Scleral-fixated Intraocular Lens Implantation Research Articles

A Study of Anatomical and Visual Outcome in Secondary Scleral Fixated Intra-Ocular Lens Implantation

Abstract:
 Aims: To study of anatomical and visual outcome in secondary scleral fixated intra-ocular lens implantation
 Settings and Design: Hospital based prospective case study conducted at a tertiary care centre over a period of 2 years.
 Methods and Material: 30 eyes of 30 patients underwent secondary scleral fixation of IOL by 2-point Ab-externo technique. Post-operatively best corrected visual acuity, IOP, Keratometry and complications encountered were noted at regular follow-up of 7th day, 6 weeks, 3 months and 6 months.
 Results: Mean age of patients in the study was 52.33 years in the range of 46-60 years. Out of the 30 cases, 56.66% were men and 43.33% were women. Best corrected pre-operative V/A was in the range of 6/24 to 6/18 (53.33%), 6/12 to 6/9 (16.66%), 6/60 to 6/36 (30%). At final follow-up of 6 months, the results were, 63.33% in range of 6/12 to 6/9, 26.66% in 6/24 to 6/18 and 10% in 6/60 to 6/36. In early complications, transient corneal oedema was seen in 20%, transient IOP elevation in 10%, while vitreous haemorrhage and post-operative hyphaema was noted in 3.33% each. In late complications, Cystoid Macular Oedema was seen in 10%, pupil distortion was seen in 6.66% of patients and decentred IOL was seen in 3.33% of the patients.
 Conclusion: Secondary scleral fixated IOL provides good visual outcome and better anatomical position with minimal complications.

Sutureless scleral-fixated intraocular lens: long-term outcomes

Background: The purpose of this study was to evaluate the long-term outcomes of sutureless scleral-fixated intraocular lens (SFIOL) implantation at a tertiary referral center.
 Methods: This retrospective observational study included 50 eyes of 43 consecutive patients who underwent sutureless SFIOL implantation by a single surgeon from January 2009 to December 2015. Indications for surgery were aphakia, dislocated intraocular lens (IOL), complicated cataract surgery (posterior capsule rupture, zonular dialysis, dropped nucleus), iris-clipped IOL with corneal decompensation, and lens with poor capsular support. Indication for surgery, visual acuity, ocular history, ocular comorbidities, intraoperative and postoperative complications, and the need for further surgery were analyzed.
 Results: The analysis conducted on 50 eyes from 43 patients with a mean ± standard deviation (SD) follow-up of 16.64 ± 9.34 months. Patients were 27 (63%) men and 16 (37%) women with a mean ± standard deviation (SD) age of 53.36 ± 22.45 years (range 8–90 years). Final visual acuity was 6/18 or better in 39 eyes. SFIOL was stable and well centered in 48 eyes. SFIOL dislocation was noted in 2 eyes, retinal detachment in 1 eye, and worsening of diabetic cystoid macular edema in 1 eye. Two patients with pre-existing corneal decompensation from complicated cataract surgery had worsening of their condition
 Conclusions: Sutureless SFIOL could be considered as a long-term option for the management of aphakia, dislocated IOL, and lens with poor capsular support. However, future studies with more subjects, longer follow-ups, and robust study design are needed to confirm the results of the present study.

Modified Technique for Scleral-Sutured Fixation with the Double Knots Technique for Posterior Chamber Intraocular Lens: Short-Term Observation

Purpose To evaluate the short-term safety and efficacy of a novel approach of utilizing the 9-0 looped polypropylene suture with double knots buried into the scleral groove and the scleral tunnel to minimize the risk of the suture erosion and suture knot exposure. Design Clinical-based retrospective study. Methods Records of consecutive patients who had anterior vitrectomy and scleral-fixated posterior chamber intraocular lens (IOL) implantation between July 2018 and April 2020 with a minimum follow-up of 3 months were reviewed. Results This study enrolled a total of 21 eyes from 20 patients (15 male). These patients had a mean age of 58.52 ± 8.55 years and were followed for an average of 1.08 ± 0.58 years postoperatively. Best-corrected visual acuity (BCVA) improved from a preoperative mean of 0.43 ± 0.41 logMAR to a significantly higher mean 3-month postoperative value of 0.09 ± 0.21 logMAR (Z = -3.35, p < 0.01). There were no statistical differences between the preoperative and postoperative corneal endothelial cell density (p=0.71). The postoperative complications included transient increased intraocular pressure in 5 eyes (24%). No other complications were detected during the follow-up. Conclusions The modified technique proposed is a safe, effective, and reliable approach resulting in good visual outcomes. Our procedure might have the potential benefit to avoid suture-related complications in scleral-fixated IOL implantation. Trial registration. Retrospective case series study, not applicable.

