Intrascleral Intraocular Lens Fixation Research Articles

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.

Motorized injector-assisted intrascleral intraocular lens fixation

For eyes with deficient capsular support, intraocular lens (IOL) implantation has long been a technical challenge. Recently, intrascleral fixation of the haptics of a three-piece posterior chamber IOL has become a popular option. In this procedure, externalization of the leading haptic during IOL injection is a stressful step. We present a modified technique to improve the ease and safety of this step. Our modified technique involves IOL injection with a motorized injector with several important modifications described here. With these modifications, a surgeon can easily maintain the correct orientation of the IOL in a well-controlled manner during IOL injection. The records of 13 patients who underwent this technique were retrospectively evaluated. Corrected-distance visual acuity improved significantly after surgery (p<0.05). No postoperative retinal detachment, endophthalmitis, IOL decentration, or vitreous hemorrhage was noted during the follow-up period. In conclusion, the motorized injector-assisted intrascleral IOL fixation technique is a safe and effective alternative to the conventional procedure. This technique makes the process of leading haptic externalization easier and more controllable.

Modified technique for intrascleral fixation of posterior chamber intraocular lens without scleral flaps

We present a modified technique for intrascleral fixation of a posterior chamber intraocular lens (IOL) without scleral flaps and assess its long-term safety and efficacy. The haptics of the IOL are externalized with a 23-gauge forceps and fixated in a scleral tunnel. Two clockwise scleral incisions are made using a 23-gauge needle at an angle 30 degrees above the sclera. A 3-piece IOL is inserted into the anterior chamber with an injector through the cornea incision, and the trailing haptic is kept outside to prevent the IOL from falling into the vitreous cavity. The leading haptic is held wit a forceps and extracted from the eye through the scleral incisions. The trailing haptic is held with a forceps and both haptics externalized onto the sclera. The conjunctival incisions are closed with 8-0 absorbable sutures tied to fixate 1 haptic (2 o'clock) after 1 more bite on the scleral bed.

Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience.

Purpose:The purpose of the study was to report our initial experience with the transconjunctival Intrascleral Intraocular Lens (SFIOL) fixation with modified Yamane's double-needle technique and flanged haptics.Methods:This was a prospective interventional study that enrolled 31 consecutive patients undergoing SFIOL with the modified Yamane's technique. All patients underwent comprehensive evaluation including uncorrected and best-corrected vision, intraocular pressure, ultrasound biomicroscopy, endothelial cell density, and macular thickness using optical coherence tomography (OCT). We excluded patients with visually significant coexistent pathology such as corneal scars, macular pathology, and glaucoma.Results:The mean age of subjects was 57 ± 16.9 years and 23 were men (74%). Surgery was performed for aphakia following complicated cataract surgery in 10 eyes (32%), with lensectomy for subluxated/dislocated cataract in 6 eyes (19%), and with IOL explantation for subluxated/dislocated IOL in 15 eyes (48%). There were no intraoperative complications. Uncorrected visual acuity improved from median of 1.48 logarithm of minimum angle of resolution (logMAR) units (interquartile range [IQR] = 1.3–2 logMAR) at baseline to 0.3 logMAR (IQR = 0.2–0.4 logMAR) at 6 weeks (P < 0.001) which was maintained at 6 months. There were no significant changes in endothelial cell density (P = 0.34) and OCT-based macular thickness (P = 0.31) at 6 months. Two eyes had slight IOL decentration.Conclusion:Our initial experience suggests that the Yamane's technique for SFIOL is a simple procedure with a short-learning curve and is independent of scleral flaps, tunnels, sutures, and fibrin glue. Using widely available 27-gauge needle instead of 30-gauge thin wall needle as originally described by Yamane makes it possible for the use of various three-piece IOLs available globally. Further studies are required for widespread acceptance of this technique.

Sutureless Intrascleral Fixated Intraocular Lens Implantation.

To review sutureless intrascleral intraocular lens (IOL) fixation methods. Review of published literature. Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics. Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [J Cataract Refract Surg. 2016;32(9):586-597.].

The "correct shake" for "handshake" in glued intrascleral fixation of intraocular lens.

