Scleral-fixated Intraocular Lens Research Articles

Vitreoretinal Outcomes Following Secondary Intraocular Lens Implantation with Pars Plana Vitrectomy

Background: Retrospective cohort study of 561 adult patients undergoing secondary intraocular lens (IOL) implantation by vitreoretinal surgeons at a single institution from April 2015-December 2020. Methods: Patient historical factors, intraoperative/postoperative complications, and outcomes of IOL type (anterior chamber IOL (ACIOL) vs scleral sutured IOL (SSIOL) vs scleral fixated IOL (SFIOL) vs sulcus) were assessed. Primary outcomes were rates of postoperative retinal tears and rhegmatogenous retinal detachment (RRD). Secondary outcomes were rates of intraoperative endolaser, intraoperative retinal tear, and further IOL surgery. Results: The incidence of intraoperative retinal tears was 7.3% and not significantly different between techniques. Rates of intraoperative endolaser use were 17.5% among all techniques and not significantly different between techniques. Rates of postoperative retinal tear were low (0-2.7%). Rates of postoperative RRD were not significantly different between techniques [ACIOL 9/198 (4.5%), SFIOL 1/54 (1.9%), SSIOL 14/274 (5.1%), sulcus 2/35 (5.7%), total 26/561 (4.6%), p=0.79]. Rates of repeat IOL surgery trended higher in sulcus lenses [ACIOL 5/198 (2.5%), SFIOL 4/54 (7.4%), SSIOL 16/274 (5.8%), sulcus 5/35 (14.3%), total 30/561 (5.3%), p=0.12]. Conclusions: Intraoperative endolaser use and intraoperative retinal tear were not uncommon in secondary IOL surgery and underscore the importance of careful vitreoretinal management among these patients.

GIANT INTRAOPERATIVE CORNEAL BULLA MANAGED WITH BANDAGE LENS TECHNIQUE DURING VITRECTOMY SURGERY.

To report a case of giant intraoperative corneal bulla formation in a patient with a history of recent phacoemulsification with clear corneal incision that was managed with a bandage contact lens intraoperatively. Retrospective case report with anterior segment optical coherence tomography. A 77-year-old woman with a history of recent complicated cataract surgery with retained lens fragments underwent pars plana vitrectomy and scleral-fixated intraocular lens placement. During pars plana vitrectomy, a large corneal bulla formed at the site of the main corneal incision, confirmed with anterior segment optical coherence tomography. A bandage contact lens with viscoelastic was used to overcome visualization challenges and safely proceed with the surgery. This is the first report of corneal bullae formation during pars plana vitrectomy that is confirmed by anterior segment optical coherence tomography and successfully managed with a bandage contact lens intraoperatively.

Safety and Efficacy of Retropupillary Fixation of Iris Claw Intraocular Lens versus Sutureless Scleral Fixated Intraocular Lens in the Management of Post Cataract Aphakia

Safety and Efficacy of Retropupillary Fixation of Iris Claw Intraocular Lens versus Sutureless Scleral Fixated Intraocular Lens in the Management of Post Cataract Aphakia

Reverse pupillary block, in contemporary scleral intraocular lens procedures.

To evaluate the frequency and anterior segment optical coherence tomography parameters of patients with scleral fixated intraocular lenses (IOL) and reverse pupillary block (RPB). Retrospective analysis at a tertiary care centre (Department for Ophthalmology and Optometry, Medical University of Vienna, Austria). We researched our records for patients who underwent scleral fixated IOL implantation from January 2018 till February 2023. Patients were included only if there was at least one adequate post-operative scan of anterior segment optical coherence tomography (AS-OCT) available. Initially, AS-OCT scans were assessed for IOL tilt and decentration employing a 3D scan and then later for anterior chamber angle (ACA), aqueous anterior chamber depth (AQD), pupil diameter and iris-IOL distance using the 2D scan at a 0° angle. Both an iris-IOL distance of 0 or less and an ACA of more than 70° were required to define an RPB. A total of 110 patients met the inclusion criteria, 41 were treated using the Carlevale, 33 the four flanged, 24 the Yamane and 12 the Scharioth technique, respectively. RPB was found in 32 patients (29%). Twenty patients with RPB were treated using YAG peripheral iridotomy, mean ACA decreased from 91.91° ± 13.77 to 61.02° ± 8.52, (p < 0.001), mean AQD decreased from 4.67 mm ± 0.47 to 4.31 ± 0.36 mm (p < 0.001) and mean iris-IOL distance increased from -0.09 ± 0.04 to 0.33 ± 0.30 (p < 0.001). RPB is found in a third of eyes who have undergone scleral fixated IOL implantation without iridectomy. YAG peripheral iridotomy is a potent option to treat RPB, and subsequently reduce the risk of iris chafing and secondary inflammation or glaucoma.