Comparison of retropupillary fixated iris claw lens versus sclera fixated lens for correction of pediatric aphakia secondary to ectopia lentis

AIM:To evaluate the postoperative visual acuity and complications in eyes with ectopia lentis in children who underwent lens removal and then implantation of retropupillary fixated iris claw lens versus scleral fixated intraocular lens (SFIOL) implantation.MATERIALS AND METHODS:A retrospective analysis of pediatric cases who presented with lens subluxation secondary to ectopia lentis and who underwent lens extraction (57 eyes of 38 patients) with either retropupillary iris fixated intraocular lens (IOL) implantation (Group A – 36 eyes of 20 patients) and SFIOL implantation (Group B – 21 eyes of 18 patients) was done over a period of 5 years from March 2010 to February 2015. The main outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA) and secondary postoperative complications.RESULTS:The study patients were divided into two groups: Group A patients were implanted with retropupillary iris claw lens whereas Group B patients were implanted with SFIOL. The mean age of presentation was 12 years, the mean follow-up period was of 24 months (range 14–36 months), and the median follow-up period was 26 months in both the groups. An improvement in the mean BCVA (LogMAR) was seen in both the groups. In Group A, the mean BCVA improved from 1.5 ± 0.2 preoperatively to 0.3 ± 0.2 postoperatively, whereas in Group B, the mean BCVA improved from 1.5 ± 0.3 preoperatively to 0.3 ± 0.2 postoperatively (P < 0.001). None of the eyes in either of the groups had any serious complications such as glaucoma, uveitis, cystoid macular edema, or endophthalmitis.CONCLUSION:Retropupillary iris fixation and scleral fixation of IOL are both safe and viable options for the correction of ectopia lentis in pediatric age group.

MYX technique: A modified adaptation of Yamane and extraocular needle-guided haptic insertion techniques for scleral-fixated intraocular lens implantation.

Scleral-fixated intraocular lens implantation in an important tool in the armamentarium of an ophthalmologist for managing aphakia. Various techniques have been described in the literature with variable learning curves. Herein, we describe an easy, fast, reproducible technique; the “MYX” technique, which utilizes the advantages of both the Yamane and the X-NIT technique, where the handshaking of the prolene haptic of a 3-piece PMMA IOL into the lumen of a 26-gauge needle is done externally (like in X-NIT technique), and the exteriorized haptic is cauterized to form a flange transconjunctivally, thereby avoiding the scleral pocket tucking (like Yamane technique), to achieve excellent surgical outcomes.

Comparative analysis of secondary implantation of Iris claw intraocular lens (ICIOL) &amp; Scleral fixated intraocular lens (SFIOL) in terms of visual outcome and complications

Background: The modern cataract surgery involves implantation of posterior chamber intraocular lens (PCIOL) when the posterior capsule is intact. However, in case of weak or no capsular support, PCIOL implantation is not possible. In such situations, implantation of secondary Iris claw lens (ICIOL) or Scleral fixated IOL(SFIOL) remains as treatment options. The aim of this study was to compare the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications in aphakic patients. Methods: This prospective randomized study was done from January 2019 to December 2019. Forty aphakic patients fulfilling inclusion criteria, who attended the ophthalmology outpatient department of VVPF’s Medical college and hospital, Ahmednagar were included in this study. These patients were randomly divided into two groups such as Group 1 included 20 patients who underwent ICIOL implantation and Group 2 included 20 patients who underwent SFIOL implantation. The preoperative and postoperative evaluation was done with visual acuity, slit-lamp examination, IOP, fundus examination for the follow up period of 6 months. Results were analysed with Chi square test and t-test using SPSS software. Results: 85% ICIOL and 80% of SFIOL patients had final Best Corrected Visual Acuity (BCVA) of 6/18-6/6. Surgical time in ICIOL was significantly less than SFIOL group (p=0.00). Suture related complications were significantly more in SFIOL group. However, oval pupil and pigment dispersion were seen more in ICIOL group but were harmless. One patient in SFIOL group developed Cystoid Macular Edema (CME) which persisted till final follow up and 1 haptic of ICIOL was disenclavated which was re-enclavated. Conclusion: Comparable final visual outcome was found between ICIOL group and SFIOL group. However, Implantation of ICIOL required less surgical time with fewer complications and hence is a better alternative to SFIOL implantation in correction of aphakia.

