Scleral Fixation Research Articles

Case Report: Yamane Fixation of a Light Adjustable Lens in a Patient with Marfan Syndrome

This paper aims to discuss a case of a Light Adjustable Lens (LAL) implanted with the Yamane technique in a Marfan patient undergoing complex cataract surgery. A 60-year-old female with a history of Marfan syndrome presented in May 2020 with complaint of worsening vision due to bilateral subluxed cataracts. Bilateral LALs were planned to be implanted in the capsular bag with scleral fixated Ahmed segments using 5-0 prolene due to zonular instability. The procedure was complicated by an anterior capsular tear at 6 O’clock due to a very friable capsular bag. This tear extended posteriorly with no vitreous loss. Given inadequate capsular support, the decision was then made to scleral fixate the LAL using a Yamane technique. The first attempt at scleral fixation resulted in the LAL haptic breaking off into the 27G needle during the scleral pass. The LAL with remaining haptic was cut in half and explanted. A new LAL was successfully fixated with the Yamane technique. A scleral fixated Ahmed segments using 5-0 prolene was done successfully for the right eye. Final adjustment and locking occurred 10 weeks after right eye procedure. The final refraction of the right eye was measured to be plano, + 0.5 cyl, 85 axis with uncorrected distance visual acuity of 20/20 and corrected distance visual acuity of 20/20. The final refraction of the left eye was measured to be -2.75 D, 0 cyl, 0 axis with uncorrected distance visual acuity of 20/200, uncorrected near visual acuity of J1+ and corrected distance visual acuity of 20/20. When choosing a lens to Yamane, LALs are uniquely capable of correcting a residual refractive error without an additional surgery. LALs are an excellent option for patients that desire a refractive outcome with limited or no capsular support.

Предварительные результаты превентивной фланцевой склерокорнеальной монофиксации комплекса внутрикапсульное кольцо – интраокулярная линза в хирургии катаракты при подвывихе хрусталика

Pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery and is associated with possible intra- and postoperative complications. To prevent further dislocation of the intraocular lens (IOL) in the postoperative period, IOL suturing with polypropylene thread is used for one or both supporting elements to the iris, or with sclerocorneal or scleral fixation. Purpose. Development of preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree and evaluation of its effectiveness. Material and methods. Preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree was performed in 15 patients aged 74.4 ± 11.4 years. The lens was fixed by the edge of the capsulorexis with four iris retractors, an intracapsular ring of the SK-2 type (Reper, Russia) was implanted into the capsule bag, an 8/0 polypropylene monofilament was attached to the inner curl of which, the second end of the thread was ab interno transclerally-transcorneally with the formation of a flange, the IOL was implanted into the capsule bag. Results. In all cases, the capsule bag was preserved and intra-capsule implantation of the IOL was performed. Complications during operations and in the postoperative period were not received in any case. The maximum corrected visual acuity (MCVA) during treatment rose from 0.2 ± 0.15 to 0.85 ± 0.14 6 months after surgery (p < 0.01; t-criterion). The loss of endothelial cells 3 months after surgery was 8,9 ± 1,4%. Conclusions. The use of preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree made it possible to preserve the capsular bag in all patients and perform the most physiological intracapsular implantation of IOL. Keywords: cataract, lens subluxation, phacoemulsification, intraocular lens.

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.

Four-flanged polypropylene optic piercing technique for scleral fixation of multifocal intraocular lens

BackgroundTo evaluate the feasibility of creating flanges using an optic piercing technique with a 6 − 0 polypropylene monofilament for scleral fixation of dislocated one-piece diffractive multifocal intraocular lenses (IOLs).Study DesignExperimental study and case series.SubjectsOptical bench test and eyes with IOL dislocation.MethodsTwo separate 6 − 0 polypropylenes were penetrated twice at the opposite peripheral optic of the TECNIS Synergy IOL (Johnson & Johnson Vision). The root mean square of the modulation transfer function (MTFRMS), at between + 1.00 and − 4.00 D of defocus, was measured in the TECNIS Synergy IOL both with and without optic piercing in the optical bench study. This case series included three eyes from two patients who underwent scleral-fixation of multifocal IOLs using the four-flanged polypropylene optic piercing technique. The postoperative corrected distance visual acuity (CDVA) at 4 m, the uncorrected near visual acuity (UNVA) at 40 cm, and IOL centration were evaluated.ResultsThe optical bench test showed no differences in MTFRMS values measured in the TECNIS Synergy IOL, either with or without optic piercing at all defocuses. In all three case series, the postoperative CDVA at 4 m was 20/20 and UNVA at 40 cm was J1. Postoperative anterior segment photographs showed good centration of IOLs in all cases.ConclusionThe four-flanged polypropylene optic piercing technique for multifocal IOL scleral fixation can provide excellent clinical outcomes and IOL stability after surgery without diminishing the performance of the multifocal IOLs.

