Scleral-fixated Posterior Chamber Intraocular Lens Research Articles

Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis.

To evaluate the effect of lens surgery on health-related quality of life (HRQoL) of preschool children with congenital ectopia lentis (CEL). A prospective self-controlled study was conducted in Zhongshan Ophthalmic Center. Children aged from 5 to 7y whom were diagnosed with CEL and underwent phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation and their parents were enrolled in this study. All of them completed the child and proxy (parental) PedsQL™ 4.0 before and after the surgery. Their preoperative scores were compared to their postoperative ones. Subgroup analyses were performed based on gender and preoperative bilateral presenting visual acuity of the children. Thirty-two children with CEL successfully underwent surgery without any complications, among whom 8 had monocular surgery and 24 had binocular surgery. Preoperative and postoperative questionnaires were completed by 32 child-parent pairs. Surgical intervention could significantly improve the vision of affected children (P<0.001). The medians of physical, psychosocial and total health scores self-reported by the children were 68.75 (62.50, 81.25), 65.00 (60.00, 80.00) and 67.39 (60.87, 78.26) preoperatively and were 93.75 (87.50, 100.00), 90.00 (83.33, 96.67) and 89.13 (85.32, 95.65) postoperatively. The preoperative scores of the affected children were significantly lower in all scales than age-matched healthy children (P<0.001). All the postoperative scores were significantly higher than the preoperative scores in affected children and their parents (P<0.001). In the physical functioning evaluation, the preoperative score reported by parents of girls was higher than parents of boys (P=0.041), and the postoperative score of girls was higher than that of boys (P=0.036). CEL is associated with significantly worse quality of life in preschool children. Surgical intervention can significantly improve the HRQoL in affected children from both personal and family perspective.

A novel ADAMTSL4 compound heterozygous mutation in isolated ectopia lentis: a case report and review of the literature

BackgroundCongenital ectopia lentis is characterized by dislocation of the lens caused by partial or complete abnormalities in the zonular fibers. It can be caused by either systemic diseases or isolated ocular diseases. Gene detection techniques can provide valuable information when an etiological diagnosis is challenging. Herein, we report the case of a six-year-old girl with a confirmed diagnosis of isolated ectopia lentis caused by a compound heterozygous ADAMTSL4 gene mutation.Case presentationThe patient was a 6-year-old Chinese Han girl with strabismus in the right eye. Slit lamp examination revealed that the lens in the right eye was opacified and dislocated, without an ectopic pupil. Gene detection demonstrated the presence of a compound heterozygous mutation in the ADAMTSL4 gene [c. 2270dupG (p.Gly758Trpfs *59) and c. 2110A > G (p.Ser704Gly)], and the diagnosis of isolated ectopia lentis was confirmed. She underwent lens extraction, and a sutured scleral-fixated posterior chamber intraocular lens (IOL) was placed in the right eye. The best-corrected visual acuity was 0.1 one month postoperatively.ConclusionGene detection plays a crucial role in diagnosing disorders with similar symptoms, such as isolated ectopia lentis and Marfan syndrome. In this study, we used whole exons sequencing to diagnose isolated ectopia lentis and identified the variant c.2110A > G (p.Ser704Gly), which may be associated with the development of ectopia lentis and early-onset cataract in the patient. These pathogenic gene mutations have significant implications for the genetic diagnosis of congenital ectopia lentis, treatment, surveillance, and hereditary and prenatal counseling for the patient and their family members.

Evolution of Scleral Fixation, Haptic Externalization and Tucking Techniques

Phakic rehabilitation poses challenges for patients without capsular support, making traditional intraocular lens (IOL) implantation difficult. In such cases, an Anterior Chamber (AC) IOL or a scleral-fixated posterior chamber IOL (SF-PC IOL) can be considered as options. To ensure a well-centered IOL, haptics should be away from the ciliary processes, iris, and oraserrata, with sufficient distance from the iris to prevent capture. Delayed IOL dislocation can occur due to suture breakage, but it can be prevented by proper IOL size and snugly opposing the stitched haptics into the ciliary sulcus.