Sutureless Scleral-Fixated Intraocular Lens Implantation for Refractive Rehabilitation in Eyes With Spherophakia.

Spherophakia is a rare, debilitating congenital ocular disorder. This institution-based, retrospective, interventional study evaluated medical records of 16 patients with spherophakia with a median age of 19.5 years. Twenty-six eyes underwent scleral-fixated intraocular lens implantation. The technique involved 2 parallel-to-limbus scleral tunnels fashioned using a microincision vitrectomy blade, followed by lensectomy, core vitrectomy, externalization of haptics through 2 separate diametrically opposite sclerotomies, and tucking in of the haptics into the tunnels. Anterior and posterior segment examination, visual acuity, and intraocular pressure (IOP) were noted at baseline and final follow-up. Baseline best-corrected visual acuity (BCVA) of all eyes was 0.49 ± 0.51 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 6/18). BCVA of more than 6/60 was present in 28 of 32 (87.5%) eyes, and 13 of 26 (50%) eyes that were operated on had a baseline BCVA of more than 6/18. Postoperative BCVA in 26 eyes improved from 0.43 ± 0.32 logMAR to 0.19 ± 0.21 logMAR (Snellen equivalent, 6/9) (P = .002). Postoperative BCVA was more than 6/18 in 20 of 26 (76.9%) operated-on eyes (P = .046), and all eyes had a final BCVA of more than 6/60. In 20 of 26 (76.9%) eyes, BCVA improved from preoperative status. Postoperatively, spherical equivalent improved from -9.55 ± 5.17 diopters to -0.29 ± 1.45 diopters (P < .001). Apart from 2 patients with Marfan syndrome, 1 with Weill-Marchesani syndrome, and 1 with homocystinuria, the remaining patients had isolated spherophakia. Six eyes presented with an IOP greater than 21 mm Hg, and 50% of these eyes had a final IOP that decreased to less than 15 mm Hg after lensectomy. Lensectomy with pars plana vitrectomy and scleral-fixated intraocular lens is an effective method of refractive rehabilitation for patients with spherophakia presenting with visual disability.

Refractive and Visual Outcomes after Scleral Fixated Intraocular Lens Implantation in Children with Ectopia Lentis

This study was conducted to report the refractive and visual outcome after Scleral Fixated Intraocular Lens (SFIOL) implantation in children with nontraumatic ectopia lentis. Retrospective review of the medical records of 25 eyes of 15 patients who underwent SFIOL implantation in children with non-traumatic ectopia lentis. The mean best corrected visual acuity (BCVA) before SFIOL implantation was 1.07 ± 0.9 logMar units [median: 0.9, Interquartile range (ΙQR): 0.415 to 1.555] which improved to 0.41 ± 0.33 logMar units (median: 0.22, ΙQR: 0.180 to 1.555) at two months postoperative follow up. In phakic group, the mean spherical refraction preoperatively was -12.04 ± 7.82 DS (dioptre sphere) (IQR: +16 to -5.875) and postoperatively was +0.93 ± 2.67DS (IQR: -0.375 to +2). In aphakic group, the mean spherical refraction preoperatively was +12.22 ± 2.05 DS and postoperatively was +1.2 ± 1.9 DS. The mean total astigmatism preoperatively was -6.44 ± 4.95 DC (dioptre cylinder) (median: 6, IQR: -10.50 to +2) and postoperatively was -1.47 ± 0.98 DC (median: -1.5, IQR: -2 to - 0.625 ). The mean IOL induced astigmatism was -1.01 ± 0.95 DC (median -0.75, IQR: -1.33 to - 0.25). The spherical refractive equivalent was within 2 Diopter (D) of the target refraction calculated preoperatively in 20 eyes and in five eyes it was more than 2 D. SFIOL implantation is associated with good visual outcome with a significant improvement in the refractive error. However, a longer follow up is required to assess the change of refraction and the stability of the SFIOL.