Supporting suture combined scleral fixation of toric IOL implantation in traumatic aniridia, aphakia and corneal astigmatic eye: a case report.

Supporting suture combined scleral fixation of toric IOL implantation in traumatic aniridia, aphakia and corneal astigmatic eye: a case report.

Four-flanged Technique for Scleral Fixation of a Dislocated Four-eyelet Intraocular Lens

Purpose: To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL).Methods: Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications.Results: The BCVA was 0.25 ± 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 ± 0.12 logMAR 6 months later (<i>p</i> < 0.001). The corneal endothelial cell count was 2,427 ± 384 and 2,367 ± 298/mm<sup>2</sup> before and after surgery, respectively (<i>p</i> = 0.285). The spherical equivalent was 6.02 ± 4.90 and 0.11 ± 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 ± 1.68° and 0.23 ± 0.09 mm, respectively. The refractive difference was 0.11 ± 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation.Conclusions: The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL.

Laser Photo-Cauterization for the Management of Exposed Polypropylene Scleral Fixation Sutures.

Laser Photo-Cauterization for the Management of Exposed Polypropylene Scleral Fixation Sutures.

Aniridic scleral fixation of intraocular lens: The answer to vision loss with photophobia!

Aniridia is defined as missing iris tissue which can be partial, subtotal, or total. Characteristic clinical symptoms include photophobia and decreased visual acuity due to an increased light perception. In addition to this, disturbing cosmetic problems are prevalent. Even after implantation of an intraocular lens, patients often tend to be unsatisfied. The answer to this problem lies in the implantation of an aniridic scleral fixation of intraocular lens (SFIOL), which has a central optical axis that acts as the refractive lens and a peripheral rim of a hyperpigmented area that mimics the iris and hence reduces photophobia. The purpose of the video was to demonstrate the use of black diaphragm intraocular lens (BDIOL) implantation, its surgical steps, and its outcomes. We report one such case where a young patient presented with post-traumatic aniridia with subluxated total cataract and spillover vitreous hemorrhage. He was subjected to a vitrectomy, cataract removal, and placement of an aniridic SFIOL with prolene 9-0 using the four-point fixation method. This gave an extremely gratifying outcome and solved both problems, that is, vision and photophobia. Highlight: Before implantation of the SFIOL, the patients had reduced visual acuity from aphakia and intolerable glare from aniridia. In this case-based approach and with relevant example, we tried to provide a solution for tricky scenarios like co-existing traumatic cataract and traumatic aniridia. The patient showed improved visual acuity and marked glare reduction after black diaphragm SFIOL implantation. https://youtu.be/atl60WetFsM.

Scleral flaps, pars plana vitrectomy and gore-tex sutured posterior chamber intraocular lens placement: a case series and review of literature.

Cataract surgery is one of the most common surgical procedures performed worldwide. Intraocular lens (IOL) implants are placed routinely in the capsular bag after successful cataract extraction. However, in the absence of adequate capsular support, IOL may be placed in the anterior chamber, fixated to the iris or fixated to the sclera. The purpose of this study is to report the clinical outcomes and safety profile of a trans-scleral sutured intraocular lens (IOL) technique using scleral flaps, vitrectomy, and Gore-Tex suture to place posterior chamber IOL. Retrospective, interventional case series of eyes undergoing scleral fixation of an IOL using Gore-Tex suture with concurrent vitrectomy. Ocular examination with the logarithm of the minimum angle of resolution visual acuity (logMAR BCVA), tonometry, and slit-lamp biomicroscopy was performed on all patients at 1, 3, 6, and 12 months after the operation. All post-operative complications were recorded. Twenty-five eyes of 25 patients were included. Mean logMAR BCVA improved from 0.43 ± 0.36 (20\40 Snellen equivalent) preoperatively to 0.13 ± 0.18 (20\25 Snellen equivalent) postoperatively at 12 months (p<0.01). Indications included surgical aphakia (16) and dislocated lens implant (9). No cases of IOL opacification, suprachoroidal haemorrhage, post-operative endophthalmitis, IOL dislocation, Gore-Tex exposure, or retinal detachment were observed during the follow-up period. Ab externo scleral fixation of IOLs with Gore-Tex suture plus scleral flap is well tolerated and associated with a very low rate of suture exposition. Moreover, our study confirms excellent refractive outcomes after surgery.

