Scleral-fixated Intraocular Lens Research Articles

Clinical Characteristics of recurrent intraocular lens dislocation after scleral-fixated sutured intraocular lens and long-term outcomes of intraocular lens re-fixation.

This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after scleral-fixated sutured IOL implantation and evaluate the long-term outcomes of scleral re-fixation of IOL. The medical records of patients who underwent surgery for IOL dislocation between January 2011 and January 2021 were reviewed. The study included 164 patients (male: 131, female: 33) (176 eyes). Patient demographics, preoperative, intraoperative and postoperative data, and the ocular and systemic conditions associated with IOL re-dislocation were analyzed. The study included 176 consecutive cases of scleral-fixated sutured IOL. Twenty-six eyes (14.8%) showed re-dislocation of IOL after the initial IOL scleral fixation and underwent reoperation (mean 75.5 ± 62.5months after the first surgery); three (11.5%) of them required a third surgery. Younger adults (aged less than 40years), and patients who underwent IOL scleral fixation in complicated cataract surgery or aphakic state had a higher risk of re-dislocation. Diabetes mellitus (DM) was the only statistically significantly higher risk factor in the re-dislocated group (p = 0.041). The complication rate with scleral re-fixation was higher than that in the non-re-dislocated group. No statistically significant differences were observed, except for vitreous hemorrhage (p = 0.024). Caution should be exercised when performing sutured scleral fixation of IOL in younger patients, cases of complicated cataract surgery and aphakia, and patients with DM to prevent IOL re-dislocation. Scleral-fixated sutured IOL in eyes with recurrent IOL dislocation seems to be a safe and effective procedure with a relatively low complication rate.

Phacoemulsification Combined With Supra-Capsular and Scleral-Fixated Intraocular Lens Implantation in Microspherophakia: A Retrospective Comparative Study.

BackgroundMicrospherophakia (MSP) is a rare ocular condition, the lens surgery of which is complicated by both insufficient zonules and undersized capsule.MethodsThis study included MSP eyes managed with phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens implantation (SCSF-IOL) and made the comparison with those treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL).ResultsA total of 20 MSP patients underwent SCSF-IOL, and 17 patients received MCTR-IOL. The postoperative best corrected visual acuity was significantly improved in both groups (P < 0.001), but no difference was found between the groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd:YAG laser posterior capsulotomy was performed 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment and one eye (5.00%) had a decentered capsule opening. Posterior capsule opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up.ConclusionsSCSF-IOL is a viable option for managing MSP and is comparable with the MCTR-IOL. Nd:YAG laser posterior capsulotomy was necessary to prevent residual capsule complications after the SCSF-IOL procedure.

Intraocular lens implantation in the absence of capsular support.

In the absence of capsular support, it is not always possible to safely place an intraocular lens (IOL) in the capsular bag at the time of surgery. Several techniques have thus been developed to enable safe placement of a secondary IOL outside the capsular bag. These techniques include placement of anterior chamber IOLs, iris-fixated IOLs (sutured, iris-claw), and scleral-fixated IOLs (sutured, sutureless). Secondary IOL placement can take place at the time of the initial surgery or in a second surgery. Each technique has its own unique advantages, as well as its potential complications. At this time, comparison studies have found no secondary IOL technique to be superior in terms of visual acuity or rate of complications. Additional comparison studies with longer follow-up times are needed to confirm these findings. The decision on which secondary IOL technique to perform depends on numerous factors including surgeon experience and comfort, as well as patient comorbidities.

Accuracy of intraocular lens power formulas for eyes with scleral-sutured intraocular lenses in congenital ectopia lentis

To compare the accuracy of intraocular lens (IOL) power calculation formulas in eyes with congenital ectopia lentis (CEL) that underwent scleral-fixated IOL implantation. Zhongshan Ophthalmic Center, Guangzhou, China. Retrospective consecutive case-series study. 158 eyes from 158 patients diagnosed from December 12, 2017, to November 16, 2020, with CEL and undergoing a lensectomy and scleral fixation of a Rayner 920H or 970C model IOL were retrospectively reviewed. The prediction errors (PEs) of the spherical equivalent of 8 formulas, Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), Haigis, Hoffer Q, Holladay 1, Kane, Hill-RBF 3.0, and SRK/T, were compared. For CEL patients with scleral-sutured IOL, all 8 formulas yielded myopic PEs without constant optimization. After such optimization, the performance of each formula ranked by median absolute error (MedAE) from the lowest to highest in diopter (D) was as follows: SRK/T (0.47), EVO (0.48), Kane (0.52), BUII (0.53), Hoffer Q (0.58), Holladay 1 (0.59), Haigis (0.61), and Hill-RBF 3.0 (0.62) formulas. The EVO and SRK/T formulas had the highest prediction accuracy concerning the percentage of cases within ±0.50 D and ±1.00 D range of PE in eyes that experienced scleral-sutured IOL surgery, respectively. All formulas before constant optimization produced myopic PEs. After optimization, the SRK/T and EVO formulas had the lowest MedAE and the highest percentage of PE in the range within ±0.50 D for CEL patients with scleral-sutured IOL implantations.

