICIOL, n = 30, and 31% of FIIOL, n = 18). Both techniques were effective in increasing preoperative CDVA with no statistical difference between them. Although complication rates did not significantly differ, the FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-piece IOL, as performed in ciliary sulcus implantation, to prevent myopic shift, is not recommended.

IMPACT OF GAS/AIR TAMPONADE ON REFRACTIVE OUTCOMES AFTER FLANGED INTRASCLERAL INTRAOCULAR LENS FIXATION.

This study aims to investigate the postoperative refractive outcomes in eyes that underwent the flanged intrascleral intraocular lens (IOL) fixation combined with vitrectomy with or without gas/air tamponade. The eyes were divided into two groups (Group A; eyes that underwent flanged intrascleral IOL fixation with gas/air tamponade, and Group B; eyes that underwent flanged intrascleral IOL fixation without gas/air tamponade). The predicted spherical equivalent (SE) refraction values were calculated using the Sander-Retzlaff-Kraff Theoretical formula. Then, the prediction error was calculated by subtracting the predicted SE refraction from the postoperative objective SE refraction and the absolute prediction error was calculated as the absolute value of the prediction error for each eye. A total of 68 eyes were included in the current study. There was a significant correlation between the predicted and postoperative SE refraction in both groups (Group A, r = 0.968, P < 0.0001, Group B, r = 0.943, P < 0.0001, linear regression analysis). The prediction error demonstrated a mild myopic shift after the flanged intrascleral IOL fixation in both groups (Group A, -0.40 ± 0.96 diopter, Group B, -0.59 ± 0.95 diopter). There was no significant difference in prediction error and absolute prediction error between the two groups ( P = 0.44, P = 0.70, Wilcoxon rank sum test). The postoperative SE refraction after flanged intrascleral IOL fixation was not influenced by gas/air tamponade.

Comparison of Surgical Outcomes between Conventional Sutured Scleral Fixation and Flanged Intrascleral Intraocular Lens Fixation

Purpose: We compared the surgical outcomes and complications of conventional, sutured scleral fixation and flanged intrascleral intraocular lens (IOL) fixation.Methods: We retrospectively analyzed the medical records of patients who underwent conventional, sutured scleral fixation or flanged intrascleral IOL fixation and who were then observed for more than 6 months. The best-corrected visual acuity (BCVA), operation time, spherical equivalent (SEQ), astigmatism, and postoperative complications were recorded up to 6 months after surgery.Results: Of sixty-nine enrolled eyes, 39 underwent conventional, sutured scleral fixation (“sutured” group) and 30 flanged intrascleral IOL fixation (“sutureless” group). The operation time was significantly shorter in the sutureless group than in the sutured group (56.3 ± 11.8 vs. 77.7 ± 17.9 minutes, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In both groups, the BCVA and SEQ improved significantly at all visits after surgery compared to the baseline values &lt;i&gt;p&lt;/i&gt; &lt; 0.05). There was no between-group difference in BCVA, SEQ, astigmatism, or complications.Conclusions: Compared to conventional, sutured scleral fixation, flanged intrascleral IOL fixation afforded equivalent improvements in visual acuity but with a shorter surgical duration. Therefore, flanged intrascleral IOL fixation is a useful alternative to conventional, sutured scleral fixation.

Intraocular Lens Formula Comparison of Flanged Intrascleral Intraocular Lens Fixation with Double Needle Technique.

To analyze visual outcomes and accuracy of intraocular lens (IOL) calculation formulas in predicting postoperative outcomes in patients undergoing flanged intrascleral IOL fixation. Case Series. Twenty-three patients who had undergone secondary IOL placement using flanged intrascleral fixation technique. Retrospective chart review. Corrected distance visual acuity (CDVA) and postoperative spherical equivalent based on manifest refraction. Visual acuity improved from 20/577 to 20/58. Overall, the actual refraction was 0.06 D more myopic than predicted. Holladay 2, Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II resulted in mild myopic surprise (-0.55, -0.18 and -0.20 D). Haigis and Hill-RBF (Radial Basis Function) resulted in mild hyperopic surprise (+0.28 and +0.28 D). Hoffer Q and Holladay 1 were the most accurate (-0.02D and -0.08 D). Flanged intrascleral IOL fixation improved vision even in patients with other posterior segment pathologies. The effective lens positioning is likely similar to in-the-bag positioning. Hoffer Q and Holladay 1 formulas with in-the-bag calculations were the most accurate.