Influencing factors of effective lens position in patients with Marfan syndrome and ectopia lentis

AimsThe aim of this study was to analyse the effective lens position (ELP) in patients with Marfan syndrome (MFS) and ectopia lentis (EL).MethodsPatients with MFS undergoing lens removal and primary...

Comparison of flanged polypropylene scleral intraocular lens fixation with scleral sutured fixation

ObjectiveTo compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket. MethodsRetrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center. ResultsA total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (–0.63 ± 2 and –2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29). ConclusionComparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.

Retropupillary Iris-fixated versus Sutured Scleral-fixated Intraocular Lenses.

Aim: To compare the anatomical and functional results and patient satisfaction following retropupillary implantation of Artisan Aphakia iris-fixated intraocular lens (rAAIF) and sutured scleral fixated intraocular lens (SFIOL). Subjects and methods: We presented a prospective double-arm non-blinded study. Forty-one eyes with acquired aphakia, no age-related macular degeneration, no previous keratoplasty, no combined procedures, no AC reaction (cells, fibrin), normal intraocular pressure, no history of endothelial corneal dystrophy in relatives or fellow eye were included. Indications, complications, corrected distance visual acuity (CDVA), endothelial cell density (ECD), and patient satisfaction score were assessed. Results: Retropupillary AAIF was implanted in 21 (51.22%) eyes and SFIOL in 20 (48.78%) eyes. The most common indication was complicated cataract surgery in 18 cases (43.90%), followed by trauma in 16 (39.02%), and spontaneous dislocation in 7 (17.07%). No difference between rAAIF and SFIOL in terms of sex, laterality (χ=0.13, p=0.72), indications (χ=0.78, p=0.68), previous ocular history, and comorbidities was observed. The complications and the visual outcomes at 6 months postoperatively were similar between the two groups (p=0.95 and p=0.321, respectively). The ECD loss in the two groups was also similar (p=0.89). The patient satisfaction score was 58.67±8.80 in the rAAIF and 56.69±11.50 in the SFIOL group, which was statistically similar (p=0.764). Conclusion: Retropupillary AAIF and SFIOL showed similar results concerning visual acuity, endothelial cell loss, and patient satisfaction. Careful preoperative individual assessment is required to have optimal results with either technique. Abbreviations: AAIF = Artisan Aphakia iris-fixated intraocular lens, rAAIF = retropupillary Artisan Aphakia iris-fixated intraocular lens, CDVA = corrected distance visual acuity, ECD = endothelial cell density, IOL = intraocular lens, SD = standard deviation, SFIOL = scleral fixated intraocular lens.

Scleral-fixated vs Iris-fixated intraocular lens in pediatric ectopia lentis: A systematic review.

Numerous intraocular lens (IOLs) options are available for treating pediatric ectopia lentis, and this paper reviews recent literature on pediatric ectopia lentis treatment with iris-fixated and scleral-fixated IOLs. A comprehensive search was undertaken on PubMed, Embase, ProQuest, Cochrane, Wiley, SCOPUS, and EBSCO. Studies published in the last ten years that met the inclusion criteria were included in this review. Seventeen studies exhibiting low to moderate risk of bias were included in this review, with eight on iris-fixated IOL (IFIOL), six on scleral-fixated IOL (SFIOL), and three on both IOLs. From the included studies, these data were extracted and compared: best-corrected visual acuity, endothelial cell density, postoperative complications, IOL stability, and intraocular pressure. IFIOL and SFIOL show comparable lens stability, offer good visual rehabilitation, and demonstrate equivalent safety profiles. There is no discerning superiority between IFIOL and SFIOL in treating pediatric ectopia lentis. The choice of which IOL to implant depends on the surgeon's preference.

Microforceps-Assisted Transscleral Fixation of Intraocular Lens.