Primary scleral-fixated posterior chamber intraocular lenses in patients with congenital lens subluxation

ObjectiveWe investigated the long-term visual outcomes and ocular complications of primary scleral-fixated posterior chamber intraocular lenses (SF-PC-IOLs) in patients with congenital lens subluxation.MethodsWe enrolled 53 patients (77 eyes) with congenital lens subluxation caused by ectopia lentis, Marfan syndrome, and Weill–Marchesani syndrome who underwent primary implantation of a SF-PC-IOL. All patients underwent a complete ophthalmic examination include visual acuity (VA), intraocular pressure (IOP), intraocular lenses (IOL) position, intraoperative complications and postoperative complications. Cox regression analysis and survival analysis were used to evaluate the risk factors for postoperative complications.ResultsSeventy seven eyes from 53 patients were included. Mean age at surgery was 23 ± 20 years (5 to 67 years), with a mean follow-up of 39 ± 27 months (12 to 130 months). The best-corrected VA improved from 0.84 ± 0.55 to 0.26 ± 0.43 logarithms of the minimum angle of resolution (p < 0.001). Best-corrected VA improved postoperatively in 73 eyes (94%). The main causes of reduced vision after surgery were retinal pathologies and amblyopia. Complications included transient intraocular haemorrhage (2 eyes, 2.6%), early vitreous incarceration (2 eyes, 2.6%), retinal detachment (6 eyes, 7.8%) and IOL dislocation (3 eyes, 3.9%). Cox regression showed that postoperative eye trauma was a risk factor for long-term postoperative complications.ConclusionSF-PC-IOLs provide good visual outcomes in patients with congenital lens subluxation. The SF-PC-IOLs showed good stability, except in patients suffering from postsurgical eye trauma.

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.

Efficacy and safety of glue assisted suture less trans-scleral fixation of posterior chamber intraocular lens (SF- PCIOL)

Context: Scleral-fixated posterior chamber lens implantation (SF-PCIOL) in eyes without sufficient capsular support remains a widely applied surgical procedure. Suture - less scleral IOL fixation, Is a new technique in which PC IOL is placed in eyes with deficient posterior capsule and the haptics are incarcerated in the scleral pocket which is sealed with quick-acting fibrin glue. Aims and Objectives: To evaluate the efficacy and feasibility of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation method in post cataract surgery. Material and Methods: The study includes 10 Patients presented with inadequate capsular support who underwent Glue assisted SF-PCIOL over a time period of 12 months at a tertiary care eye hospital. Statistical analysis was done on Microsoft excel. Results:In present study of ten eyes the final postoperative BCVA at 3rd month was improved or remained same in nine (90 %) patients and only one patient had reduced BCVA. Conclusion: Lots of complications are encountered with the use of sutures in the operative procedures; bio-adhesives fibrin glue have emerged as a viable alternative for glue assisted suture less transscleral fixation of posterior chamber intraocular lens (SF- PCIOL), over the last three decades. Keywords:Scleral-Fixated Posterior Chamber IOL (SF-PCIOL), haptics, Fibrin glue, Best Corrected Visual Acuity (BCVA)

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

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

Combined Intracapsular Lens Removal and Scleral Fixation of Intraocular Lenses Through the Same Scleral Tunnel in Cases with Severely Dislocated Lenses.