Attaining optimal flange size with 5-0 and 6-0 polypropylene sutures for scleral fixation.

A technique for achieving an optimal flange size with 5-0 polypropylene and 6-0 polypropylene used for flanged intrascleral intraocular lens fixation is described. Flange size in polypropylene sutures is dependent on heating length and independent of forceps grip during heating. It was identified that heating of 1 mm created the optimal flange size for a 5-0 polypropylene suture when used for a 27-gauge needle scleral tunnel and for a 6-0 polypropylene suture when used for a 30-gauge needle scleral tunnel. Alternatively, 2 mm heating of a 6-0 polypropylene suture fits well for a 27-gauge needle tunnel. Even gentle forceps grip caused flattening of the polypropylene sutures but did not influence shaping and sizing of the flange.

Comparison of Intraocular Lens Power Formula Accuracy for Flanged Intrascleral Intraocular Lens Fixation

Comparison of Intraocular Lens Power Formula Accuracy for Flanged Intrascleral Intraocular Lens Fixation

Combining flanged intrascleral IOL fixation with Glaucoma Surgery: Initial experience.

To report the initial clinical outcomes of combining glaucoma surgery with flanged intrascleral intraocular lens (F-SFIOL) fixation as a single stage procedure. Retrospective, non-comparative case-series of eyes which underwent combined surgery for glaucoma with F-SFIOL and had at least 6-months of follow-up. A fellowship-trained senior glaucoma surgeon managed all the cases. Twelve-eyes of 10 glaucoma patients (8 males, 2 females) underwent F-SFIOL; only 8 of these eyes were combined with a glaucoma procedure. Mean age of patients was 55.1 ± 16.1 years (95%CI [44.4,73.2], median 61 years) and were followed-up for a mean of 21.0 ± 9.5 months, 95% CI [13.1,28.9], median 18 months. F-SFIOL was combined with trabeculectomy ± Mitomycin C in 4 eyes, Ahmed Glaucoma Valve in 3 eyes and needling of a pre-existing bleb in 1. Each eye had controlled intraocular pressure (IOP) at last follow-up (pre-procedure 29.1 ± 13.4 mmHg, 95% CI [17.9, 40.3], median 27 mmHg to 14.5 ± 3.2 mmHg, 95% CI [11.8, 17.1], median 13 mmHg, p = 0.006) and decreased need for number of anti-glaucoma medication (AGM) (pre-procedure 3.7 ± 1.1, 95% CI [2.8,4.6], median 4 to 0.7 ± 0.7, 95% CI [0.1,1.3] median 1, p < 0.001). In all the eyes, best corrected visual acuity (BCVA) was either stable or improved; only 1 eye had astigmatism worse than that pre-existing. In 1 eye IOL was explanted, with an additional procedure to control IOP. No serious long-term complications occurred in any subject. The initial experience of single-stage F-SFIOL along with glaucoma surgery, both being performed by the same anterior-segment surgeon, is promising, thereby avoiding the cost, specialised skill, and potential complications of a posterior approach. Glaucoma surgery combined with and adapted to suture-less, flap-less, glue-less intra-scleral IOL fixation is hitherto unreported.

Accuracy of intraocular lens calculation formulas for flanged intrascleral intraocular lens fixation with double-needle technique.

To evaluate the refractive prediction error (RPE) of intraocular lens (IOL) calculation formulas in eyes that have undergone the Yamane technique for scleral fixation of IOLs. Alkek Eye Center, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Retrospective case series from electronic chart review. Patients who had undergone scleral fixation of secondary IOLs were selected. The IOL RPEs for 4 IOL prediction formulas-Barrett Universal II, Holladay 1, Hoffer Q, and SRK/T formulas-were obtained by subtracting the predicted spherical equivalent from the postoperative spherical equivalent. The arithmetic mean RPE, mean absolute error (MAE), and percentages of eyes with prediction error of 0.50 diopter (D) or lesser and 1.00 D or lesser were calculated and compared. Forty eyes of 40 patients met inclusion criteria. All formulas produced hyperopic mean arithmetic RPE. MAE values were 0.73 D for Holladay 1, 0.76 D for Barrett Universal II, 0.80 D for SRK/T, and 0.86 D for Hoffer Q formulas. The percentage of eyes with prediction error of 0.50 D or lesser and 1.00 D or lesser with these formulas were 45% (18 eyes) and 75% (30 eyes) for Holladay 1, 38.5% (15 eyes) and 77% (30 eyes) for Barrett Universal II, 32.5% (13 eyes) and 67.5% (27 eyes) for SRK/T, and 27.5% (11 eyes) and 62.5% (25 eyes) for Hoffer Q formulas. There were no statistically significant differences in prediction errors between the 4 formulas. Refractive outcomes of the Yamane technique were less predictable than those of standard cataract surgery. Arithmetic RPE ranged from hyperopic to predicted values for all formulas tested.

