Inadequate Capsular Support Research Articles

Postoperative complication rates in intraocular lens placement and fixation methods for inadequate capsular bag support: a review and meta-analysis.

To evaluate the complication rates of different IOL placement methods in adults with inadequate capsular bag support. The surgical correction of inadequate capsular bag support for the intraocular lens (IOL) harbors several challenges, and there is a wide-range of surgical procedures. For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (i) AC placement, (ii) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL (iii) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of two or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557). Fifteen studies were included in the final analysis, which reported results of 1,247 eyes. The overall complication rate was non-significantly lower in iris fixation (4.4%; 95%CI: 3.6-5.4%, P=0.150) than in AC placement (7.4%; 95%CI: 6.4-7.9%) and scleral fixation (7.4%; 95%CI: 6.5-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95%CI: 2.4-57.5%, P<0.001), compared to scleral fixation (11.9%; 95%CI: 2.6-21.2%) and iris fixation (4.1%; 95%CI: 0.8-7.3%;). Vitreous hemorrhages were more frequently reported following scleral fixation (8.5%; 95%CI: 6.3-11.2%, P=0.006) than in AC placement (5.4%; 95%CI 3.4-8.5%) and iris fixation, 1.4%; 95%CI 0.4-4.2%), and so was IOL decentration/dislocation (8.9%; 95%CI: 6.7-11.8%, P=0.047 compared to 1.1%; 95%CI: 0.4-3.4% and 4.0%; 95%CI: 2.2-7.3%, respectively). The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.

CM T flex scleral fixated intraocular lens short-term outcomes in different clinical scenarios

Objective: The purpose is to report the visual outcomes of a “T”-shaped haptic scleral fixated intraocular lens (SFIOL) implanted using the sutureless technique in different clinical scenarios. Material and Methods: A retrospective case series, where patients implanted with “T”-shaped haptic SFIOL between September 2022 and February 2023, were included in the study. Subjects with missing data were excluded from the study. All surgeries were performed by a single surgeon. Pre- and post-surgery follow-up visual acuity and intraocular pressure were noted. Post-operative centration of intraocular lens (IOL), haptics condition, and occurrence of any complication were noted. Results: Overall, 20 eyes of 19 patients were implanted with “T”-shaped haptic SFIOL and had a mean age of 54.15 ± 15.99 years. None of the patients had any intraoperative IOL damage or any other intraoperative complication. There was a significant improvement in visual acuity post-SFIOL implantation (Paired t-test, P &lt; 0.001), which was noted. Corneal edema was noted in one patient. IOL was stable and well-centered in all patients. No haptic-related complications were encountered. Conclusions: SFIOL with “T”-shaped haptic is a viable option for aphakic cases with inadequate capsular support. IOL implantation with “T”-shaped haptic is sutureless, less damaging to ocular structures and has a shorter learning curve making it easier for implantation.

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

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

Ab Externo Scleral-Fixated Intraocular Lens As A Management in Aphakic Eye

Introduction : Varied technique of secondary intraocular lens (IOL) implantation are exist. Scleral-fixated IOL implantation become popular both with or without sutures. The one of sutures technique is ab externo&#x0D; Case Illustration : A 68 year old man came with blurry vision on left eye (LE) since one month ago. He had history of primary angle closure suspect and posterior subcapsular cataract on LE and managed with Intracapsular Cataract Extraction in January 2021. Ophthalmology examination of LE revealed uncorrected visual acuity (UCVA) 1/60, irregular updrawn pupil with diameter 7.4mm x 5.3 mm, and aphakic lens. The best corrected visual acuity (BCVA) with S+12.00 C-0.75 x 80 was 0.4f. The patient underwent secondary IOL by using 3 pieces IOL with ab externo scleral- fixated on his left eye (Figure 1). Power IOL determined was +24.00 diopter with target of refraction was emmetropia. One day postoperatively, the UCVA was 0.08 pinhole 0.125 with good centration of scleral fixation IOL. First month postoperatively, BCVA with S-1.75 C-1.00 x 50 was 0.4 on snellen chart.&#x0D; Discussion : Aphakia with inadequate capsular support can be seen in several conditions. Technique of introducing two suture loops for scleral fixation of an IOL by ab externo procedure, which proved safe and effective. Scleral fixation of IOL in the posterior chamber, although technically demanding, allows good visual outcomes.&#x0D; Conclusion : Ab externo scleral-fixated IOL implantation is an effective rescue procedure for eyes with deficient capsular support.

Z-suture scleral fixation intraocular lenses: A refractive and safety report.