We present a novel technique for intraocular lens (IOL) fixation. The technique can be used on single-piece acrylic IOLs and can manage the patients who are either aphakia or with a dislocated IOL. One end of Gore-Tex suture is tied into the optic-haptic junction of the IOL. Another end is fixated in the scleral wall. The single sclerotomy and double sclerotomies settings can be applied to different situations. Twelve eyes received this procedure. After a follow-up period of up to 20 months, the IOLs were well centered. The technique is a reliable method for scleral fixation of IOLs, which can be applied on the widely used single-piece acrylic IOLs. In our experience, it is reproducible and rarely cause complications.

Clinical observation of a modified technique for intrascleral fixation of flanged three-piece foldable intraocular lenses through a Hoffman pocket.

To present the outcomes of a new technique for intrascleral fixation of a flanged three-piece foldable intraocular lens (IOL) without a conjunctival incision. We retrospectively reviewed a consecutive series of 12 eyes of 12 patients who underwent scleral IOL fixation using this technique. The follow-up period ranged 3-12 months. There was a significant improvement in best-corrected visual acuity, from 0.8 (1.6) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.45 (0.8) logMAR at the final postoperative follow-up (p = 0.012). Notable complications included one case of pupillary IOL capture and increased intraocular pressure. Our novel technique is a viable solution for managing secondary IOL fixation, enabling the use of a wider variety of IOLs and simplifying the reposition process for dislocated three-piece IOLs. This approach has the potential to lower complication rates and enhance patients' recovery.

Bilateral spontaneous late anterior dislocation of in-the-bag intraocular lens with phimosis in uveitis patient

The late in-the-bag dislocation of the intraocular lens (IOL) is an uncommon complication in uveitis patients and can occur after uneventful surgery as a result of progressive zonular dehiscence. A 57-year-old diabetic and uveitic male developed bilateral spontaneous anterior dislocation of in-the-bag IOLs with phimosis following 15 and 23 months, respectively, in the right and left eye after uneventful phacoemulsification with foldable IOL. The dislocated bag and IOL complex were removed and scleral fixated IOL (SFIOL) was implanted in both eyes with good results. Late in-the-bag dislocation of IOL could be multifactorial, and its management is challenging. Many surgical options are available to handle such situations, but dislocated IOL replacement with SFIOL is a good option for restoring and maintaining the vision of such eyes.

Double-Bubble Technique Assisted by Holding Forceps: A Modified Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes With Scleral Fixated Intraocular Lens.

Several techniques have been developed for graft unfolding approaches in Descemet membrane endothelial keratoplasty (DMEK). However, despite these techniques, graft deployment and configuration in eyes with deep anterior chambers remain challenging in some cases. Therefore, in this study, we described a modified technique for DMEK, known as the "double-bubble technique assisted by holding forceps." This was a retrospective interventional case series. Patients who underwent DMEK between August 2022 and July 2023, including cases with a history of vitrectomy and scleral fixation of intraocular lens, were enrolled in this study. Two experienced surgeons performed DMEK. In brief, after graft insertion into the anterior chamber, the first bubble with a small volume of air was injected above the graft to open the tight roll, and the graft edge was held using a 25-gauge graft manipulator. The second bubble was injected underneath the graft for fixation, while the graft edge was grasped using forceps during gas injection. The graft was released from the forceps. Best spectacle corrected visual acuity, central corneal thickness, endothelial cell density, and incidence of postoperative complications were measured before and after DMEK. Eleven eyes of 11 patients were included in this study (mean follow-up period, 4.5 ± 4.4 months). Best spectacle corrected visual acuity and central corneal thickness significantly improved postoperatively ( P < 0.001). Rebubbling was required in 2 eyes; no other postoperative complications or primary graft failure were observed. The present technique enables safe and feasible DMEK surgery in vitrectomized eyes with scleral fixated IOLs and in those with a deep anterior chamber.

A Modified Girth-Hitch Suture Technique to Rescue Single-Haptic Dislocation of Scleral Fixated IOL's.

To describe the technique of modified girth-hitch suture for one side transscleral fixation to rescue a single haptic dislocation. In this surgical technique report, dislocated scleral fixated posterior chamber IOL were secured to the sclera using 10-0 polypropylene suture looped around the IOL haptic. Three types of IOL were secured in this study (4 case of 1-piece PMMA IOL, 1 case of 3-piece acrylic IOL with PMMA loop and 1 case of acrylic foldable IOL with a two-plate loop design). Six patients, who had subluxation of the scleral-fixated posterior-chamber IOL due to single-knot dehiscence, underwent refixation of scleral-fixated IOL surgery using this technique. In all cases successful repositioning with stable and central fixation of the IOLs was achieved. No intraoperative or postoperative complications were noted. Internal re-fixation with a girth-hitch suture is relatively quick and convenient method for management of a dislocated IOL haptic on one side.