A Modified Flanged Intrascleral Intraocular Lens Fixation Technique Using an Externalized Needle for Haptic Docking.

The Yamane intrascleral flanged haptic fixation technique has obviated the need for resources such as suture or glue. However, intraocular maneuvers to properly dock haptics into the needles for externalization can be difficult for even adept eye surgeons and is especially difficult when visualization through the cornea is poor. Additionally, one traditional resource, intraocular forceps, has been critical in both the original technique and proposed modifications since its inception. We describe a modified flanged intrascleral intraocular lens fixation technique by docking the second haptic externally at the main corneal incision. This technique does not require the use of microforceps, which is advantageous to surgeons who lack access to specialized instrumentation. Additionally, this technique may provide added safety, visibility, and ease for surgeons by docking the haptic externally at the corneal incision rather than within the eye.

Standardized Flanged Intrascleral Intraocular Lens Fixation with the Double-Needle Technique for Cataract Luxation in the Vitreous Chamber during Phacoemulsification.

Purpose To assess the visual and refractive outcome of immediate intraoperative vitrectomy and intrascleral intraocular lens implantation using a “standardized” sutureless Yamane technique during cataract luxation in the vitreous chamber as a complication of phacoemulsification. Design A prospective, interventional, consecutive case series. Materials and Methods Twelve patients underwent vitrectomy and intrascleral intraocular lens fixation using a standardized Yamane technique as the primary procedure during complicated phacoemulsification. Patients were evaluated preoperatively and 6 months postoperatively for best-corrected distance visual acuity, correspondence to the preoperative refractive target in the spherical equivalent, endothelial cell count, and complications. Results Mean preoperative best-corrected visual acuity was 1.16 ± 0.3 logarithm of the minimum angle of resolution (logMAR), the endothelial cell count was 1910.5 ± 297.64, and target refraction at baseline was −0.197 ± 0.087. Postoperatively, best-corrected visual acuity was significantly improved; the mean value was 0.05 logMAR ± 0.06. Mean baseline target refraction in the spherical equivalent was −0.20 ± −0.09 (range: −0.08 to −0.37), and mean final refraction was −0.44 ± −0.14 (range: −0.25 to −0.75) with no significant difference (p=0.87). No complication was registered intra- and postoperatively. Conclusion Standardization of the Yamane technique seemed a valuable option for patients who had complicated phacoemulsification to achieve a predictable refractive outcome. Synopsis. The predictable refractive outcome could be achieved with the immediate standardized Yamane technique in patients with intraoperative cataract luxation in the vitreous chamber during phacoemulsification.

Secondary intraocular lens implantation using the flanged intrascleral fixation technique in pediatric aphakia: case series and review of literature

To present a pediatric case series in which the flanged intrascleral intraocular lens (IOL) fixation technique (Yamane technique) was used to correct aphakia. The surgical database of a single tertiary children's hospital was reviewed to identify all patients who underwent secondary IOL implantation by a single surgeon from May 2018 to January 2020. The medical records and operative reports of all patients operated on using the Yamane technique were reviewed retrospectively. Intra- and postoperative complications and pre- and postoperative vision and refraction were documented to assess outcomes. A total of 12 eyes of 10 consecutive patients were included. Mean age at surgery was 10±6years. Indications for scleral fixation were ectopia lentis (secondary to Marfan syndrome [n=3] or idiopathic [n=1]), lens subluxation with intermittent pupillary block secondary to Weill- Marchesani syndrome (n=2), early childhood lensectomy with insufficient residual capsular support (n=5), and traumatic aphakia after an open globe (n=1). Mean follow-up was 8±5months. No major intraoperative complications occurred. Postoperatively 1 patient required IOL repositioning 1week after surgery. The location of one haptic was noted to be intrascleral but superficial in another patient, who did not require surgical intervention. The mean postoperative astigmatism was 2±2 D. Good visual results were achieved in all eyes. With slight modifications, the Yamane technique can be adapted to the pediatric eye. This technique has significant surgical and anatomic advantages and provides stable IOL fixation. Visual outcomes and adverse events compare favorably with older techniques.