We hereby describe the correct method to perform a “handshake technique” and easy transfer of haptics from one hand to another for glued intrascleral fixation of an intraocular lens (glued IOL). The procedure was implemented in 57 cases that necessitated the application of performing a glued IOL procedure and it resulted in an appropriate and easy externalization of haptic in all the cases. The surgeons’ positioning with reference to the scleral flap is an essential component and the surgeon should always be positioned perpendicular to the plane of scleral flaps and the plane of haptic maneuver. The surgeons who intend to perform glued IOL should adopt this technical point.

Tips and Tricks of Intrascleral Fixation of Single-Piece and Toric Intraocular Lens

Various techniques for scleral fixation of IOL in cases of poor capsular support have been described in past. Sutured scleral fixation of IOLs has been attempted for single piece and toric IOLs also. But this predisposes to various suture releated complications. Sutureless fixation of three piece IOLs with or without glue has gained popularity worldwide. However, odd power lenses and high astigmatism cannot be countered with three piece lenses. Our technique of sutureless, glueless scleral fixation of IOL using single piece and toric IOLs has shown favourable results and a potential option in such scenarios.

Sutureless intrascleral intraocular lens fixation with lamellar dissection of scleral tunnel.

PurposeTo report the results of sutureless scleral fixation of a posterior chamber intraocular lens (IOL) by using our developed simple technique.MethodsWe retrospectively reviewed the medical records of 48 eyes of 47 patients who underwent sutureless intrascleral IOL fixation by using our modified technique. A 25-gauge microvitreoretinal knife was used to perform sclerotomies and create limbus-parallel scleral tunnels with lamellar dissection in which the haptics were fixed.ResultsThe IOLs were fixed and centered well. The mean follow-up period was 26.7 months. Postoperative complications included smooth vitreous hemorrhage in four eyes (8.3%), cystoid macular edema in two eyes (4.2%), and iris capture of the IOL in two eyes (4.2%). No other complications, such as breakage of the IOL, spontaneous IOL dislocation, or retinal detachment, were detected during the follow-up period.ConclusionThe lamellar dissection of the limbus-parallel scleral tunnel can simplify the forceps-assisted introduction of the haptics into the scleral tunnel, and this technique seemed to be safe.

Glued Intrascleral Fixation of Intraocular Lens With Pupilloplasty and Pre-Descemet Endothelial Keratoplasty: A Triple Procedure.

To describe a surgical approach of glue-assisted intrascleral fixation of an intraocular lens (IOL) with pupilloplasty and pre-Descemet endothelial keratoplasty as a single-stage procedure. Glue-assisted intrascleral fixation of an IOL is performed initially because it helps to secure the IOL fixation, followed by pupilloplasty that imparts stability to the anterior chamber and prevents air diversion into the vitreous cavity, thereby facilitating the pre-Descemet endothelial keratoplasty procedure that is performed to complete the surgical repair. The procedure was performed in 5 eyes of 5 patients, and the donor age ranged from 9 months to 65 years. There was a significant change in the uncorrected (P = 0.034) and corrected (P = 0.043) distance visual acuities in the postoperative period. The mean graft size was 7.6 ± 0.4 mm (range, 7-8 mm). The mean preoperative and postoperative specular endothelial counts were 2788 ± 204 cells per square millimeter and 1898 ± 90 cells per square millimeter, respectively. No incidence of primary graft failure or graft rejection during the entire follow-up period was reported in any of the eyes. The combined procedure serves as an effective method in select cases of endothelial decompensation that require a secondary IOL implantation or an IOL exchange with good postoperative results.

Scleral-Fixated Intraocular Lenses: An Update on the Current Surgical Approaches

In the past, the available surgical options for patients with a lack of capsulozonular support or aphakia were limited to placing an intraocular lens (IOL) in the anterior chamber, suturing an IOL to the iris, or suturing it to the sclera. The first two options involve leaving the IOLs in close proximity to the iris and the cornea and are not ideal for patients with compromised corneas, peripheral anterior synechiae, shallow anterior chambers, or glaucoma. Scleral-sutured IOL fixation allows the IOL to sit away from the cornea and closer to the nodal point of the eye, but the suture-related complications and the technically challenging nature of the surgery are unappealing. In recent years, with the advent of novel sutureless scleral fixation techniques, an increasing number of surgeons are adopting the sutureless techniques, such as the fibrin glue and the intrascleral tunnel IOL fixation techniques. We discuss the pros and cons as well as the preliminary results of these techniques as reported in the recent literature.