Quaternary Knot Technique: Suture Knot Burial without Scleral Flap or Incision for Trans-scleral Fixation.

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted scleral fixation. If the scleral fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

A Novel Technique for Scleral Fixation of an Intraocular Telescopic Device

A Novel Technique for Scleral Fixation of an Intraocular Telescopic Device

Modified Rectangular Loop Suture for Refractory Pupillary Optic Capture of Scleral Fixated Intraocular Lens

Purpose: To report a modified rectangular loop suture technique for patients with refractory pupillary optic capture after intraocular lens scleral fixation.Methods: A modified rectangular loop suture was performed in four patients with persistent pupillary capture despite medication and laser iridotomy. A loop suture pattern was designed in the two quadrants without the scleral fixation knot. A 2 mm loop suture point was marked 2 mm away from the corneal limbus. The suture point was similarly marked in the opposite quadrants. Small conjunctival incisions were made at a marked point and a non-absorbable 10-0 prolene long needle was passed. The needle was inserted at the 1 o’clock position through the conjunctival incision and passed between the intraocular lens and the iris plane. Then it was withdrawn using a 26-gauge (G) syringe from the 8 o’clock position in the opposite quadrant. Similarly, the needle was passed from the 7 o’clock position under the conjunctiva, and pulled out of the sclera at the 2 o’clock position. It was then passed to the 1 o’clock position under the conjunctiva and a knot was made and buried. The operation was completed without closure of the conjunctival incision.Results: In all four eyes, pupillary optic capture was corrected and remained stable without recurrence for an average of 7.25 months.Conclusions: The modified rectangular loop suture may be useful for refractory pupillary capture cases. The procedure is relatively simple and minimizes scleral exposure to the conjunctival suture. It is expected that this may reduce patient discomfort.

Aetiology and Management of IOL Dislocations.

Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.

Scleral fixation of a novel modified, injected canine intraocular lens by haptic capture, in 17 dogs.

The aims of lens removal surgery are to re-establish or preserve both a clear visual axis and emmetropic vision. Trans-scleral intraocular lens (IOL) fixation has been described in cases where lens capsule instability precludes the insertion of a prosthetic intraocular lens into the lens capsule. Previous techniques have necessitated enlargement of the corneal incision to accommodate either a rigid polymethylmethacrylate IOL or an acrylic foldable IOL inserted using forceps. This paper reports the modification of an endocapsular IOL to be used as an injectable suture-fixated IOL introduced through a 2.8 mm corneal incision. All cases underwent lens extraction by phacoemulsification followed by removal of the unstable lens capsule. A PFI X4 IOL (Medicontur) was modified to create four open-loop haptics. The IOL was injected into the anterior chamber, each haptic was captured in a loop of suture introduced ab externo, and the lens was sutured with four-point fixation. The results from 20 eyes in 17 dogs are reported. Over an average follow-up time of 14.5 months, vision was retained in 16/20 eyes. Vision was lost in four eyes due to corneal ulceration and ocular hypertension (1/20), retinal detachment (2/20), and Progressive Retinal Atrophy (1/20). The modified PFI X4 proved suitable for injection and scleral fixation through a 2.8 mm corneal incision, with a success rate comparable to previously published techniques.

4-Flanged intrascleral fixation of an intraocular lens through the dialing hole.