Clinical profile and outcome of ocular manifestation in Marfans syndrome in India.

Purpose:Marfan syndrome (MFS) is a genetic disorder associated with considerable morbidity and mortality. Presently, well-documented information on this condition is not available in India.Methods:In this retrospective cohort study, we recruited patients with clinically diagnosed MFS who presented to the outpatient department using revised Ghent nosology. We retrieved complete ophthalmic information, including vision, anterior and posterior segments, exported from electronic medical records, and relevant investigations, surgical details, and follow-up data were obtained in a specific, pretested format.Results:Our cohort consisted of 86 eyes of 43 patients and had a male preponderance. The prevalence was 20.5 per 100,000 individuals. The mean age of the patients was 23.9 years. All eyes were treated either optically with refraction or surgically using lensectomy and vitrectomy with suture supported scleral fixated intraocular lens (IOL), which significantly affected the visual outcome (P = 0.000).Conclusion:Although considered a rare disease, MFS is commonly found in the ophthalmological setting. Refraction and surgery (lensectomy with scleral fixated IOL) may improve the vision significantly.

Management of Irvine-Gass syndrome with a scleral intraocular lens

Pseudophakic cystoid macular edema is a common complication when placing an intraocular lens (IOL) in the sulcus (8%). The vitrectomy with implantation of a new scleral-fixated IOL with self-blocking plugs permits to resolve the chronic pseudophakic cystoid macular edema resulting from the implantation of a 3-piece acrylic IOL placed in the sulcus. This new type of IOL seems to have multiple potential advantages compared with glued IOL or iris-claw IOL in the management of Irvine-Gass syndrome secondary to the placement of IOL in the sulcus.

Recurrent scleral-fixated intraocular lens dislocation with spontaneous repositioning produced by tilting and head movements

Introduction: An unusual case of a patient who could repeatedly reposition his dislocated sulcus poly(methyl methacrylate) intraocular lens (IOL) by head movements and tilting his body is reported. Patient and clinical findings: An 86-year-old man presented with a 3-year history of recurrent episodes of transient blurred vision and monocular diplopia in his left eye. 20 years previously, he had phacoemulsification cataract surgery complicated by posterior capsule tear, which was treated with anterior vitrectomy and a secondary scleral-fixated IOL. Over the previous 3 years, he had recurrent episodes of IOL dislocation. He could regain normal vision by tilting his head and trunk. The dislocated IOL was maneuvered into position by capturing the haptic into the residual capsular remnant by appropriate head movements. On examination, his corrected distance visual acuity (CDVA) was counting fingers, and the posterior chamber IOL was subluxated inferiorly. During presentation, he could not reposition it himself, warranting a surgical intervention. Diagnosis, intervention and outcomes: He underwent suturing of the IOL in the sulcus. The IOL was well-centered with a CDVA of 6/9. Conclusions: To the authors’ knowledge, this is the first case report of a patient who could repeatedly reposition a dislocated IOL through tilting and head movements.

