Intraocular Lens Haptics Research Articles

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.

Capsular Bag Distension Syndrome Following Phacoemulsification with Implantation of Intraocular Lens

Capsular bag distension syndrome is a rare complication following phacoemulsification with posterior chamber intraocular lens implantation. We describe the case of a middle-age male, who developed early onset capsular bag distension syndrome of the right eye after phacoemulsification with implantation of plate haptic posterior chamber intraocular lens (Zeiss CT ASPHINA 509MP). There was persistent poor vision during follow up at 1 week and 5 weeks post-surgery with a myopic shift of 2.5 diopters sphere (DS). The intraocular pressure was only elevated at 2 hours post-operative and was normal during the subsequent followup. Distension of capsular bag was confirmed with the IOP Master 700 which showed abnormal separation of posterior capsule from the intraocular lens. He was diagnosed with capsular bag distension syndrome secondary to retention of viscoelastic. Right eye removal of retained viscoelastic was performed and the capsular bag distension syndrome resolved successfully with best corrected visual acuity at 6/6. Hence, complete clearance of viscoelastic during phacoemulsification with plate haptic intraocular lens is important in order to prevent capsular bag distension syndrome.

Study on buckling of intraocular lens haptic in 2 types of intraocular lens material and its effect on vision.

Aim: To study the buckling of intraocular lens (IOL) haptics and its effect on vision in patients implanted with either hydrophilic or hydrophobic lens material.Study design: Prospective, observational and descriptive study.Setting: Tertiary eye care center in India.Material and methods: Patients operated for age-related cataract by phacoemulsification technique implanted with hydrophilic or hydrophobic IOL came either for follow-up surgery or complaints in an operated eye, being examined for visual acuity, refraction, anterior segment evaluation, and retinal examination. The position of IOL in terms of optic and haptics was noted and photographed.Results: 317 patients participated in the study. The mean age (SD) of the patients was 65 years (± 4.5). Of 317 patients, 127 (254 eyes) had bilateral, and 190 (190 eyes) had one eye IOL implantation. Out of 444 eyes, 254 (57.2 %) had hydrophilic and 190 eyes (42.8%) had hydrophobic IOL implantation. Buckling of IOL haptic was seen in 37 (8.3%) eyes of which 34 (13.9%) had hydrophilic, and 3 (1.6%) had hydrophobic IOL. Maximum eyes (n=20) with hydrophilic IOL presented during 1-3 years after IOL implantation. Major complaint for which patients came for follow up was blurring of vision (48.9%) and diminished vision (36.3%). Posterior capsular opacification (PCO) was observed in 2/ 190 (1.1%) eyes with hydrophobic and 28/ 254 (11%) eyes with hydrophilic IOL.Discussion: The present study dealt with the long-term performance of the haptics of the hydrophilic and hydrophobic IOLs in relation to its stability in the capsular bag. Conclusion: Buckling of haptic was seen more in the hydrophilic than in the hydrophobic IOLs. PCO was common in these eyes. Change in refraction occurred in eyes with hydrophilic IOL with buckling.

Prospective study to compare axial position stability after fellow-eye implantation of 2 distinct intraocular lens designs.

To compare the dynamics of axial intraocular lens (IOL) position and stability in the capsular bag after fellow-eye implantation of a 1-piece C-loop and a 4-point haptic IOL. Hanusch Hospital, Vienna. Prospective, comparative, randomized bilateral study. One hundred eyes of 50 patients were randomly implanted with a C-loop IOL (CT LUCIA 611P) in 1 eye and a 4-point haptic IOL (CT ASPHINA 409MP) in the other eye. Anterior chamber depth (ACD) was measured at 1 week (W1), 1 month (M1), and 4 to 6 months (M4-6) postoperatively using a swept-source optical coherence tomography device (IOLMaster 700). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, and subjective refraction outcomes were assessed at M4-6 postoperative follow-up. Hundred eyes of 50 patient were included. Pseudophakia ACD values at W1, M1, and M4-6 timepoints were significantly different in eyes implanted with the C-loop IOL compared with the 4-point haptic IOL (P < .001). The overall IOL shift was 0.25 ± 0.16 mm for the 4-point haptic IOL and 0.14 ± 0.09 mm for the C-loop IOL (P < .001). The M4-6 mean monocular UDVA outcome for eyes with C-loop IOL was 0.06 ± 0.14 logarithm of the minimum angle of resolution (logMAR) and 0.03 ± 0.10 logMAR for the eyes with 4-point haptic IOL. M4-6 mean spherical equivalent was -0.32 ± 0.48 diopter (D) in the C-loop IOL group and -0.33 ± 0.42 D in the 4-point haptic IOL group. Statistically significant differences in IOL design results in different postoperative ACD values. No relevant or statistically significant differences were found in refraction or visual acuity between the groups.