Iris-claw intraocular lens, scleral-fixated intraocular lens, and angle-supported anterior chamber intraocular lens in Hospital Melaka: a four-year retrospective analysis

Introduction: Cataract surgery with insufficient capsular support has become an intense challenge to surgeons in intraocular lens (IOL) selection. Anterior chamber IOL (ACIOL), iris-claw (Artisan) IOL, and scleral-fixated IOL (SFIOL) are the three common types of IOL used. However, each type of IOL has its own characteristics and different clinical requirements. IOL selection is important in ensuring good visual outcome.&#x0D; Purpose: The purpose is to compare the duration or surgery, visual outcomes, and complications among ACIOL, Artisan IOL, and SFIOL.&#x0D; Study design: Retrospective comparative analysis.&#x0D; Material and methods: This is a four-year retrospective analysis of patients who underwent either ACIOL, Artisan IOL, or SFIOL implantation between January 2014 and January 2018. Patients were divided into ACIOL, Artisan, and SFIOL groups. Demographic data, duration of surgery, preoperative and postoperative visual acuity, and postoperative complications were identified and compared among the different groups.&#x0D; Results: Sixty-four eyes from 58 patients were analysed: twenty (31.3%) eyes with ACIOL, 28 (43.8%) eyes with Artisan, and 16 (25%) eyes with SFIOL. Mean surgery times for ACIOL, Artisan, and SFIOL were: 61 ± 27.8, 64 ± 26.9, and 104.1 ± 46.8, respectively. SFIOL showed significantly longer surgery time than the ACIOL and Artisan groups (p &lt; 0.05). There was no significant difference in surgery time between the ACIOL and Artisan groups (p &gt; 0.05). The Artisan group showed significantly better visual recovery at postoperative 1 week than both the ACIOL and SFIOL groups (Artisan vs ACIOL: 6/18 vs 6/24, p &lt; 0.05; Artisan vs SFIOL: 6/18 vs 6/60, p &lt; 0.05). However, final best-corrected visual acuity (BCVA) at two months was comparable among all three groups with a median BCVA of 6/9. Elevated intraocular pressure occurred in all IOL groups, retinal detachment developedin the Artisan and SFIOL groups, epiretinal membrane developed in the ACIOL and SFIOL groups, corneal decompensation developed in the ACIOL group only. Cystoid macular oedema and IOL tilt occurred in SFIOL only.&#x0D; Conclusions: All three groups of IOL showed comparable good visual outcomes. The decision of IOL selection should be based on patients’ clinical condition and availability of surgical skill and resources.

Outcomes and complications in scleral-fixated intraocular lens implantations.

This study compares outcomes and complications of scleral-fixated intraocular lens implantation between 2 levels of surgeons. A retrospective case series of patients undergoing scleral-fixated intraocular lens implantation at Prince of Wales Hospital, Hong Kong, between May 2012 and April 2017 were reviewed. Data collected included age, gender, affected eye, preoperative and postoperative visual acuities, refractive target and outcome, surgeon profile, operative details including method of scleral fixation, intraoperative and postoperative complications and length of follow-up. Ninety eyes of 90 patients were included for analyses. The mean LogMAR visual acuities were 1.17 ± 0.70 at postoperative week 1, 0.81 ± 0.56 at 1 month, 0.66 ± 0.55 at 3 months, 0.56 ± 0.59 at 6 months, and 0.51 ± 0.60 at 1 year, respectively. After adjusting for age at operation, operative time, axial length, subspecialty of the surgeon and preoperative LogMAR, surgeon seniority was not significantly associated with final visual outcomes. There was no statistically significant difference between the mean improvement in visual acuities between eyes operated by consultants and fellows under direct supervision of a senior surgeon. Scleral-fixated intraocular lens implantation is safe and effective in improving visual acuity in aphakic adults without capsular support. Under good supervision, fellows were able to produce comparable results compared with experienced specialists.