Scleral fixation of intraocular lenses constitutes a surgical option in cases where there is inadequate capsular support or zonular insufficiency. Knotless techniques, such as the z-suture technique, avoid suture-related complications, such as conjunctival erosion or exposure. The purpose of this study was to evaluate the visual outcomes and postoperative complications of patients who underwent scleral z-suture fixation of the Akreos AO® intraocular lenses. A retrospective, observational study was conducted, including 22 eyes of 20 patients who underwent Akreos AO® intraocular lenses using the z- suture scleral fixation technique. The mean age of the patients was 55,64 ± 28,47 years old, and the mean follow-up time was 25,64 months. The most common indication for surgery was previous complicated cataract surgey. The mean postoperative spherical equivalent was +0,058D ± 0,79D, with values ranging from - 1,50D to +1,00D. Mean best-corrected visual acuity was 0,178 ± 0,15 logMAR. Intraocular pressure was 15,07 ± 2,56 mmHg on the day after surgery, and 16 ± 2,15 mmHg 1 month after. No suture-related complications were observed in any patient postoperatively. One patient had a slight inferonasal lens dislocation and another patient had a severe case of herpetic keratitis posoperatively. The knotless z-suture technique appears to be a reliable and safe way to fix an intraocular lens in the sclera, regardless of the patient's age. Our results show good visual results and predictable refractive outcomes. Decades of follow-up may be necessary to assess the long-term risk of lens dislocation.

Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus

Objective: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).&#x0D; Materials and Methods: A retrospective study was conducted at the Ophthalmology Department of Lahore General Hospital, Lahore between 2017 and 2022. The study included 51 patients (33 males and 18 females) between the age 35 to 85 years who were referred after a complicated phacoemulsification with dropped nucleus.&#x0D; Results: This study included 51 patients in which 33 were males (64.71%) and 18 were females (35.29%). All patients underwent 23-gauge pars plana vitrectomy. Posterior chamber phacofragmentation was carried out in 32 (62.75%) eyes while in remaining 19 (37.25%) patients vitrectomy cutter was used for the dropped nucleus. Out of 51, 06 (11.76%) patients received an anterior chamber IOL at the time of cataract surgery, 21 (41.18%) eyes had IOL in the ciliary sulcus, 07 (13.73%) had a posterior chamber IOL, and the remaining 17 (33.33%) patients were aphakic. Of these 17 aphakic patients, an anterior chamber IOL was placed at the time of vitrectomy in 07 (41.18%) patients who were judged to have inadequate capsular support for a posterior chamber lens. In the remaining 10 (58.82%) eyes, where capsular support was deemed adequate, a posterior chamber IOL was inserted. Final visual acuity was 20/40 or better in 34 (66.67%) eyes and 20/50 in 06 (11.76%) patients.&#x0D; Conclusion: Poor visual outcome after dropped nucleus at phacoemulsification cataract extraction can be avoided if managed by prompt pars plana vitrectomy as it offers the advantages of a closed system for vitrectomy and manipulation of the nucleus, an improved view of the posterior segment and facilitated recognition and management of intraoperative complications with better visual and anatomical outcomes with low rate of postoperative complications.

Novel A-type scleral suture technique for sulcus-fixated intraocular lens tilt

This report describes the first use to the authors' knowledge, of a simple technique for repositioning a tilted intraocular lens (IOL) after scleral fixation. A 76-year-old woman presented with sudden blurred vision in the right eye. She had previously undergone IOL scleral fixation due to traumatic cataract and acute angle-closure glaucoma. IOL tilt was revealed on examination, and repositioning was performed with polypropylene sutures across the pupil from limbus to limbus by forming an A shape to stabilize the IOL and prevent rotation. 6 months after the repositioning surgery, the IOL was well positioned and the patient's corrected distance visual acuity improved from counting fingers to 20/25. This surgical technique was successfully performed for a patient with IOL tilt. It decreased operative time and corneal damage while increasing IOL stability. The procedure was a safe and effective alternative to IOL exchange for a patient with inadequate capsular support.

Methods of intraocular lens fixation in complicated cases of lens surgery

There is a growing attention to the lens surgery in complicated cases that require to obtain a good functional result and to minimize the surgical volume. The intraocular lens fixation remains a major problem in complicated cases in lens surgery due to the inadequate capsular support. It is essential to achieve the refractive goal and correct positioning of the intraocular lens both immediately after operation and in the long-term period.&#x0D; The article reviews current available scientific literature of domestic and international authors devoted to the problem of intraocular lens fixation in complicated cases of lens surgery.