Flattened flanged intrascleral intraocular lens fixation technique

To evaluate the visual outcomes of the patients who had undergone sutureless scleral fixated IOL implantation operation in which a new modified Yamane technique called flattened flanged intrascleral intraocular lens fixation technique was applied. Forty-two eyes of 42 patients who had undergone scleral IOL fixation operation with Yamane technique comprised Group 1. The mean age of this group was 60.24 ± 14.3 (20-77) years. Out of 42 patients, 25 of them (60%) were males and 17 of them (40%) were females. Forty-three eyes of 43 patients who had undergone scleral IOL fixation operation with flattened flange technique comprised Group 2. The mean age of this group was 55.35 ± 15.77 (18-79) years. Out of 43 patients, 23 (53.4%) of them were males and 20 (46.6%) were females. There were no significant differences between two groups in respect to mean preoperative UCVA, postoperative UCVA, preoperative BCVA, and postoperative BCVA (p values 0.35, 0.11, 0.28, and 0.16, respectively). The mean postoperative UCVA and preoperative BCVA were significantly higher than those of preoperative values in both groups (p < 0.05). Intraoperative haptic sliding occurred in three eyes (7%) in the first group, and there was no intraoperative haptic sliding in the second group (0%) (p = 0.05). Postoperative IOL dislocation occurred in one eye (2.5%) in the first group, and there was no postoperative IOL dislocation in the second group (0%) (p = 0.32). In conclusion, this technique does not require sutures, decreases intraoperative haptic sliding, may provide more IOL stability and less tilt, and facilitates the implantation of the second haptic. For long-term results, further studies should be conducted.

Combined Keratoplasty, Pars Plana Vitrectomy, and Flanged Intrascleral Intraocular Lens Fixation to Restore Vision in Complex Eyes With Coexisting Anterior and Posterior Segment Problems.

To restore vision in complex eyes with coexisting anterior and posterior segment problems, combined corneal transplantation (penetrating keratoplasty [PK] or Descemet-stripping automated endothelial keratoplasty [DSAEK]), pars plana vitrectomy (PPV), and/or flanged intrascleral intraocular lens (IOL) fixation, designated vitreocorneal surgery are performed. In this study, we evaluated the usefulness of vitreocorneal surgery for eyes with complex comorbidities. Thirteen consecutive eyes in 13 patients with coexisting corneal pathology (ie, corneal scarring, bullous keratoplasty, corneal laceration) and posterior segment pathology (ie, aphakia without capsular support, retinal detachment, intravitreal foreign body) underwent vitreocorneal surgery. Visual outcomes, intraoperative and postoperative complications, and additional surgery were retrospectively evaluated. Vitreocorneal surgery included PK + PPV + intrascleral IOL fixation (n = 5), PK + PPV (n = 3), PK + intrascleral IOL fixation (n = 1), DSAEK + intrascleral IOL fixation (n = 1), and DSAEK + PPV + intrascleral IOL fixation (n = 3). An intraoperative Eckardt temporary keratoprosthesis use enabled safe PPV. No vitreoretinal/IOL complications occurred. One eye required repeat DSAEK to repair endothelial graft detachment and inversion. In 3 eyes, secondary glaucoma was subsequently treated by glaucoma drainage device implantation through the pars plana. Mean best spectacle-corrected visual acuity (logMAR) improved from 1.8 ± 0.9 preoperatively to 1.1 ± 0.6 at 11.2 ± 14.6 months postoperatively (P = 0.002). Postoperative refraction was -0.68 ± 2.56 D (spherical equivalent). PK or DSAEK with PPV and/or flanged intrascleral IOL fixation is useful for complex eyes with coexisting anterior and posterior segment problems.