Post-cataract Surgery Fungal Endophthalmitis: Management Outcomes and Prognostic Factors

ABSTRACT Purpose: To describe the clinical and microbiological features, management outcomes, and prognostic factors of visual improvement in post-cataract surgery fungal endophthalmitis. Methods: We evaluated 17 patients with culture-confirmed fungal endophthalmitis following cataract surgery. Data were collected regarding intravitreal antibiotics and antifungals, pars plana vitrectomy (PPV), intraocular lens (IOL) explantation, and scleral-fixated IOL (SFIOL) implantation. Clinical outcomes were recorded in terms of visual acuity and management strategies. Results: PPV was performed as a primary procedure at first presentation in three eyes. Fourteen eyes (82.3%) received intravitreal voriconazole. IOL explantation was performed in four eyes, followed by an SFIOL implantation in three eyes. Six eyes additionally presented with keratitis. At the final follow-up, cases having visual acuity ≥6/60 doubled from 17.6% to 35.3%. Eyes receiving antifungals had a trend toward worse visual outcome. Conclusions: Corneal involvement in addition to endophthalmitis and the presence of Aspergillus terreus were found to be poor prognostic markers.

Flattened flanged intrascleral intraocular lens fixation technique

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

Trocar-assisted, flanged sutureless scleral-fixated intraocular lens implantation combined with silicone oil injection after penetrating keratoplasty surgery.

We describe a combined technique of trocar-assisted sutureless scleral-fixated intraocular lens implantation and silicone oil injection at the same session. Two 3 mm scleral tunnels were created 2 mm away from and parallel to the limbus with the 23-gauge vitrectomy trocars entering the sclera transconjunctivally at an angle of approximately 10° at the 3 o’clock and 9 o’clock meridians. After the 3-piece foldable IOL was delivered to the anterior chamber through the corneal incision, the tip of one of the IOL haptics was grasped with a 23-gauge serrated retinal forceps entered through the trocar located at the 3 o’clock meridian. Then the haptic was removed from the scleral tunnel together with the trocar out of the globe. The same procedure was applied to the other haptic. A transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. The ends of the haptics were cauterized to make a flange. The resultant flanges of the haptics were pushed back and fixed into the scleral tunnels. Perfluorooctane was taken out of the eye with vitreoretinal surgery and the silicone was injected into the eye to prevent hypotonia. No complications were seen intraoperatively or postoperatively. After 1-month follow-up period, IOL was seen stabilized.

Comparative study of secondary implantation of iris-claw lens and scleral-fixated intraocular lens in terms of visual outcome and complications

Introduction: The modern cataract surgery is involved in implanting the posterior chamber intraocular lens (PCIOL) in the intact posterior capsule. However, the implantation of PCIOL is not possible in case of weak or no capsular support. In such situations, iris-claw lens (ICIOL) and scleral-fixated intraocular lens (SFIOL) remain as treatment options. Objective: The objective was to analyze the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications. Materials and Methods: It was a prospective study with 30 aphakia patients fulfilling inclusion criteria. These patients were divided into two groups with 15 in each group. Group I patients underwent ICIOL and other 15 patients in Group II underwent SFIOL implantation. Patients with preexisting ocular pathologies were excluded. The preoperative and postoperative evaluation was done for the follow-up period of 6 months. Results were analyzed with Chi-square test and t-test using SPSS software. Results: In ICIOL group, 86.67% of patients and 80.6% of SFIOL patients had final best-corrected visual acuity (BCVA) 6/18–6/6. The mean logMAR BCVA in both groups was comparable. The surgical time in ICIOL was significantly less than SFIOL group (P = 0.00). Suture-related complications were significantly more in the SFIOL group. Complications found in the ICIOL group were harmless. Conclusion: The visual outcome was found to be comparable in both groups. ICIOL requiring less surgical time with fewer complications was found to be a good alternative to SFIOL in correction of aphakia.

Incidence and management of rhegmatogenous retinal detachment after pars plana vitrectomy and sutureless scleral-fixated intraocular lens.