Case Report: Yamane Fixation of a Light Adjustable Lens in a Patient with Marfan Syndrome

This paper aims to discuss a case of a Light Adjustable Lens (LAL) implanted with the Yamane technique in a Marfan patient undergoing complex cataract surgery. A 60-year-old female with a history of Marfan syndrome presented in May 2020 with complaint of worsening vision due to bilateral subluxed cataracts. Bilateral LALs were planned to be implanted in the capsular bag with scleral fixated Ahmed segments using 5-0 prolene due to zonular instability. The procedure was complicated by an anterior capsular tear at 6 O’clock due to a very friable capsular bag. This tear extended posteriorly with no vitreous loss. Given inadequate capsular support, the decision was then made to scleral fixate the LAL using a Yamane technique. The first attempt at scleral fixation resulted in the LAL haptic breaking off into the 27G needle during the scleral pass. The LAL with remaining haptic was cut in half and explanted. A new LAL was successfully fixated with the Yamane technique. A scleral fixated Ahmed segments using 5-0 prolene was done successfully for the right eye. Final adjustment and locking occurred 10 weeks after right eye procedure. The final refraction of the right eye was measured to be plano, + 0.5 cyl, 85 axis with uncorrected distance visual acuity of 20/20 and corrected distance visual acuity of 20/20. The final refraction of the left eye was measured to be -2.75 D, 0 cyl, 0 axis with uncorrected distance visual acuity of 20/200, uncorrected near visual acuity of J1+ and corrected distance visual acuity of 20/20. When choosing a lens to Yamane, LALs are uniquely capable of correcting a residual refractive error without an additional surgery. LALs are an excellent option for patients that desire a refractive outcome with limited or no capsular support.

Evaluation of DMEK with secondary IOL implantation in cases of aphakic bullous keratopathy

Context DMEK is used to treat corneal decompensation. This study focuses on the succcess and outcome of DMEK with and without secondary IOL implantation. Aims The purpose of our work is to evaluate Descemet membrane endothelial keratoplasty (DMEK) with secondary Intraocular lens (IOL) implantation in cases of aphakic bullous keratopathy with insufficient capsular support. Settings and design Pilot study. Methods and material This was a nonrandomized comparative prospective interventional case series where 11 eyes of 11 patients with aphakic bullous keratopathy secondary to complicated cataract surgery underwent DMEK with secondary IOL implantation using modified Yamane technique, and results were compared to 11 eyes of 11 patients underwent DMEK only. Statistical analysis used The statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS 15.0.1 for windows; SPSS Inc, Chicago, IL, 2001). Results Both groups showed a high success rate (81.8%) with rebubbling required in 3 eyes in both groups. Both groups also showed significantly improved BCVA, decreased CCT and a decrease in donor graft ECD. Conclusions DMEK combined with secondary IOL implantation by modified Yamane technique appears to be a feasible method in managing aphakic bullos keratopathy with inadequate capsular support, and results are comparable to DMEK alone.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens.

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3-12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21-30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12-19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

Commentary: When in a fix, rely on four-point intraocular lens fixation.

This study[1] on Observation of the curative effect of scleral suture fixation technique with four loop foldable intraocular lens is appreciable as it deals with a difficult technique, which has been described and illustrated well in the manuscript. Every ophthalmologist encounters the problem of inadequate capsular support, whether preoperative or intraoperative. It is imperative and crucial to learn how to tackle it and fix an intraocular lens (IOL) to provide good postoperative vision. As polypropylene sutures are non-absorbable, the 9-0 sutures used in this study have the advantage of a greater diameter and cross-sectional area than 10-0 polypropylene suture and will provide permanent wound support; the color blue helps in easy identification and the tensile strength is excellent.[2] Published studies on the use of 9-0 polypropylene sutures in scleral fixation of IOLs are very few.[3] The four-point IOL fixation to fixate the four haptics has been reported to provide a variety of advantages, including enhanced IOL stability and centration, avoidance/minimal of IOL tilt or postoperative pupil capture, and posterior segment complications.[4,5] However, there are a few concerns: The follow-up appears to be too short, with a range of 3–12 months, compared to other studies.[6,7] In eight eyes of this study, having elevated IOP, no medication was used though the IOP stabilized within a week. It may have been better to lower the IOP in the initial stages to prevent any damage. The central corneal thickness and applanation tonometry for the corrected IOP would have added further value. In one patient, it is mentioned that one side of the IOL was dislocated into the vitreous, yet another IOL was implanted and secured by the same technique. In statistical analysis ;newer version of SPSS formula would have been better to use instead of SPSS 16.0. The measurement of IOL tilt has been done at only one month postoperatively in the study. The postoperative endothelial count could have been compared to the preoperative count to provide more valuable insight. The postoperative UCVA was 0.09 ± 0.09, which was significantly better than the preoperative UCVA (t = 13.28, P < 0.001). The quality of vision further improved on correction, and postoperative BCVA was 0.08 ± 0.07, which was significantly better than preoperative BCVA (t = 6.89, P < 0.001). The potential drawback of the type of IOL used is that it is made of a hydrophilic acrylic material, in which opacification can occur. Cases having inadequate capsular support are not only complicated but require skill, expertise, and mentorship. When a surgeon is faced with such a patient, the onus lies only on them to give the best outcome. The importance of the study lies in the management of a complication or condition that can cause a devastating effect on vision. The difficult yet effective procedure described and analyzed is a valuable tool to a solution in a challenging situation.