Intrascleral Suture Anchoring: A Flapless/Grooveless Four-Point Intraocular Lens Fixation Technique.

Purpose We describe a minimally invasive suture fixation technique for four-point fixation of intraocular lenses (IOLs) in the treatment of aphakic eyes, namely, the intrascleral suture anchoring technique. Neither scleral flaps nor large conjunctival dissections are required. Methods This study included 11 eyes (11 patients). After looping the eyelets on the IOL haptics and externalizing the threads, the curved needle attached to the externalized thread was started with two sequential intrascleral passes from the first fixation point to reach the second fixation point. The same procedure was performed for the other side of the IOL. A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached curved needle. Results The mean postoperative follow-up period was 9.7 ± 5.8 months (range 5–15 months). The IOLs of all eyes remained well positioned and stable postoperatively. The postoperative visual acuities were improved. No suture erosion, suture loosening, hypotony, scleral atrophy, chronic inflammation, retinal tear, and/or detachment were observed within the follow-up period. Conclusion The present technique is an alternative, flapless method for the four-point suture fixation of IOLs. It provides both minimal surgical trauma and reliable stability.

Clinical Outcomes of the Scleral Fixation of Posterior Chamber Intraocular Lens using the Modified Yamane's Technique: a Swept-source Optical Coherence Tomography Study

To observe the postoperative outcomes of the scleral fixation of posterior chamber intraocular lens (SF-PCIOL) using the modified Yamane's technique with the aid of swept-source optical coherence tomography (SS-OCT). Prospective observational case series. This study involved 20 patients who underwent SF-PCIOL with the modified Yamane's technique, from December 2017 to November 2019. All patients had routine preoperative examinations, including biometric measurement by IOL master, measurements of uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (BCDVA). The SRK/T formula was used to calculate the power of intraocular lens (IOL). After the surgery, UDVA and intraocular pressure were evaluated for 1 d, UDVA, BCDVA, spherical equivalent (SE) and corneal endothelial cell density were measured for 1 week, 1 month, 3 and 6 months, respectively. The IOL tilt and the symmetry of hepatitis in the scleral tunnel were measured by SS-OCT. The mean follow-up duration was (7.20±6.56) months (range, 3-26 months). The mean preoperative UDVA was (1.70±0.38) LogMAR, and it improved to (0.48±0.50) LogMAR ( P=0.001). There was no statistically significant difference between the pre- and post-operative BCDVA, i.e. (0.44±0.50) LogMAR and (0.32±0.48) LogMAR, respectively ( P=0.08). The mean spherical equivalent was (-0.53±0.86) diopter (D) and the postoperative refractive error was (0.27±0.82) D. Seventeen patients underwent SS-OCT examinations. The mean IOL tilt was (3.28±3.00)°. There was no significant difference between the horizontal and vertical tilt ( P=0.326). The IOL tilt did not show a significant correlation with spherical and cylindrical refractive error ( P=0.532, P=0.241). There was no statistically significant difference in the HL (the length of haptics fixed in the scleral tunnel) of nasal and temporal haptic, which were (2.24±0.20) mm and (2.17±0.23) mm, respectively ( P=0.193). And there were no statistically significant differences between the HD (the distance between the center of haptic flange and scleral spur) of nasal and temporal haptic, (1.58±0.07) mm and (1.66±0.08) mm, respectively ( P=0.338). The changes of IOL haptics in the scleral tunnel were tracked by 10 patients. The HL (nasal: HL-N; temporal: HL-T) and the HD (nasal: HD-N; temporal: HD-T) of haptics in the tunnel were measured and recorded at three time points, including 1 week, 1 and 3 months after surgery. There was no significant difference in HL-N, HL-T, HD-N and HD-T at the three time points ( P=0.931, P=0.091, P=0.175, and P=0.505, respectively). All patients underwent uneventful surgery. The postoperative complications included transient corneal edema in 6 eyes, transient IOP elevation in 3 eyes, vitreous hemorrhage in 1 eye, cystoid macular edema in 2 eyes, and macular hole in 1 eye. The SF-PCIOL using modified Yamane's technique, is capable of producing satisfactory and consistent postoperative outcomes for patients with few postoperative complications. SS-OCT is a powerful tool for measuring optic tilt and the IOL hepatic symmetry in scleral tunnel.

Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 2: repositioning of subluxated IOLs.

To describe the technique of modified adjustable flange scleral fixation using 6-0 polypropylene sutures for repositioning of subluxated intraocular lenses (IOLs). Center for Applied Eye Research, Meir Medical Center, and the Ein-Tal Eye Center, Israel. Case series. Subluxated capsular-fixated posterior chamber IOLs are secured to the sclera using 6-0 polypropylene sutures looped around the IOL haptics. This method can be performed for any type of IOL: hydrophobic, hydrophilic, silicone, or poly(methyl methacrylate); 1-piece or 3-piece; and with either closed-loop or open-loop haptics. It can also be used in conjunction with capsular stabilizing devices. In the 18 cases performed, successful repositioning with stable and central fixation of the IOLs was achieved. One eye required a repeated surgery due to suture slippage. The eyes recovered relatively quickly with noted quiescence as early as 1 week postoperatively. Patients did not complain of ocular irritation from the subconjunctival flange up to the 6-month follow-up period. In 1 case, a flange was exposed postoperatively but the patient refused additional intervention and developed intraocular infection 7 months postoperatively. The adjustable 6-0 polypropylene flanged technique for IOL repositioning and scleral fixation was a relatively quick and simple method for management of subluxated IOLs. Complete coverage of the flange by conjunctiva and Tenon layer must be confirmed at the end of surgery.

The forceps-needle: Combining needle and grasping functions in a single instrument.

A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication.

Penetrating Keratoplasty With Sutureless Intrasclerally Fixated Intraocular Lens.

In this retrospective study, we reviewed the use of penetrating keratoplasty with sutureless intrasclerally fixated intraocular lens implantation in a closed anterior chamber in patients with several corneal pathologies and aphakia. The medical records of 6 patients, who underwent the procedure, were reviewed. In the procedure, lamellar scleral tunnels at the 2- and 8-o'clock positions were created with a microvitreoretinal blade, 1.5 mm away from the limbus. Two 27-gauge bent needles were passed, first horizontally, through these tunnels, and then vertically, which allowed them to enter the posterior chamber and to be left in position. Partial thickness trephination was made, and anterior stroma was removed where necessary. An incision was made at the 11-o'clock position, where the trephination was made, which was then extended to both sides for about 6 mm with corneal scissors. From the superior incision, the anterior haptic of a 3-piece intraocular lens was pushed through the needle at the 2-o'clock position, then the posterior haptic was pushed through the needle at the 8-o'clock position, and both haptics were removed through the sclera. Both ends were cauterized and placed into the sclera. Residual stroma was removed, and the donor graft was sutured. At the last follow-up visit, the mean bestcorrected visual acuity was significantly increased. No serious complications were seen, with the exception of increased intraocular pressure in 3 patients. Penetrating keratoplasty with sutureless intrasclerally fixated intraocular lens implantation can be used safely in patients with aphakia. With this technique, the globe stabilization can be maintained, and the trauma to the donor graft endothelium can be minimized.

Comparison of the rotational stability between plate-haptic toric and C-loop haptic toric IOLs in myopic eyes.

