Partial-thickness Scleral Flap Research Articles

Scleral Fixation of Posterior Chamber Intraocular Lenses Using Fascia Lata to Cover the Knots

To describe the use of fascia lata to cover the polypropylene knots of scleral fixated posterior chamber intraocular lenses (PCIOL). Fascia lata was used to cover the knots of scleral fixated PCIOL in 5 eyes with significant scleral thinning. Four of the 5 eyes had the PCIOL insertion and the fascia lata patching in the same setting. The fifth eye previously had scleral fixated PCIOL with late suture erosion through a partial thickness scleral flap. There was no suture exposure or graft thinning throughout a follow-up period of 8 to 16 months. The eyes tolerated the fascia lata well with no early or late postoperative complications. Fascia lata provides an effective means to cover the knots of scleral fixated PCIOL, especially in aphakic patients with significant scleral thinning.

A Simple Closed Chamber Technique for Repair of Traumatic Iridodialysis in Phakic Eyes

A surgical technique was developed for traumatic iridodialysis repair using a small partial-thickness scleral flap and a 24-gauge disposible hypodermic needle. This procedure is a "direct iridodialysis-site approach" closed chamber technique with minimal surgical trauma that can be used in phakic, pseudophakic, or aphakic eyes.

LONG-TERM SAFETY OF POLYPROPYLENE KNOTS UNDER SCLERAL FLAPS FOR TRANSSCLERALLY SUTURED POSTERIOR CHAMBER LENSES (TS-PCL)

To evaluate the safety of polypropylene knots used in TS-SPCL combined with PK and AV over time.A retrospective review of 26 consecutive cases of TS-SPCL by one surgeon (WSVM) with at least 12 months follow-up (mean 26, range 12-62). All patients had a double strand polypropylene knot buried under partial thickness scleral flaps at 2 and 8 o'clock. Knots were rotated into the globe (R) in 10 cases, and could not be buried (N) in 13 cases, and in 3 cases 1 knot was buried.No cases of suture erosion occurred in R or N. One or more polypropylene sutures were visible in 17 patients (8 R, 9 T) at last exam. Twenty-three of 52 knots were rotated into the globe, and 70% of rotated knots were not even visible at the slit lamp at final visit. There was no evidence of conjunctival erosion in any patient. There was no lens dislocation and no endophthalmitis.The combination of partial thickness scleral flaps with double strand polypropylene knots reduces the incidence of suture erosion through the conjunctive if knots cannot be rotated into the globe.

Management of a Partial-Thickness Scleral-Flap Buttonhole During Trabeculectomy

I report the use of partial-thickness Tenon's-conjunctival tissue in the repair of an intraoperative scleral-flap buttonhole that developed during trabeculectomy using adjunctive mitomycin C.

Sulcus Fixation without Flaps

Numerous techniques for sulcus fixation of posterior chamber implants in the absence of capsular support have been reported. All rely on partial thickness scleral flaps or the conjunctiva to prevent the requisite polypropylene knot from eroding. The author compares their success with that of a new surgical procedure. This new technique buries the knot within the eye. One hundred scleral-sutured, sulcus-fixated cases were studied retrospectively. Each case was performed by the author or by a resident under this direction. Suture erosion was defined as the absence of scleral or conjunctival cover on part of the polypropylene suture. On 60 patients, partial thickness scleral flaps were used to protect the knot from exposure. Twelve (20%) of these patients had some degree of externalization of the suture. Of the 40 patients in whom knots were buried and no scleral flap was used, no (0%) erosion was observed. Sulcus fixation of posterior chamber knots has been criticized for increasing the risk of endophthalmitis. The track formed by an exposed suture allows an infectious agent to pass from the external eye to the supported intraocular lens (IOL). Scleral flaps add a degree of safety, but the knot can erode after several months. The author advocates burying the knot within the eye to avoid erosion and therefore endophthalmitis.

Necrotizing Scleritis of Scleral Flaps After Transscleral Suture Fixation of an Intraocular Lens

A 56-year-old woman with rheumatoid arthritis underwent intracapsular cataract extraction and sulcus fixation of an intraocular lens using transscleral fixation sutures buried under partial-thickness scleral flaps. Necrotizing scleritis confined to the area of the scleral flaps developed one month postoperatively, resulting in exposure and loosening of one fixation suture and lens implant decentration. The scleritis responded to systemic prednisone and cyclophosphamide treatment, with healing in two weeks. The final visual acuity was 20/30. Surgical trauma may stimulate local intravascular immune complex deposition and initiate the inflammatory process, thereby leading to necrotizing scleritis. This process should be considered when contemplating the use of scleral flaps in patients with collagen vascular disease and systemic vasculitis.

Late Infectious Endophthalmitis From Exposed Glaucoma Setons

Seton implantation has become increasingly useful in the surgical management of glaucoma. 1 Complications of this surgery include those common to any filtration surgery, such as cataract, choroidal effusion or hemorrhage, early or late endophthalmitis, retinal detachment, or Tenon cyst and others unique to the presence of an implanted foreign body, such as extrusion or late erosion through the overlying sclera and/or conjunctiva and Tenon's fascia. 1 A single case of early postoperative endophthalmitis has also been reported. 2 We treated two patients for late endophthalmitis following external erosion of the implant through the conjunctiva. To our knowledge, this complication has not been previously reported. Report of Cases. —Case 1. —A 65-year-old woman with neovascular glaucoma following an ischemic central retinal vein occlusion underwent implantation of a shorttailed Krupin-Denver valve beneath a partial-thickness scleral flap in her right eye in 1984. Preoperative visual acuity was hand motions. During the

Repair of Inferior Iridodialysis Using a Partial-Thickness Scleral Flap

We present a technique of inferior iridodialysis repair using a partial-thickness scleral flap, which, in turn, employs a modification of the technique currently used to suture posterior chamber intraocular lenses under scleral flaps.

Episcleritis and Secondary Glaucoma After Transscleral Fixation of a Posterior Chamber Intraocular Lens

Transscleral fixation of a posterior chamber intraocular lens (PC IOL) is a method of implanting a pseudophakos in the absence of posterior capsular support. 1 We describe a patient with secondary glaucoma and episcleritis associated with transscleral PC IOL fixation. Report of a Case. —A 62-year-old man underwent extracapsular cataract extraction of his left eye with PC IOL implantation in January 1988. Three months later, a lens explantation and anterior vitrectomy were performed for a subluxed implant. A subsequent extracapsular cataract extract of his right eye with PC IOL implantation in 1989 was uneventful. Because of contact lens intolerance, a PC IOL with 1 to 7 o'clock transscleral fixation 1 mm from the limbus (JF3U00; Alcon Surgical, Ft Worth, Tex) was implanted on January 30, 1990. Hypotony prevented dissection of partial-thickness scleral flaps to cover the knots securing the PC IOL at the exit sites (Figure). Two months later, corrected

A New Technique for Transscleral Fixation of a Posterior Chamber Intraocular Lens in the Absence of Capsular Support During Penetrating Keratoplasty

In the setting of penetrating keratoplasty for the rehabilitation of aphakic or pseudophakic bullous keratopathy, a posterior chamber intraocular lens is frequently implanted in the absence of capsular support. Some surgeons have advocated transscleral fixation over iris fixation of the intraocular lens. Problems faced during such a procedure, however, include the obstructed approach of the suture needle behind the iris, and the exposed or eroded knot of the polypropylene suture. To circumvent both problems, we propose an ab externo technique that takes advantage of the work of Duffey et al and avoids the use of partial thickness scleral flaps.