Sutureless intrascleral fixation of a custom-tailored iris prosthesis with an intraocular lens

We describe a technique for sutureless intrascleral fixation of a 3-piece intraocular lens (IOL) and custom silicone iris prosthesis complex to address the optical and functional issues of aphakia and aniridia, as well as to restore excellent cosmesis. The 3-piece IOL is anchored to the iris prosthesis using the belt-loop technique. We believe the intrascleral haptic fixation is overall a more robust fixation method in patients with aphakia and aniridia, who are often younger and require a long-lasting anterior segment reconstruction. Dr. Ahmed is a consultant to Alcon Laboratories, Inc., and Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Modified technique for combining DMEK with glued intrascleral haptic fixation of a posterior chamber IOL as a single-stage procedure.

To describe changes in the surgical technique required for combining Descemet membrane endothelial keratoplasty with glued intrascleral haptic fixation of a posterior chamber intraocular lens ([IOL] glued IOL) as a single-stage surgery in patients diagnosed as having aphakic or pseudophakic bullous keratopathy. Six patients with corneal decompensation and inadequate capsular support requiring implantation/exchange of an IOL underwent a single staged glued IOL with Descemet membrane endothelial keratoplasty at a tertiary care center. Stability of the anterior chamber and structure of iris diaphragm-IOL complex were assessed intraoperatively by injecting air and, when required, iridoplasty was performed. Patients were observed postoperatively. One patient had partial graft detachment requiring re-bubbling and 1 patient had a small peripheral detachment with spontaneous resolution. The graft remained attached in all patients. An iridoplasty was required for 2 patients. Visual acuity improved in all patients. The mean preoperative and postoperative corrected distance visual acuity were 0.11 ± 0.07 and 0.7 ± 0.17, respectively. There was significant change in the corrected distance visual acuity after surgery (P = .028). The mean postoperative endothelial cell density at 6 months was 1,710.3 ± 205.8 cells/mm(2). Descemet membrane endothelial keratoplasty with glued IOL provides stable IOL with decreased pseudophacodonesis for better graft fixation. Iris diaphragm covering IOL optic all around is essential to restore bicamerality, allows sufficiently sized, non-migrating air bubbles, and decreases graft detachment and dislocation both intraoperatively and postoperatively. A need for iridoplasty must be confirmed intra-operatively.

Simplified and safe method of sutureless intrascleral posterior chamber intraocular lens fixation: Y-fixation technique

We report a new surgical technique that allows intrascleral fixation of a posterior chamber intraocular lens (IOL) without sutures. The Y-fixation technique does not involve complicated intraocular manipulation and achieves safe sutureless fixation. A Y-shaped incision is made in the sclera and a 24-gauge microvitreoretinal (MVR) knife is used to create the sclerotomy instead of a needle. The Y-shaped incision eliminates the need to raise a large lamellar scleral flap and to use fibrin glue because the haptic can be fixed both inside the tunnel and in the groove, and performing the sclerotomy with the 24-gauge MVR knife simplifies extraction of the haptic and improves wound closure. There is no risk of infection from exposure of the haptic on the sclera and no use of fibrin glue. There was significantly less IOL decentration and tilt than with suture fixation.

Sutureless 27-Gauge Needle–Guided Intrascleral Intraocular Lens Implantation with Lamellar Scleral Dissection