Objectives:The management of severely dislocated lenses floating in the anterior vitreous is challenging. This study describes the clinical outcome of a surgical approach with intracapsular lens extraction (ICCE) and implantation of a scleral-fixated posterior chamber intraocular lens (SF-IOL) at the same surgical session.Methods:Records of patients who had severely dislocated lenses were retrospectively reviewed. All included patients had undergone ICCE, followed by implantation of an SF-IOL during the same surgical session through the same scleral tunnel placed 1.5 mm posterior to the limbus. Clinical characteristics of the patients were collected, and surgical videos were watched again to review intraoperative complications.Results:Thirty eyes of 30 patients (mean age, 68±11.1 years, 23 male, 7 female) were included in the study. Twenty-five patients had a history of blunt trauma, and five patients had pseudoexfoliation syndrome. The best-corrected visual acuity of the patient improved significantly after the procedure (p=0.001). The intraocular pressure of the patients remained unchanged (p=0.38). Three patients developed mild IOL dislocation that did not require any intervention. A patient developed transient hypotony, and another developed mild vitreous hemorrhage. These complications improved spontaneously without the need for further intervention.Conclusion:Simultaneous removal of dislocated lens and SF-IOL implantation through the same scleral tunnel was a safe and effective procedure for patients with severely dislocated IOLs.

Outcomes of Using Sutureless, Scleral-Fixated Posterior Chamber Intraocular Lenses

ABSTRACTBackground. Implantation of sutureless, scleral-fixated posterior chamber intraocular lenses (SSFIOL) is a promising option in the surgical management of patients unable to undergo standard cataract surgery due to insufficient capsular support. The purpose of this study was to describe the indications, visual outcomes and complications of SSFIOL implantation.Methods. Retrospective, investigational cohort study of 112 consecutive SSFIOL implantations between July 2013 and August 2017. Pre-operative ocular morbidity, operative indications, postoperative outcomes, complications, and reinterventions were summarized. Visual and refractive outcomes were compared between the pre- and latest postoperative visit using Wilcoxon signed-ranked test.Results. Mean follow-up: 13.0 ± 10.4 months. Primary surgical indication was dislocated IOL due to zonular weakness (77 eyes (68.8%)). At latest follow-up, there was improvement in uncorrected visual acuity (1.3 ± 0.8 to 0.64 ± 0.60 logMAR, p < .01), best-corrected visual acuity (BCVA) (0.6 ± 0.5 logMAR to 0.36 ± 0.40 logMAR, p < .01). Postoperative complications included transient IOP elevation >30 mmHg (26.8%), cystoid macular edema (CME) (14.3%), transient hypotony (13.4%), iris capture (12.5%), uveitis-glaucoma-hyphema (UGH) syndrome (11.6%), vitreous hemorrhage (VH) (6.3%). Operative reinterventions included SSFIOL exchange (3.6%), SSFIOL repositioning (5.4%), SSFIOL removal (2.7%). Ten (8.9%) patients required multiple re-interventions.Conclusion. SSFIOL implantation is a reasonable option for eyes with inadequate capsular support, resulting in visual improvement in most patients. Many of the surgical complications were related to a floppy iris-lens diaphragm (UGH syndrome, iris capture), which were predisposed in eyes with complex pathology. Surgical modifications can be made to minimize the iris-related complications.

PARS PLANA VITRECTOMY WITH ANTERIOR CHAMBER VERSUS GORE-TEX SUTURED POSTERIOR CHAMBER INTRAOCULAR LENS PLACEMENT: Long-Term Outcomes.

To compare clinical outcomes of combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) placement versus scleral fixation of a posterior chamber intraocular lens (PCIOL) using Gore-Tex suture. Retrospective, interventional case series of eyes undergoing combined PPV and IOL placement for retained lens material, aphakia, or dislocated IOL. Eyes with history of amblyopia, corneal opacity, retinal, or optic nerve disease were excluded. Outcome measures were change in visual acuity and occurrence of postoperative complications with minimum follow-up of 1 year. Sixty-three eyes of 60 patients were identified. Thirty-three eyes underwent combined PPV and ACIOL placement and 30 eyes underwent combined PPV and scleral fixation of a PCIOL using Gore-Tex suture. Mean follow-up was 502 ± 165 days (median 450, range 365-1,095 days). In the ACIOL group, mean visual acuity improved from 20/914 preoperatively to 20/50 postoperatively (P < 0.001). In the scleral-fixated PCIOL group, mean visual acuity improved from 20/677 preoperatively to 20/46 postoperatively (P < 0.001). No difference in visual acuity was noted between groups at 1-year (P = 0.91) or final follow-up (P = 0.62). Regarding postoperative complications, eyes undergoing ACIOL placement had a significantly higher rate of transient corneal edema (30.3 vs. 6.7%, P = 0.02) compared with eyes undergoing scleral fixation of a PCIOL. Combined PPV with ACIOL placement or scleral fixation of a PCIOL with Gore-Tex suture were well tolerated. The techniques resulted in similar visual outcomes at minimum follow-up of 1 year.