Long Term Follow-up of Retropupillary Fixation of Iris-clipped Intraocular Lens for Children with Inadequate Capsular Support

Children with weak or absent capsular support requiring lens removal and intraocular lens implantation presentas one of the more challenging cases in pediatric ophthalmology practice. The authors present a case series with postoperative follow-up of at least five years after retropupillary fixation of iris-clipped lenses. All cases had improved visual acuity with only minor focal iris atrophy as complication in one case. Retropupillary fixation of iris-clipped IOL should be included in an ophthalmologist's armamentarium when operating on cases with weak or absent capsular support.

Intraocular Lens Elongation Technique with Haptic Modification for Sulcus Implantation.

Objectives:To define a haptic modification technique to increase the overall length of the intraocular lens (IOL) and evaluate the postoperative outcomes of patients in whom this technique was applied.Materials and Methods:The preoperative and postoperative characteristics of patients who underwent modified IOL implantation into the sulcus between May 2019 and December 2019 were evaluated. Modified Sensar AR40e lenses with hydrophobic acrylic optic and polymethylmethacrylate haptics were implanted to all eyes. Before implanting the IOL, the haptics were grasped with two toothless forceps and bent to elongate the total diameter of the IOL from 13.0 mm to 14.5 mm.Results:The study included 11 eyes of 11 patients who underwent modified three-piece IOL implantation into the sulcus due to insufficient capsular support. The mean age of the patients was 53.9±12.2 years. The mean axial length was 24.13±1.93 mm. Sulcus implantation was required due to aphakia in 9 eyes and IOL dislocation in 2 eyes. No haptic breakage occurred during the IOL modification technique or implantation. The mean preoperative best corrected visual acuity (BCVA) was 0.88±1.1 logMAR, while postoperative BCVA was 0.28±0.30 logMAR. No IOL dislocation or decentration was observed during 6-month postoperative follow-up.Conclusion:The larger diameter lenses obtained with this inexpensive and easily applicable technique may allow a more stable sulcus implantation in eyes with inadequate capsular support.

Visual outcomes of secondary lens implants in children with different etiologies

There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficien...

Second-generation capsular anchor for subluxated lenses: first clinical results.

To evaluate the use of the second-generation capsular anchor in the treatment of subluxated crystalline and synthetic intraocular lenses. Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel. Prospective interventional study. This study evaluated the second-generation capsular anchor, a 3D poly(methyl methacrylate) intraocular implant designed to anchor the lens capsule to the sclera. All surgeries were performed by a single surgeon. Intraoperative and postoperative complications were recorded. Corrected distance visual acuity, lens centration, and lens tilt were assessed at the final follow-up of 3 months. 10 eyes of 10 patients were included in this study. Mean age was 56.2 (22 to 87) years. The reasons for the lack of zonular support were pseudoexfoliation in 3 cases, trauma in 3 cases, and Marfan, ectopia lentis, and pathologic myopia (1 case each). In 1 case, pseudoexfoliation and a history of recent trauma coexisted. 8 of the 10 surgeries were due to subluxation of crystalline lenses and 2 due to subluxation of intraocular lenses. Vision improved in all patients after surgery. Centration of the IOLs was excellent in all patients at the third postoperative month. One patient developed a retinal detachment at the third postoperative week and underwent successful surgery, and 1 patient developed macular edema at the fifth postoperative month, which resolved with topical medication. The second-generation capsular anchor, designed to provide significant improvements over the first-generation device, is effective in fixating the capsular bag to the scleral wall in cases with inadequate capsular support.