To compare the rotational stability of a plate-haptic toric intraocular lens (IOL) vs a C-loop haptic toric IOL in myopic cataract eyes. Eye and Ear, Nose, and Throat Hospital of Fudan University, China. Prospective, randomized, controlled study. Cataract eyes with axial length (AL) more than 24.5 mm were randomly assigned to receive implantation of a C-loop haptic toric IOL (AcrySof Toric IOL) (Group A) or a plate-haptic toric IOL (AT TORBI 709M IOL) (Group B). IOL rotation, residual astigmatism, visual acuity, and higher-order aberrations (HOAs) evaluated with OPD-Scan III aberrometer were compared at 3 months postoperatively. In total, 62 eyes of 62 patients were eligible for analysis: 31 in Group A and 31 in Group B. The mean rotation of toric IOLs was greater in Group A than that in Group B (8.00 ± 3.60 degrees vs 4.42 ± 3.24 degrees, respectively, P < .001), especially when IOLs were vertically placed. IOL rotation was positively correlated with AL in Group A, whereas no such correlations were found in Group B. Residual astigmatism in Group A was greater than that in Group B (-0.76 ± 0.30 diopter [D] vs -0.51 ± 0.29 D, respectively, P = .001). Fewer eyes achieved residual astigmatism of 0.50 D or less in Group A than in Group B (38.71% vs 64.52%). Group A had worse postoperative uncorrected visual acuity and higher total HOAs and coma for a 6.0 mm pupil than Group B, whereas postoperative corrected visual acuity was not different between the 2 groups. The plate-haptic toric IOL might be a better choice for myopic cataract eyes with corneal astigmatism because of reduced postoperative rotation.

Modified Intraocular Lens Intrascleral Fixation Technique Using Two Vitrectomy Ports as Lens Haptic Fixation Sites.

IntroductionWe developed a new technique that uses two of the vitrectomy ports as intraocular lens (IOL) haptic fixation sites and compared that with a conventional T-fixation method.MethodsA total of 33 eyes were retrospectively divided into the port-fixation (n=21) and conventional (n=12) groups. For the port-fixation group, supranasal and inferotemporal trocars (25-gauge) were placed in the center of a T-shaped lamellar scleral incision 2 mm from the corneal limbus and a supratemporal trocar at 3.5 mm. Following a vitrectomy, along with lens or IOL extraction as needed, the infusion cannula was changed from an inferotemporal to supratemporal trocar. The first IOL haptic and trocar were then simultaneously withdrawn from the eye by grasping with vitreoretinal forceps, with the same performed for the second IOL haptic and trocar, after which the infusion cannula was removed. In the conventional group, 2 T-shaped scleral incisions and three trocars were separately placed.ResultsPostoperatively, transient ocular hypotension and hypertension were observed in a few eyes in both groups. At 6 months after surgery, astigmatism was 1.71±1.13 D in the port-fixation group and 2.21±1.78 D in the conventional group (p=0.40, t-test).ConclusionThis new technique may be effective because of the lower number of scleral wounds.

New surgical approach for sutureless scleral fixation.

The aim of this article is to describe a novel surgical technique for sutureless scleral fixation of an intraocular lens using the newly developed FIL SSF Carlevale IOL (Soleko, Italy). Four eyes of four patients with poor capsular support were recruited to our study, three resulting from intraocular lens subluxation and one case resulting from traumatic cataract. A novel sutureless sclera-fixated intraocular lens was implanted into the posterior chamber of each eye with sclerocorneal plugs fixating the lens to the wall of the eye. Mean age of patients was 52 ± 16 years, ranging from 35 to 70 years. Mean follow-up was 6.50 ± 1.29 months (range: 5-7 months). Mean preoperative best-corrected visual acuity was 0.50 ± 0.33 logMAR (range: 1-0.3 logMAR). Postoperative best-corrected visual acuity improved to 0.08 ± 0.08 logMAR (range: 0.2-0 logMAR). There was no significant change in the mean intraocular pressure and there were no postoperative complications, such as iatrogenic distortion or breakage of the intraocular lens haptic, intraocular lens decentration, endophthalmitis, or retinal detachment. To the best of our knowledge, this is the first report of outcomes using the novel sutureless sclera-fixated FIL SSF Carlevale IOL. This new surgical technique offers a simplified and effective approach for sutureless scleral intraocular lens fixation with good refractive outcomes.