Cyst Masquerading as Inadvertent Bleb After a Scleral-Fixated Intraocular Lens in Marfan Syndrome: A Case Report.

IntroductionTo present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome.Case ReportA woman with Marfan syndrome presented with a subluxed crystalline lens in her right eye, which progressively subluxed over the following 2 years. A lensectomy was performed with placement of an anterior chamber intraocular lens (IOL); however, the patient experienced blurred vision and photopsias and preferred IOL explantation. The IOL was removed and a scleral-fixated posterior chamber IOL was placed. Vision improved with an uncomplicated postoperative course. Five months later, the patient experienced sudden onset redness and sharp pain in this eye. A 3-mm cystic lesion with tan material was found over a prior scleral incision site. Intraocular pressure was normal and no aqueous leaked from the lesion. Owing to concerns of an infected inadvertent bleb, treatment with topical and oral antibiotics was started, but the lesion did not change in appearance and the patient experienced persistent pain. The lesion was surgically excised and histopathology revealed a conjunctival epithelial inclusion cyst with intralesional keratin. A month later, another conjunctival inclusion cyst developed and was excised per patient preference.ConclusionMarfan syndrome is characterized by defects in the FBN1 gene and may theoretically lead to an abnormal sclera, increasing the risk of bleb formation after scleral incision. Distinguishing between a filtering bleb and an epithelial inclusion cyst is critical in patient care. Although retained keratin from a cyst may mimic a bleb with purulence, intraocular pressure, aqueous leakage, and response to topical antibiotics may help distinguish between the two.

Long-term Outcome of Pars Plana Vitrectomy and Sutured Scleral-Fixated Posterior Chamber Intraocular Lens Implantation or Repositioning

To assess the long-term stability of sutured scleral-fixated posterior chamber intraocular lenses (PCIOLs) performed in combination with pars plana vitrectomy. Retrospective, consecutive, interventional case series. Retrospective single-surgeon study of 118 eyes of 111 patients seen at Retina Consultants of Hawaii, who underwent sutured scleral fixation of at least 1 haptic of a posterior chamber intraocular lens with 10-0 polypropylene combined with a pars plana vitrectomy. The fixation knot-tying technique required 2 separate 10-0 polypropylene sutures tied into 1 combined knot-1 suture closed the fixation sclerotomy and created the scleral fixation, and 1 suture looped together around the haptic of the PCIOL, securing the haptic to the scleral fixation site. The primary outcomes were position of the PCIOL at last follow-up, dislocation of either 1 or both haptics of the PCIOL, and breakage of the 10-0 polypropylene fixation suture. PCIOLs remained well stabilized and positioned at last follow-up in 116 of 118 eyes (98.3%), with a mean follow-up of 6.0 years. The maximum stable follow-up with 2 intact fixation sutures was 24.75 years. There were 4 cases of redislocation (3.4%), but 2 cases were owing to unstable residual capsular support. There was 1 case of suture breakage in 214 fixation sutures (0.47%) and 1 case of haptic breakage. Scleral fixation sutures with 10-0 polypropylene provide excellent long-term fixation of PCIOLs, with a less than 0.5% incidence of suture breakage and documented suture stability for up to 24+ years.

Long-term outcome of scleral-fixated posterior chamber intraocular lens implantation with the knotless Z-suture technique

To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. University Eye Hospital, Tübingen, Germany. Retrospective case series. Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3years were reviewed. Sixty-six eyes of 62 patients were included. The meanpreoperative corrected distance visual acuity (CDVA) was0.71 logarithm of the minimum angle of resolution (logMAR)±0.58 (SD). The mean CDVA was 0.67±0.54 logMAR (P=.257; n=66) after 3years, 0.73±0.55 logMAR (P=.399; n=60) after 5years, 0.8±0.68 logMAR (P=.348; n=30) after 8years, and 1.09±0.76 logMAR (P=.069; n=13) after 10years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P=.049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture.