Anterior Versus Retropupillary Iris-Claw Intraocular Lens: Indications, Visual Outcome and Postoperative Complications.

IntroductionIn cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations. MethodsWe retrospectively examined the characteristics and outcomes of patients who underwent iris-claw “Artisan®” intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications.ResultsIn this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior iris-claw IOL patients had more high intraocular pressure readings and macular edema.ConclusionsThis study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.

Novel Sutureless Scleral Fixated IOL for Inadequate or Absent Capsular Support

Purpose To evaluate the clinical outcome and safety profile of a new sutureless scleral fixation (SSF) technique using a single-piece foldable acrylic Carlevale intraocular lens. Methods In this case study, 27 eyes of 27 patients were implanted with an SSF single-piece IOL because of inadequate or absent capsular support. The hand-shake technique used during surgery was combined with the creation of scleral pockets in order to secure the IOL haptics. The BCVA was evaluated in the 1st and 6th month in every patient and in the 12th and 24th months, when possible. Also, we evaluated the improvement achieved in spherical equivalent values from baseline to the 6th month after the procedure. Intraoperative and postoperative complications were assessed. Results The mean age was 69.1 ± 14.9 years, and the mean follow-up was 13.6 ± 4.8 months. Indications of scleral-fixated IOL included dislocated posterior chamber IOL (40.7%), dislocated anterior chamber IOL (11.1%), subluxated traumatic cataract (18.5%), subluxated nontraumatic cataract (18.5%), and aphakia (11.1%). Concurrent PPV was performed on eight of the eyes (32%). The mean preoperative logMAR BCVA increased from 0.85 ± 0.59 baseline to 0.44 ± 0.30 one month after surgery (p < 0.01) and 0.36 ± 0.34 (p < 0.003) six months after surgery. The baseline refractive status expressed in SE was 4.3 ± 6.4 D, and the postoperative status was −0.5 ± 0.99 D. Postoperative complications included vitreous hemorrhage (7.4%), hypotony (7.4%), transient IOP elevation (3.7%), and postoperative cystoid macular oedema (3.7%). The IOL was very well centered and stable in every case during the follow-up period. Conclusion The use of the SSF technique with implantation of a single-piece foldable acrylic Carlevale IOL seems to be a safe and effective alternative method that provides good preliminary results in cases where capsular support is inadequate or absent. Long-term stability results would be required to evaluate the benefit of this novel surgical approach in order to compare it with other existing methods.

Double-flanged 6/0 polypropylene suture versus flanged haptic technique for intraocular lens fixation

Background Aphakia due to inadequate capsular support is a well-known complication of cataract surgery. Secondary intrascleral IOL fixation is favoured by many surgeons to overcome this problem. However, the technique of intrascleral fixation of the IOL still remains controversial and no single technique is considered ideal. Aim The aim of this study was to compare the clinical outcome of double-flanged 6/0 polypropylene (prolene) suture and flanged haptic technique for intraocular lens fixation in patients with aphakia and inadequate capsular support. Patients and methods This is a retrospective, nonrandomized, comparative study. The study included 50 eyes of 50 patients with aphakia and inadequate capsular support. They were divided into 2 groups: 25 eyes underwent the double-flanged 6/0 polypropylene suture technique (group I) and 25 eyes underwent the flanged haptic-fixation technique (group II). All patients were subjected to complete preoperative ophthalmic evaluation. The mean operative time was calculated for each method. Postoperatively, the best-corrected visual acuity (BVCA), endothelial cell count, and intraocular pressure were measured at 1-week, 1-month, 3-month, and 6-month intervals. Any intraoperative or postoperative complications were recorded. Results Both groups showed statistically significant improvement in BVCA at 1 week, 1 month, 3 months, and 6 months postoperatively compared with the preoperative BVCA (P<0.001). The mean operative time was significantly shorter in group II than in group I (12.3±1.93 min vs. 21.8±2.5 min, respectively, P<0.001). Differences in the mean endothelial cell counts and mean intraocular pressure values at 1 week, 1 month, 3 months, and 6 months postoperatively were not statistically significant within or between groups (P>0.05). Furthermore, there were no statistically significant differences in the frequency of intraoperative or postoperative complications between the 2 groups (P>0.05). Conclusions Both surgical techniques showed similar outcomes in the treatment of aphakic patients without capsular support, each with unique benefits. The double-flanged 6/0 polypropylene suture technique has a shorter learning curve and variable intraocular-lens options, while the flanged haptic technique is a faster procedure in the hands of experienced surgeons.

Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support.

There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficient approach for paediatric aphakic patients.