Refractive outcomes of Carlevale IOLs compared to Artisan iris-claw IOLs considering the type of incision

Refractive outcomes of Carlevale IOLs compared to Artisan iris-claw IOLs considering the type of incision

Scleral Fixated Secondary IOLs: An Outcomes Comparison Between the Yamane and Gore-Tex-Sutured Techniques.

Among secondary intraocular lens (IOL) techniques, scleral fixated IOLs (SFIOLs) offer advantages in cases without capsular support. In this article, we compare outcomes between two types of Gore-Tex scleral sutured IOLs with the Yamane technique. This study was a retrospective chart review of patients who underwent SFIOL implantation. Analysis revealed a statistically significant improvement in final postoperative visual acuity (VA) for sutured SFIOLs (P < 0.001, Envista (n = 29) 95% CI 0.47-1.04, Akreos (n = 23) 95% CI 0.32-0.81) with no statistical improvement in the Yamane group (P = 0.44, n = 15, 95% CI -0.33-0.71). Outcomes analysis revealed greater incidences of cystoid macular edema (CME) in the Yamane cohort (P < 0.05) and a higher rate of reoperations in the Akreos cohort (P < 0.02). All complications related to suture material (n = 4) and IOL decentration (n = 2) occurred in the sutured SFIOL group. The sutureless Yamane technique offered fewer subsequent surgeries and suture-specific complications while revealing diminished VA improvement in long-term follow-up compared to the sutured SFIOLs. [Ophthalmic Surg Lasers Imaging Retina 2024;55:xx-xx.].

RELAY INTRASCLERAL 6-0 POLYPROPYLENE-ASSISTED INTRAOCULAR LENS FIXATION: A Retrospective Comparison With Modified Yamane Technique.

To describe a new surgical technique that uses a relay suture to optimize sutureless scleral fixation of intraocular lens in eyes with capsular insufficiency and to evaluate the outcomes of this technique versus Flanged, double needle-guided, scleral fixation of intraocular lens with haptic trimming (modified Yamane approach). Relay intrascleral 6-0 polypropylene sutures with flanges generated at the intraocular ends were used to fixate and securely hold a rigid intraocular lens with haptic eyelets against the inner scleral wall. The results were analyzed at 3-, 6-, and 12-month follow-up. This retrospective cohort study found that compared with the control group (n = 27), the relay-sutured group (n = 26) had greater mean changes in corneal astigmatism (0.44 vs. -0.52 diopters [D]) and fewer mean degrees of intraocular lens astigmatism (0.62 vs. 1.1 D). The mean intraocular lens decentration was comparable between both the groups; however, in the control group, there was a significant increase in intraocular lens tilt degrees from 3 to 12 months. Moreover, significantly higher proportions of patients with persistent macular edema and iris-optic capture were seen in the control group. The relay-sutured technique may be an alternative to flapless scleral fixation of intraocular lens and provides a stable intraocular lens position with acceptable complication rates.

A Modified Four-point Scleral Fixation of Intraocular Lens in Aphakic Eyes without Adequate Capsular Support

Abstract Background: Polypropylene is a commonly used suturing material for intraocular lens (IOL) scleral fixation, but a high breakage rate after several years of follow-up is reported. Meanwhile, Gore-Tex has been a popular artificial material in ophthalmic surgery. Aim: This pilot study investigated the safety and efficacy of a modified surgical technique for scleral fixation of a four-point, close-loop haptic IOL using Gore-Tex as the suture material for aphakic patients without adequate capsular support. Methods: A modified IOL scleral fixation technique was developed using a four-point, close-loop haptic IOL and Gore-Tex as the suture material. Patients undergoing the operation between March 2018 and May 2019 at one center were included in the study. The preoperative uncorrected distance visual acuity (UDVA) with spectacles and postoperative UDVA with an IOL were compared as the main outcome. Follow-up time was 17–43 months. Results: A total of 10 eyes of 10 patients were enrolled, including 3 with iatrogenic IOL dislocation, 3 with iatrogenic lens drop, 2 with traumatic lens dislocation, and 2 with late in-the-bag IOL dislocation. The mean age was 70.8 ± 12.11 years. The mean UDVA, evaluated by the logarithm of the minimum angle of resolution, was decreased from preoperative 1.89 ± 0.28 to postoperative 0.58 ± 0.70 (P &lt; 0.001). No complications were reported except in one case with a postoperative corneal ulcer which healed after antibiotic treatment. Conclusions: The favorable outcome suggests Gore-Tex sutures as a safe and stable material for IOL scleral fixation. Prospective studies with a larger sample size would be necessary for more details on the safety and efficacy of the Gore-Tex suture in IOL scleral fixation.