Late dislocation of in-the-bag intraocular lenses in uveitic eyes: An analysis of management and complications.

Aim:An analysis of late in-the-bag dislocation of intraocular lenses (IOL), in uveitic eyes.Setting:Referral uveitis clinic.Design:Retrospective case series.Materials and Methods:All case records of eyes with chronic uveitis that had phacoemulsification with IOL implantation, at a referral uveitis clinic between February 1997 and January 2015 were retrieved and analyzed. Only those eyes with no documented intraoperative complication and no predisposing risks to IOL dislocation, such as pseudoexfoliation, high myopia, trauma, and prior VR surgery were included in this study.Results:A total of 581 eyes with chronic uveitis underwent phacoemulsification with IOL implantation under steroid cover from February 1997 to December 2015. Out of these 581 eyes, 10 patients (11 eyes) had experienced late in-the-bag IOL dislocation (1.89%). All 11 eyes had chronic intermediate uveitis. The mean duration from the time of cataract surgery to IOL dislocation was 11.24 years. 5 out of 11 eyes had pars plana vitrectomy (PPV) with IOL removal with 4-point sutured scleral fixated IOL. Two out of 11 eyes had PPV with in-the-bag IOL re-fixation. Out of 11, 2 eyes had PPV with IOL removal only. Remaining 2 eyes of 2 patients did not opt for surgery. Out of 11, 8 eyes had improved vision at last follow-up.Conclusions:In-the-bag dislocation of IOL is a rare late complication in uveitic eyes. With tight perioperative inflammatory control, scleral-fixated posterior chamber intraocular lens or IOL re-fixation are good options of restoring vision in these high-risk eyes.

Use of the anterior chamber maintainer in secondary scleral-fixated posterior chamber intraocular lens implantation for aphakia after traumatic surgery

Objective To evaluate the effect and safety of secondary scleral-fixated posterior chamber intraocular lens (PCIOL) implantation using an anterior chamber maintainer for aphakia after traumatic surgery. Methods Thirty-four eyes of 34 cases with aphakia after traumatic surgery were subjected to scleral-fixated PCIOL using an anterior chamber maintainer. The clinical effect and the complications were observed 3 months to 18 months after the operation. Results All operations were performed successfully. There was no complication such as epichoroidal hemorrhage, anterior chamber collapse or intraocular lens dislocation. After 3-18 months follow-up, visual acuity was at ≤0.1 in 3 eyes, 0.12~0.3 in 11 eyes, 0.4~0.5 in 7 eyes and ≥0.6 in 10 eyes. The difference between post-and pre-operative best corrected visual acuity was not statistically significant (P>0.05). Conclusion Secondary scleral-fixated PCIOL implantation using an anterior chamber maintainer is effective to correct aphakia after trauma and provides favorable visual outcomes with low complication rate. Key words: Maintainer, anterior chamber; Lens, intraocular; Aphakia, traumatic

Practice patterns of cataract surgeons at academic medical centers for the management of inadequate capsule support for intracapsular or sulcus intraocular lens placement during cataract surgery