Novel Sutureless Scleral Fixated IOL for Inadequate or Absent Capsular Support

Purpose To evaluate the clinical outcome and safety profile of a new sutureless scleral fixation (SSF) technique using a single-piece foldable acrylic Carlevale intraocular lens. Methods In this case study, 27 eyes of 27 patients were implanted with an SSF single-piece IOL because of inadequate or absent capsular support. The hand-shake technique used during surgery was combined with the creation of scleral pockets in order to secure the IOL haptics. The BCVA was evaluated in the 1st and 6th month in every patient and in the 12th and 24th months, when possible. Also, we evaluated the improvement achieved in spherical equivalent values from baseline to the 6th month after the procedure. Intraoperative and postoperative complications were assessed. Results The mean age was 69.1 ± 14.9 years, and the mean follow-up was 13.6 ± 4.8 months. Indications of scleral-fixated IOL included dislocated posterior chamber IOL (40.7%), dislocated anterior chamber IOL (11.1%), subluxated traumatic cataract (18.5%), subluxated nontraumatic cataract (18.5%), and aphakia (11.1%). Concurrent PPV was performed on eight of the eyes (32%). The mean preoperative logMAR BCVA increased from 0.85 ± 0.59 baseline to 0.44 ± 0.30 one month after surgery (p < 0.01) and 0.36 ± 0.34 (p < 0.003) six months after surgery. The baseline refractive status expressed in SE was 4.3 ± 6.4 D, and the postoperative status was −0.5 ± 0.99 D. Postoperative complications included vitreous hemorrhage (7.4%), hypotony (7.4%), transient IOP elevation (3.7%), and postoperative cystoid macular oedema (3.7%). The IOL was very well centered and stable in every case during the follow-up period. Conclusion The use of the SSF technique with implantation of a single-piece foldable acrylic Carlevale IOL seems to be a safe and effective alternative method that provides good preliminary results in cases where capsular support is inadequate or absent. Long-term stability results would be required to evaluate the benefit of this novel surgical approach in order to compare it with other existing methods.

Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation.

To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance. A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.

Multipiece posterior chamber intraocular lens as sutureless, glueless scleral fixated intraocular lens.

PURPOSE:The purpose of the study is to report the outcomes of sutureless, glueless multipiece posterior chamber intraocular lens (PCIOL) as scleral fixated intraocular lens (SFIOL) implantation in patients with poor or no posterior capsular support.METHODS:Medical records of 45 eyes of 42 patients who underwent SFIOL implantation where no suture or glue was used to fixate intraocular lens (IOL) to the sclera from November 2016 to October 2017, with minimum 18 months of follow-up were retrospectively analyzed. The best-corrected visual acuity, indication of surgery, other significant eye examination findings, and complications were analyzed.RESULTS:Out of 42 patients, 62% were males and 38% were females. Mean age of subjects was 48.5 ± 16.5 years (range 13–79 years). Mean preoperative and postoperative visual acuity was 1.48 ± 0.6 Logarithm of the Minimum Angle of Resolution (logMAR) units and 0.6 ± 0.3 logMAR units, respectively. Most common complication was vitreous hemorrhage six eyes (13.3%) followed by postoperative hypotony in five eyes (11.11%). Other complications such as transient postoperative intraocular pressure rise, hyphema, tilted IOL, cystoid macular edema, retinal detachment were also noted.CONCLUSION:Multipiece PCIOL used as SFIOL without any sutures and glue is a viable, cost-effective method of IOL implantation in eyes with aphakia following surgical complication or trauma, with comparable outcome to other techniques of SFIOL implantation.

Scleral fixation of intraocular lenses using MERSILENE suture

AbstractPurposeTo report the outcomes of the scleral fixation of intraocular lens using MERSILENE suture technique in the absence of adequate capsular bag supportMethodsWe report a retrospective study carried out in the ophthalmology department of Habib Thameur hospital (Tunis, Tunisia) of patients who underwent scleral fixation of Bausch and Lomb Akreos AO60 IOL using MERSILENE suture 5‐0. All patients were evaluated for surgical indication, complete ocular examination pre and postoperatively was performed including refractive status, intraocular pressure (IOP) as well as anterior segment evaluation and fundus examinationResultsWe included 12 eyes of 10 patients operated using the mentioned surgical technique. Surgical indication was Ectopia Lentis for 5 eyes, post‐traumatic lens dislocation for 3 eyes, post‐traumatic IOL dislocation for two eyes and surgical management of postoperative aphakia in two eyes. Best corrected visual acuity increased from 1.15 logMAR preoperatively to 0.49 logMAR at 6‐months postoperatively, with an average gain of 0.66 logMAR. Mean postoperative IOP was 15.5 mmHg. Complications included post‐operative hypotony in 3 eyes resolved with medical treatment, conjunctival inflammation and erosion due to an unburied knot after one month in 2 eyes managed with topical antibiotic and steroids followed by surgical burial of the knot.ConclusionsScleral fixation of Akreos AO60 IOL with MERSILENE suture is a safe, economical and well tolerated procedure leading to improvement of visual acuity. MERSIENE suture use appears to be effective and safe without suture‐related complication on the short‐term. However, long‐term assessment and comparative studies will be necessary to extend our results.