To report a new technique for performing sutureless intrascleral fixation of a posterior chamber intraocular lens (IOL). Prospective, noncomparative, interventional case series on the results of sutureless intrascleral fixation of a posterior chamber IOL. Thirty-five eyes of 34 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied. The haptics of the IOL were externalized with a 27-gauge needle passed through the ciliary sulcus using the double needle technique. The haptics were fixed in a scleral tunnel made by lamellar scleral dissection. The postoperative tilt of the IOL was measured by swept source optical coherence tomography. The best-corrected visual acuity (BCVA), corneal endothelial cell density, IOL tilt, and complications were determined. The IOLs were fixed with exact centration and axial stability. No wound leakage was seen even without any sutures. The mean BCVA was 0.48 logarithm of the minimum angle of resolution (logMAR) units preoperatively and 0.17 logMAR units at 3 months postoperatively (P= 0.003). The mean corneal endothelial cell loss was 6.0±7.3% (P= 0.63) at 3 months. The mean IOL tilt was 2.3±1.9°. The postoperative complications included iris capture by the IOL in 3 eyes (8.6%), ocular hypertension in 2 (5.7%), and cystoid macular edema in 1 (2.9%). There was no postoperative retinal detachment, endophthalmitis, IOL dislocation, or vitreous hemorrhage. The 27-gauge needle-guided intrascleral posterior chamber IOL implantation technique provides good IOL fixation with reliable wound closure without the use of any sutures. We recommend this technique for secondary IOL implantation.

No-Assistant Technique: Simplified Haptic Externalization For Glued IOL

A modified technique for externalizing the haptics in the Agarwal method of glued intrascleral fixation of a posterior chamber intraocular lens (IOL) is described. This technique eliminates the role of an assistant in holding the haptic during the entire surgical manoeuvre and subsequent complications associated with inappropriate handling of the haptic. The technique was used in 45 cases and was reproducible in all cases with no intraoperative complications. This technique is an attempt to make the process of haptic externalization, considered the most technically demanding part of the surgery, more easy and feasible.

Implants à fixation sclérale sans suture : série de neuf cas et revue de la littérature

To report the results of a technique of sutureless intrascleral fixation of a three-piece foldable hydrophobic acrylic posterior chamber intraocular lens (PC IOL) in the absence of capsular support and to compare our results to those reported in the literature. We report a single-center (Limoges University Medical Center) retrospective series of nine patients with deficient posterior capsular support who underwent sutureless sulcus fixation of a hydrophobic acrylic Tecnis Aspheric(®) model ZA9003 (AMO, Inc.) PCIOL using permanent incarceration of the haptics in scleral tunnels parallel to the limbus, between November 2010 and November 2011. All patients were evaluated for surgical indications, pre- and postoperative refractive status (visual acuity and corneal cylinder), and intra- and postoperative complications. We included six men and three women with post-traumatic subluxed IOL's in three cases and lack of iris and capsular support secondary to traumatic corneoscleral wounds in six cases. Mean age was 63.22 ± 18.79 years. Posterior vitrectomy was performed in all cases. Mean 3-month postoperative visual acuity was 0.42 ± 0.16 LogMAR, and mean corneal postoperative astigmatism was 1.39 ± 0.78 diopters. Complications included IOL decentration of 1.5mm in one case, haptic rupture requiring intraoperative IOL exchange in one case, and transitory postoperative macular edema in two cases. Artificial intraocular lens implantation in the absence of capsular support is always a surgical challenge. Currently, the two most widely used approaches include fixation to the iris by suturing or iris claw, and fixation to the sclera with sutures. However, these techniques require wide corneal or scleral incisions resulting in significant postoperative astigmatism. Furthermore, iris fixation is impossible in cases of significant iris trauma, and scleral sutures are often technically difficult and expose the patient to late IOL dislocation or tilt. Sutureless intrascleral fixation of foldable hydrophobic acrylic three-piece IOL's inserted through a conventional sub-2.8mm clear corneal incision is a recent technique. This technique is compatible with cases of iris trauma and allows sutureless fixation of the haptics in scleral tunnels parallel to the limbus, while minimizing the risk of postoperative astigmatism. In addition, it allows the repositioning of IOL's dislocated into the vitreous without re-opening the corneal incision. Complications are mainly related to IOL manipulation and positioning. Results obtained after sutureless intrascleral PCIOL implantation showed good visual outcomes with minimal complications in eyes with deficient capsular support.