Determining and Comparing the Effective Lens Position and Refractive Outcome of a Novel Rhexis-Fixated Lens to Established Lens Designs

WE sought to evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOLs) with plate-haptic, c-loop haptic, and a rhexis-fixated lens were compared. Retrospective, multicenter, comparative case series. The study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic, or a novel rhexis-fixated IOL. Biometry and refraction measurements were conducted preoperatively and 3months postoperatively. Lens constant optimization was performed. Seventy eyes of 56 subjects were included. ELP for rhexis-fixated IOL was shortest (4.29 ± 0.24mm), followed by c-loop haptic (4.41 ± 0.42mm) and plate-haptic (4.51 ± 0.26mm) IOL. Difference in ELP was significant between rhexis-fixated IOL and both plate-haptic (P= .001) and c-loop haptic IOL (P= .000). Anterior chamber depth adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P < .05). For the rhexis-fixated IOL the differences in refraction ranged from -0.039 diopters (D) for the Hill-Radial Basis Function to -0.096 D for Haigis. The other 2 lenses showed mean differences in refraction between+0.046 D for Hill-Radial Basis Function and+0.097 D for Haigis. The difference in IOL fixation and its resulting position in the capsular bag have a significant effect on the effective lens position and consequently a significant effect on the prediction of postoperative refraction.

Uveitis\u2013glaucoma\u2013hyphema syndrome with sclera-fixed posterior-chamber two-haptic intraocular lens in a highly myopic eye: a case report

BackgroundWe report a case of uveitis–glaucoma–hyphema (UGH) syndrome in a highly myopic pseudophakic eye with seemingly normal positioning of a two-haptic intraocular lens (IOL).Case presentationThe patient was a 61-year-old woman suffering recurrent episodes of blurred vision, floaters, redness, elevated intraocular pressure (IOP), and pain in the right eye following implantation of a sclera-fixed IOL. The symptoms were alleviated by the systemic and topical administration of IOP-lowering and anti-inflammatory medications. A slit-lamp examination revealed depigmentation and atrophy of the iris, and a quiet anterior chamber in the right eye. Endophthalmitis caused by hypovirulent bacteria and UGH syndrome were both considered. Ultrasound biomicroscopy (UBM) and gonioscopy provided direct evidence of malpositioned IOL haptics, which pushed the root of the iris forward, resulting in persistent mechanical chaffing, the probable cause of UGH syndrome. IOL explantation resolved her symptoms. Negative bacterial culture results for the IOL excluded the possibility of endophthalmitis.ConclusionsHeightened awareness of underlying UGH syndrome and prompt UBM are important when doctors encounter a patient with a sclera-fixed IOL suffering from recurrent anterior segment inflammation and elevated IOP.

Curious Case of a Foldable Intraocular Lens that did not Unfold

Phacoemulsification is a modern technique of cataract surgery that allows the removal of cataractous lens and implantation of a foldable Intraocular Lens (IOL) through a small sub 3 mm incision. For a good visual outcome, it is imperative that the IOL is well centered and its haptics unfold properly inside the capsular bag and keep it distended. However, at times the IOL haptics may not unfold properly leading to adverse visual symptoms. Herein, Authors present an unusual case of a 61-year-old elderly male with no other associated ocular or systemic illness, who presented nine months after cataract surgery in his left eye, with both haptics of the IOL unusually folded and the edge of one haptic encroaching into the pupillary area leading to visual symptoms. As multiple attempts to dial the haptics into the capsular bag were unsuccessful, likely due to strong capsular adhesions, the unfolded haptics were placed in the sulcus with attempted optic capture. The postoperative period was uneventful with BCVA of 20/20 at one year. The current case highlights the need to be vigilant about the proper positioning of the haptics at the end of routine cataract surgery and the need for early intervention in the event of any complication.