To determine practice patterns with regard to intraocular lens (IOL) placement during cataract surgery when there is inadequate capsule support for intracapsular or sulcus IOL placement. Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA. Cross-sectional study of anonymous survey results. An online survey was e-mailed to the coordinators of all Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs with a request to forward to all faculty who perform cataract surgery. Sixty-seven (57.2%) of 117 confirmed survey recipients participated. Thirty-six (62.1%) said they felt comfortable placing scleral-fixated posterior chamber IOLs (PC IOLs) independently. Faced with inadequate capsule support, 58.6% would place a primary anterior chamber IOL (AC IOL), 29.3% would place a primary scleral-fixated PC IOL, and 5.3% would leave the patient aphakic for secondary scleral-fixated PC IOL placement. Surgeons not comfortable placing scleral-fixated PC IOLs were most likely to choose primary AC IOLs (77.3%). Surgeons comfortable placing scleral-fixated PC IOLs were more evenly divided between primary AC IOLs (47.2%) and scleral-fixated PC IOLs (41.7%). Among surgeons who favored primary scleral-fixated PC IOLs, 63.7% cited a decreased risk for long-term complications as their reason for IOL choice; 50.0% of surgeons who favored primary AC IOLs cited avoidance of a second surgery. In general, primary AC IOL placement was preferred in the setting of inadequate capsule support, although less so among surgeons who were comfortable placing scleral-fixated PC IOLs. Lack of comfort with scleral-fixated PC IOL placement suggests a potential unmet training need in residency and fellowship programs. No author has a financial or proprietary interest in any material or method mentioned.

The efficacy of lens removal plus IOL implantation for the treatment of spherophakia with secondary glaucoma

AimsTo evaluate the efficacy of lens removal plus intraocular lens (IOL) implantation for spherophakia with secondary glaucoma.MethodsA series of 19 patients (n=24 eyes) were split into two groups according to...

New Management Strategies for Ectopia Lentis

Ectopia lentis refers to displacement of the crystalline lens in the setting of various systemic and metabolic disorders. A literature review was conducted to investigate the management of non-traumatic ectopia lentis in the pediatric population, particularly focusing on surgical intervention. Both limbal and pars plana approaches for lensectomy are well established in the literature. Surgical options for intraocular lens implantation in pediatric eyes with ectopia lentis include anterior chamber intraocular lenses and iris-fixated or scleral-fixated posterior chamber intraocular lenses. Recently, the use of capsular tension rings has also been described with promising results. Visual rehabilitation and treatment of amblyopia are essential for patients within the amblyogenic age group following surgical intervention.

Preoperative Evaluation of Cases with Aphakia and Intraocular Lens Dislocation by Ultrasound Biomicroscopy

The purpose of this study is to evaluate the capabilities of ultrasound biomicroscopy (UBM) as a diagnostic method for surgical planning of secondary intraocular lens (IOL) implantation in aphakia and intraocular lens dislocation. In this retrospective study, 19 eyes of 19 patients with aphakia and IOL dislocation that was not possible to evaluate by biomicroscopy because of the causes like corneal edema, opacity, anterior chamber reaction, ectopic pupil or poor pupil dilatation following cataract surgery were included. Ultrasound biomicroscopy was performed preoperatively to determine the capsule integrity, degree of ciliary sulcus support and iridocapsular adhesions. Seven patients with aphakia and 12 patients with posterior chamber IOL following cataract surgery were studied. Ultrasound biomicroscopy revealed that 4 of 7 eyes with aphakia had adequate capsule integrity (two eyes also had iridocapsular adhesions) and ciliary sulcus support, and 3 eyes had inadequate capsular remnant. Sulcus-supported posterior chamber IOLs were implanted in 4 eyes, and scleral-fixated posterior chamber IOLs were implanted in 3 eyes. Ultrasound biomicroscopy showed that 4 of 12 eyes with IOL dislocation had adequate capsule remnant, and there was no adequate capsular remnant and ciliary sulcus support in 8 eyes. IOL reposition or IOL exchange were performed in 4 eyes and IOL exchange and scleral-fixated posterior chamber IOLs implantation or scleral fixation of dislocated IOLs were performed in 8 eyes. In conclusion, ultrasound biomicroscopy helps the surgeon to select the appropriate surgical protocol by determining the capsule integrity, implant bed and iridocapsular adhesions preoperatively. It is also useful to choose the IOL model and its fixation type.

Observation of two types of foldable scleral-fixated posterior chamber intraocular lens to treat cataract dislocation

Observation of two types of foldable scleral-fixated posterior chamber intraocular lens to treat cataract dislocation