Purpose:To evaluate the incidence, risk factor(s), and surgical outcomes of rhegmatogenous retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) with sutureless scleral-fixated intraocular lens implantation (SFIOL).Methods:Records of patients (1311 eyes, 1234 patients) who underwent PPV and sutureless SFIOL from 2017 to 2018 were retrospectively analyzed.Results:The indications SFIOL were subluxated lens (33.7%), dislocated IOL (21.7%), surgical aphakia (20.1%), congenital lens subluxation (11.1%), nucleus drop (6.9%), and post-open globe injury (OGI) repair (6.5%). History of closed-globe injury (CGI) was present in 27.2% eyes.Twenty-two eyes (1.7%) developed RRD. The incidence of RRD in eyes, which underwent SFIOL surgery for subluxated lens, dislocated IOL, surgical aphakia, congenital lens subluxation, nucleus drop, and post-OGI repair was 1.4% (n = 6), 2.5% (n = 7), 1.1% (n = 3), 3.4% (n = 5), 0 and 1.2% (n = 1), respectively (P = 0.382). The incidence of RRD in eyes with and without CGI was 1.7% each (P = 0.996).Twenty-one eyes underwent RD surgery. Retinal reattachment was achieved in 76.2% eyes, while 66.7% eyes required only one surgery. The eyes in which retina failed to reattach had a high grade of proliferative vitreoretinopathy present at the time of presentation. Final best-corrected visual acuity of ≥20/60 and <20/60 to ≥20/200 and <20/200 was seen in 38.1%, 19.0%, and 42.9% eyes.Conclusion:Eyes with the congenital subluxated lens are at a marginally higher risk of developing post-SFIOL RRD. The surgical outcome of RD surgery in these eyes is good.

The effect of intraocular lens tilt on visual outcomes in scleral-fixated intraocular lens implantation.

To investigate the effect of scleral-fixated intraocular lens (IOL) tilt on visual outcomes. Ninety-four eyes of consecutive 94 patients who underwent scleral-fixated IOL implantation with Z-suture technique were included in this prospective study. The values of pre- and postoperative 12th month uncorrected visual acuity (UCVA), cylindrical refractive error, best-corrected visual acuity (BCVA) and corneal and lenticular astigmatism were recorded. The position of the implanted IOL was evaluated with anterior segment optical coherence tomography (AS-OCT). The relationships between the AS-OCT measurements and the visual acuity or refractive errors were investigated. The IOL position was evaluated as tilted in 68 (72.3%) patients: 29 (30.8%) in both vertical + horizontal axes, 30 (31.9%) in the horizontal axis and 9 (9.6%) in the vertical axis. There were no significant differences between patients with and without tilt IOL position in terms of the UCVA, BCVA, cylindrical refractive error and lenticular astigmatism (p > 0.05, for each). The mean BCVA was significantly higher in the no-tilt group than in the both horizontal + vertical tilt and the vertical tilt groups (p = 0.03, p = 0.04, respectively). The mean lenticular astigmatism was significantly higher in the vertical tilt group than the other groups (p = 0.04). Tilting in IOL position occurs commonly; however, IOLs with tilting on any of the axes do not have significantly worse outcomes when compared with IOLs with no tilt, in terms of visual results and refractive errors. On the other hand, tilting on the vertical axis is observed less commonly, yet is more effective on visual results and refractive errors, when compared with tilting on the horizontal axis.

The visual outcome and surgical complications in posterior capsular rupture following cataract surgery with scleral fixated intraocular lens in tertiary care centre – A prospective study

Aim: To analyse the complications as well as the long term functional and visual outcomes of anterior vitrectomy with scleral fixated posterior chamber intraocular lens implantation in patients with inadequate posterior capsular support. Settings and Design: This was a prospective study done at Coimbatore Medical College Hospital, Coimbatore during the period of May 2016 to December 2017. Materials and Methods: 30 eyes of 25 aphakic patients and 5 patients who had primary scleral fixated IOL implantation were included in the study. Anterior segment examination with slit lamp, preoperative visual acuity, intraocular pressure, fundus examination and IOL power calculation was done. Results: Scleral fixation of IOL is a safe procedure with a success rate of 93% and most of the intraoperative and postoperative complications were minor. Postoperative best corrected visual acuity of 6/12 and above was seen in 70% of patients. Conclusion: Anterior vitrectomy with scleral fixated IOL implantation is a safe and effective procedure to correct aphakia in eyes without adequate posterior capsular support. Complications seen with anterior chamber IOL are not seen with SFIOL and dreaded complications like retinal detachment, suture lysis and infection were not encountered in our study. However precise determination of small differences in visual outcome and long-term complication rates would require a large prospective, randomized clinical trial. Keywords: Aphakia, Inadequate posterior capsular support, Scleral fixated IOL.