CM T – Flex intraocular lens an innovative design for aphakia secondary to postcataract surgery

Here, we report a case of 66-year-old female who came with a history of secondary aphakia due to the complication of cataract surgery in the left eye with a vision of HM + which is improving with pinhole to 6/9 and right eye PCIOL with a vision of 6/6, managed with new foldable acryflex T IOL (CM T FLEX) scleral fixated intraocular lens (IOL). Two partial-thickness limbal-based scleral flaps of 2.5 mm × 2.5 mm were created 180° apart; sclerotomies were made using 23G needle 1.5 mm away from the limbus. The new acryflex T–flex IOL implantation was performed through the 2.8 mm clear corneal tunnel incision, and T-shaped IOL haptics were externalized with the 23G forceps under the scleral flap. Fibrin glue was used to close the scleral flaps and conjunctiva. Postoperative period was uneventful; at the end of 1 month, the patient regained a good visual acuity of 6/6 (P) with a good stable centration of IOL.

Uveitis‐glaucoma‐ hyphema syndrome (UGH) as complication in the long‐term cataract surgery

AbstractPurposeAlthough uveitis‐glaucoma‐hyphema (UGH) syndrome was described as a postoperative complication associated with intraocular lenses (IOL) in the anterior chamber, cases with IOL in the posterior chamber have also been described in both into capsular bag, in sulcus as well as lenses anchored to the iris. The physiopathology is not clear but it seems that the mechanical friction produced by the IOL haptics, in contact with different structures, produces erosion, pigment dispersion and consequently anterior uveitis accompanied by elevated intraocular pressure (IOP) and hyphema. Different treatments have been proposed: topical or systemic drugs, YAG laser iridectomies, capsular tension rings, anti‐VEGF or IOL explantion.MethodsWe present the case of a 40‐year‐old man who came to our emergency department with painful red left eye and blurred vision since several hours. He had a history of left congenital cataract surgery when he was 14. The patient presented uveitis with elevated IOP that did not yield with topical treatment with mydriatics, corticoids, antihypertensive drugs and oral diuretic agent. 24 hours later, he showed hyphema, deciding to enter the hospital IV for treatment. Symptomatic control was achieved, being discharged with topical treatment. 15 days later he returned to A&amp;E at the same clinic. He was treated in the same way and ultrasonic biomicroscopy (UBM) was performed.ResultsUBM demostrated a poorly positioned IOL.Then, we diagnosed him with UGH syndrome. After presenting a third episode a week after discharge, explantation exchange was decided. Since then it is in follow‐up and has not submitted incidents.ConclusionThe increase in cataract surgeries implies that a growth of the possible associated complications.UGH syndrome must be taken into account in all those patients who present their characteristic triad. Before suspicion a UBM should be performed.

АНАЛІЗ ГАПТИЧНИХ ЕЛЕМЕНТІВ ІНТРАОКУЛЯРНИХ ЛІНЗ

After operations performed toremovecataracts, anintraocularlens (IOL) isimplanted into the humaneye. The IOL includes the optical part (thelens) and the haptic with whichitisproper lyplaced intheplace of the removed naturallens. Hapticelements mustper form a number of important functions: preventing the dislocation of the lens, providing the corrects hape of the capsulebag, protecting the capsule from the development of secondary cataracts. To ensurethese and other functions, fasteningelements (haptics) mustsatisfy the conditions of both physical and chemical properties. The article provide sananalysis of theexisting hapticintraocular lenses and the iropportunities

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.

Scleral pockets for an innovative technique of intrascleral fixation of intraocular lens.

The aim of this article is to report the results of an innovative technique for a scleral fixation of a posterior chamber intraocular lens using our new modified technique. We retrospectively reviewed the medical records of 15 eyes of 15 patients who underwent sutureless intrascleral intraocular lens fixation using our modified technique. We used a 23-gauge knife to perform sclerotomy and create two parallel scleral pockets for the haptics. The mean follow-up period was 3 years (3 ± 1). No complications were detected during the follow-up period. The creation of two parallel scleral pockets, parallel to the limbus, greatly simplifies the introduction of intraocular lens haptics.