The high prevalence of mature, hypermature, and traumatic cataracts in developing countries, combined with the limited availability of surgical resources and skill by anterior segment surgeons to manage the resultant aphakia, leaves the patient needlessly blind. Relying on posterior segment surgeons, expensive surgical setup, and appropriate lenses for aphakia management limits the number of patients receiving a secondary intraocular lens (IOL). Utilizing the well-acknowledged flanging technique and the readily available polymethyl methacrylate (PMMA) lenses with dialing holes in their optic, a hammock can be created through the dialing holes using a 7-0 polypropylene suture on a straight needle. This 4-flanged scleral fixation through the dialing hole of an IOL makes scleral fixation of PMMA lens possible by even anterior segment surgeons without requiring any specialized equipment or scleral fixated lens with eyelet. This technique was successfully performed in a series of 103 cases with no incidence of IOL decentration.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Vacuum-assisted levitation of posteriorly dislocated cataract lens

Abstract We describe a technique that uses 23 G pars plana vitrectomy without using fragmatome or perfluorocarbon liquid to manage a posteriorly dislocated cataract lens. The vacuum of the vitrector is used to levitate the lens up to the iris plane and then it is delivered using a wire-Vectis through a sclerocorneal tunnel. Subsequently, scleral fixation of an intraocular lens is performed.

SCLERAL FIXATION OF CARLEVALE INTRAOCULAR LENS: A Systematic Review and Meta-Analysis.

The mean change in best-corrected visual acuity (BCVA), intraocular pressure, and endothelial cell counts after intraocular lens (IOL) implantation and the incidence rate of postoperative complications were estimated by systematic review and meta-analysis to assess the surgical and refractive outcomes of the sutureless scleral fixation Carlevale IOL. A literature search was conducted using PubMed, Embase, and Scopus. The weighted mean difference (WMD) was used to present the mean change in BCVA, intraocular pressure, and endothelial cell count after IOL implantation, whereas a proportional meta-analysis was used to estimate the pooled incidence rate of postoperative complications. In the meta-analysis of 13 studies involving 550 eyes, the pooled WMD of the mean change in BCVA showed a significant improvement in BCVA in patients who underwent Carlevale IOL implantation (WMD = 0.38, 95% confidence interval: 0.30-0.46, P < 0.001; heterogeneity [I 2 ] = 52.02%). The subgroup analyses indicated that the mean change in BCVA was not significantly higher according to the last follow-up visit, with no statistically significant subgroup effect ( P = 0.21) (WMD up to 6 months: 0.34, 95% confidence interval: 0.23-0.45, I 2 = 58.32%, WMD up to 24 months: 0.42, 95% confidence interval: 0.34-0.51, I 2 = 38.08%). In the meta-analysis of 16 studies involving 608 eyes, the pooled incidence rate of postoperative complications was equal to 0.22 (95% confidence interval: 0.13-0.32, I 2 = 84.87, P ≤ 0.001). Carlevale IOL implantation represents a reliable method of restoring vision in eyes with missing capsular or zonular support.

Preferred surgical techniques for secondary intraocular lens implantation in adults with aphakia.

To identify the current surgical management of aphakia and the outcomes and complications of each technique. This cross-sectional study included ophthalmic surgeons with at least one-year experience in surgery for aphakia. A study questionnaire was formulated to collect data in Saudi Arabia and other regional countries. The questionnaire included 22 questions on demographics, preferred surgical techniques, complications and the factors related to surgeon decision and the choice for managing aphakia. The study included 145 participants (111; 76.6% were males) with mean age of 46.7 ± 11.5years. The mean duration of cataract surgery experience was 17.6 ± 11.1years. Most participants (86.2%) were trained in cataract surgery. Scleral fixation of intraocular lens (SFIOL) was the most commonly preferred technique, followed by iris fixation IOL, and anterior chamber IOL (75.2%, 9%, and 15.9%, respectively). The main determinants for selection of a surgical technique were simplicity (56.6%), surgical instrument availability (48.3%), and training on the technique (47.6%). The most frequent postoperative complications were pupil distortion, high intraocular pressure (IOP), pupillary capture of the IOL, and IOL decentration. SFIOL is the preferred surgical technique for managing aphakia. The decision to choose one technique over another is complex and is based on several factors, including technical difficulty, previous training, anatomical variations, ocular comorbidities, and the potential complications.The most frequent complications after surgical correction of aphakia are pupil distortion, high IOP, pupillary capture of the IOL, and decentered IOLs.

Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment of dislocated intraocular lenses

BackgroundTo compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL).MethodsThirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed.ResultsThe major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was − 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01).ConclusionAll three IOL repositioning techniques resulted in favorable ocular prognosis.