Long-term outcome of scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients

BackgroundTo investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal.MethodsRecords of ocular trauma patients who underwent implantation of SFIOL without conjunctival peritomies and sclerotomy during primary pars plana vitrectomy or silicone oil removal.ResultsSixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6–99 months). The average patient age at the time of surgery was 44 years old (range, 4–80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively (P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (5.8%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%).ConclusionsUse of a scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support.

Scleral Fixation of Intraocular Lenses with Gore-Tex Suture: Refractive Outcomes and Comparison of Lens Power Formulas

To report refractive outcomes of scleral-fixated intraocular lens (IOL) implantation with Gore-Tex (W.L. Gore & Associates, Newark, DE) suture and combined pars plana vitrectomy and compare predicted refractive outcomes among 5 IOL power calculation formulas. Retrospective case series. Patients undergoing scleral-fixated IOL implantation with Gore-Tex suture at our institution between January 2015 and June2018. Comparison of preoperative biometrics with postoperative refraction and calculation of predicted refractive outcome with 5 different IOL formulas. Prediction error and absolute error to compare postoperative refraction with refraction predicted by lens power calculation formulas. Thirty-one eyes of 31 patients were included. All power calculations assumed in-the-bag position of the IOL. The Akreos A060 (Bausch & Lomb, Rochester, NY) was implanted in 23 eyes and the CZ70BD (Alcon, Fort Worth, TX) in 8 eyes, and all lenses were sutured 3 mm behind the limbus. Average postoperative spherical equivalent (SE) was -0.79±0.95 diopters (D). Average prediction error (postoperative SE refraction minus target refraction) was -0.19±0.72 D. Postoperative SE was within 1.0 D of target in 25 of 31 patients (81%) and 2.0 D of target in 31 of 31 patients (100%). The repeated-measures analysis of variance of absolute error by lens power formula was significant (P= 0.012), with Haigis demonstrating greater error. There was no significant difference among Barrett II, Sanders-Retzlaff-Kraff theoretical (SRK/T), Holladay 2, or Hoffer Q. For eyes undergoing pars plana vitrectomy with scleral-sutured IOL implantation, assumption of in-the-bag IOL position when calculating lens power leads to acceptable refractive outcomes. Barrett II, SRK/T, Holladay 2, and Hoffer Q formulas were noninferior to each other.

Outcome of Sutured Scleral-Fixated Intraocular Lens in Blunt and Penetrating Trauma in Children.

To determine the anatomical and functional outcomes of sutured scleral-fixated intraocular lens (SSFIOL) implantation in children with blunt and penetrating injuries to the eye. This is a retrospective, interventional case series study. Case records of children who underwent SSFIOL implantation in a tertiary eye care facility for traumatic aphakia, cataract, or subluxation were screened. Relevant data on demographics, visual acuity (VA) outcomes, and complications and their management were collected. Results for blunt and penetrating trauma were compared. There was stability or improvement of vision in 88.9% of eyes during the follow-up period. Young age at time of trauma (P = .031) and SSFIOL implantation (P = .002), history of retinal detachment (RD) before SSFIOL implantation (P = .019), poor preoperative best-corrected VA (BCVA) (P = .004), and development of RD in the follow-up period (P = .046) were independent risk factors for low final BCVA on univariate regression analysis. RD rate was 6.53% and was comparable in open and closed globe injuries. Intraocular lens (IOL) dislocation rate was 3.9%, and probability of survival was higher for open globe (0.78) as compared to closed globe (0.64) injuries (P = .042). SSFIOL implantation results in good VA improvement in both open and closed globe injuries. RD remains an important vision-threatening complication. IOL dislocation is more likely to occur in closed globe injuries. A prospective study evaluating the outcomes would better elucidate the role of these IOLs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:757-764.].