Clinical Outcomes of Intraocular Lens Scaffold Surgery: A One-Year Study

To evaluate the safety and 1-year outcome of the intraocular lens (IOL) scaffold technique in eyes with soft to moderate nuclear remnants after intraoperative posterior capsule rupture (PCR). Single-center, retrospective, interventional, noncomparative, consecutive case series. A total of 20 eyes of 20 patients who had intraoperative PCR underwent IOL scaffold surgery in a tertiary clinic. A retrospective analysis of medical records of a consecutive series of patients who underwent IOL scaffold surgery from August 2011 to February 2013 was reviewed. All surgeries were performed by a single surgeon, and a 3-piece, 6.0-mm optic, acrylic, foldable IOL with a modified C-loop haptic configuration was implanted in all eyes. The preoperative and postoperative parameters evaluated were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), specular microscopy, gonioscopy, ultrasound biomicroscopy, central macular thickness, intraocular pressure (IOP), and anterior and posterior segment inflammation. The final visual outcome at 1 year was evaluated. At 1-year follow-up, the mean postoperative UDVA and CDVA in Snellen's decimal equivalent was 0.58 ± 0.15 and 0.90 ± 0.17, respectively. The IOL was placed in the sulcus for 14 eyes and in the capsular bag for 3 eyes, and glued intrascleral fixation of IOL was performed in 3 eyes. The mean postoperative refractive error at the final examination was -0.4 ± 0.05 diopter (standard error of mean). Postoperative CDVA of 20/20 and 20/30 was achieved in 75% (15 eyes) and 25% (5 eyes), respectively. There was no correlation between preoperative specular count and percentage loss of cells (P = 0.602; r(2)=0.015). The mean central macular thickness at 1 year was 182.5 ± 11.79 μm. Clinical macular edema was observed in 1 of 20 eyes (5%). The IOL scaffold provided an effective, relatively noninvasive means of emulsifying moderate to soft nuclear remnants in eyes with intraoperative PCR, with a good visual outcome and a favorable complication rate.

Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lens

We describe a technique for easy externalization of the haptics for glued intrascleral fixation of a posterior chamber intraocular lens (IOL). The "handshake" technique is a modification of the glued-IOL procedure in which the IOL haptic is bimanually transferred from one glued IOL forceps to another under direct visualization in the pupillary plane. The modification provides better intraocular maneuverability throughout the surgery and extends applicability of the technique to challenging cases that require haptic manipulation, such as IOL drop and haptic slippage. It also provides the intraoperative advantage of a well-formed globe throughout the surgery.

Glue-assisted intrascleral fixation of posterior chamber intraocular lens

Purpose:To analyze the visual outcome of patients undergoing glue-assisted intrascleral fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsular support.Materials and Methods:This retrospective study analyzes 25 eyes which underwent IOL implantation by the glued intrascleral fixation technique. The pre and post-operative uncorrected visual acuity (UCVA), pre and post-operative best corrected visual acuity (BCVA), intraocular pressure (IOP), IOL position, anterior chamber reaction and central macular thickness were assessed and recorded. Immediate and late post-operative complications were also recorded.Results:A total of 25 eyes of 22 patients were reviewed and analyzed over a period of one year. All eyes had a foldable three-piece IOL implanted. About 84% of the eyes had a gain of one or more lines, 12% had no gain, and 4% had a fall of three lines of BCVA on Snellen's visual chart, which was attributed to cystoid macular edema (CME). Postoperatively, there was a significant improvement in the UCVA (P < 0.05) and in the BCVA (P < 0.05). Postoperative complications included decentration in one case and vitritis with chronic macular edema in another case. Optical coherence tomography (OCT) demonstrated well placed IOL with no tilt.Conclusion:Although the results of one year follow-up of glued intrascleral fixation are promising, long term studies are recommended.

Modified method of haptic externalization of posterior chamber intraocular lens in fibrin glue–assisted intrascleral fixation: No-assistant technique

A modified technique for externalizing the haptics in the Agarwal method of glued intrascleral fixation of a posterior chamber intraocular lens (IOL) is described. This technique eliminates the role of an assistant in holding the haptic during the entire surgical maneuver and subsequent complications associated with inappropriate handling of the haptic. The technique was used in 45 cases and was reproducible in all cases with no intraoperative complications. This technique is an attempt to make the process of haptic externalization, considered the most technically demanding part of the surgery, more easy and feasible.