Scleral-fixated intraocular lens implantation with “irregular, knotless, zigzag-shaped scleral tunnel suture technique” combined with pars plana vitrectomy or anterior vitrectomy

Abstract: PURPOSE: This study aims to introduce a new suture method and report surgical outcomes of patients who underwent scleral-fixated intraocular lens (SF-IOL) implantation combined with either pars plana vitrectomy (PPV) or anterior vitrectomy (AV). METHODS: Twenty-three eyes performed SF-IOL implantation combined with PPV (Group 1), and 34 eyes performed SF-IOL implantation combined with AV (Group 2) were included in the study prospectively. The SF-IOL, either polymethyl methacrylate or foldable IOL, was sutured into the sclera using PC-9 sutures in an irregular, knotless, and zigzag-shaped manner. The scleral tunnel was approximately 12-15 mm long, with at least four sharp edges. Suture tips were trimmed within the scleral tunnel. Postoperative outcomes and complications were evaluated. RESULTS: Both groups showed no complications such as suture tip expulsion, suture reaction, IOL dislocation, or increased intraocular pressure during postoperative visits. Group 1 exhibited a statistically significant improvement in visual acuity compared to preoperative values (P = 0.036 for the 1st month, &lt;0.001 for the 3rd month). Similarly, Group 2 demonstrated a statistically significant improvement in visual acuity compared to the preoperative period (P = 0.001 for the 1st month, &lt;0.001 for the 3rd month). CONCLUSION: The “irregular, knotless, and zigzag-shaped scleral tunnel suture technique” yielded favorable results in terms of IOL stability and visual acuity. This technique can be safely employed in patients undergoing SF-IOL implantation combined with PPV or AV.

Severe Spontaneous Tilt of Scleral-Fixated Intraocular Lenses

Purpose: To report and evaluate a multicenter series of 18 cases of severe, spontaneous IOL tilt involving the flanged intrascleral haptic fixation technique (FISHF). Design: Clinical study with historical controls Methods: We report a cross-sectional study of 46 FISHF cases using the CT Lucia 602 IOL at a single academic center over a period of 24 weeks to determine the incidence of severe rotisserie-style rotational tilt. These rates were then compared with the same time-frame the prior year to help determine if this is a new phenomenon. Additional cases of severe tilt were solicited from another four academic centers. Results: Among 46 FISHF cases at a single center, five developed severe tilt. No clear pattern in surgical technique, ocular history or ocular anatomy was evident in these cases compared with controls, although the involved IOLs clustered within a narrow diopter range, indicative of a batch effect. In the same 24-week interval the year before, 33 FISHF cases were performed, none of which exhibited severe rotational tilt. In our multi-center dataset, 18 cases of tilt were identified. Surgeons included fellow and early-career physicians as well as surgeons with multiple years of experience with the Yamane technique. A variety of surgical approaches for FISHF were represented. In at least eight of the cases, haptic rotation and/or dehiscence at the optic-haptic junction was documented. Conclusions: The identification of haptic rotation and dehiscence intraoperatively in several cases may reflect a new stability issue involving the optic-haptic junction.

Clinical outcome in patients with 4- point scleral fixated intraocular lens: Our experience

Visual rehabilitation following cataract surgery with compromised capsular bag includes various options like anterior chamber (ACIOL), fixation to the iris (Iris claw IOL), or fixation to the sclera (SFIOL), as a primary or secondary procedure. We studied the clinical outcome in patients who underwent 4- point fixation of SFIOLs. Retrospective data analysis of fourteen patients who underwent sclera fixated intraocular lens implantation from 2016 to 2018 at our institute under standard operative conditions was done. The postoperative vision by three months ranged from LogMAR 1.0 – 0.2, out of fourteen patients, BCVA in 60 % of the patients ranged from LogMAR 0.3-0.2 which was maintained at six months follow up with minimal complications. 4- point fixation of scleral fixated IOL is a good option with favourable outcome, in aphakics who are not ideal candidates for iris claw lens.