Outcome of retropupillary Iris claw lens implantation at Lagos State University Teaching Hospital

Introduction: Cataract surgery with intraocular lens (IOL) implantation is one of the most common intraocular surgeries performed in the Department of Ophthalmology of the Lagos State University Teaching Hospital (LASUTH). Failure to implant an IOL in the posterior chamber can result in a compromised posterior capsule because of rupture or weak zonular support. Iris claw lens (ICL) implantation posterior to the iris (retropupillary) allows for posterior chamber implantation in the absence of adequate capsular support. Objectives: To assess the immediate and short-term outcomes of retropulillary ICL implantation as well as the immediate and short-term complications in patients at the LASUTH. Materials and Methods: A retrospective analysis of all patient case notes seen from January 2022 to November 2022 at the Ophthalmology department of LASUTH who met the inclusion criteria and had ICL implantation were collected and assessed. Patient’s demographic data, indication for ICL implantation, visual status preoperatively, postoperatively, and complications were analyzed. Results: A total of 20 eyes of 20 patients had the procedure in the study period. The age range was 12–70 and the longest follow-up period was 7 months with the shortest being 3 weeks. The mean preoperative visual acuity was 3/60, and the mean postoperative best-corrected distant visual acuity was 6/12. Immediate postoperative complications were uveitis (23%), raised IOP (5%), hypotony (10%), vitreous inflammation (13%), and cornea edema (13%). Conclusion: Retropupillary ICL implantation carries a good postoperative visual outcome; it is encouraged that this procedure is considered as an alternative to both anterior chamber IOL and scleral fixated IOL.

Intrascleral Knotless Zigzag Suture Fixation of Four-Haptic Hydrophilic Acrylic Foldable IOL: Clinical Outcomes.

BackgroundThe main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL).PurposeTo describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL.MethodsRetrospective cohort study of consecutive cases.ResultsNinety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1±15.2 years (range 18–94), and the median follow-up duration was 19.5 months (range 3–81). The best-corrected visual acuity improved from a mean±SD of 1.34±0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49±0.56 logMAR at the end of follow-up (p<0.001). The mean±SD final SE was −1.24±1.82 diopters. The mean±SD prediction error was −0.51±1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7).ConclusionThis knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.

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

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

Sutured Scleral-Fixated Versus Anterior Chamber Intraocular Lens Implantation: A Meta-Analysis.

No consensus exists on the comparative efficacy and safety of sutured scleral-fixated (SSF) and anterior chamber (AC) intraocular lens (IOL) implantation. We aim to compare outcomes of these two techniques. A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was conducted (2005 to 2020). Studies comparing SSFIOLs with ACIOLs were included. Outcomes included corrected distance visual acuity and complications. A meta-analysis was conducted with a random effects model. Weighted mean differences and risk ratios with 95% CIs were computed. Seven hundred eighty-three eyes from nine studies were included. SSFIOLs had a significantly higher absolute postoperative spherical equivalent (weighted mean difference, 0.32; 95% CI, 0.03 to 0.60; P = .03; low certainty) and incidence of IOL decentration/subluxation (risk ratio, 2.69; 95% CI, 1.03 to 7.01; P = .04; moderate certainty) than ACIOLs. There was no difference in final corrected distance visual acuity (P = .26). SSFIOLs have a higher absolute postoperative spherical equivalent and incidence of IOL decentration/subluxation than ACIOLs. Future prospective studies are needed to confirm these findings. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:12-21.].

Comparison of astigmatism between glued and sutured scleral-fixated intraocular lens

Background Posterior chamber intraocular lens implantation in the bag is the preferred mode of correcting aphakia. But, in certain circumstances, this is not possible, thereby requiring modalities of secondary fixation of intraocular lens (IOL).Purpose The aim of this study was to compare the postoperative astigmatism till six months after surgery between the sutured scleral-fixated IOL and the glued scleral-fixated IOL.Patients and methods This is a single-center, prospective, observational, open-label study comparing the postoperative outcome (till 6 months), including astigmatism and best-corrected visual acuity (BCVA), of sutured scleral-fixated intraocular lens (SFIOL) (Group 1) and glued SFIOL (Group 2). There were 25 patients in each group. Patients were followed up on day 1, first week, first, second, third, and sixth month postoperatively. During each postoperative visit, slit-lamp biomicroscopy was performed to evaluate the status of the cornea, anterior chamber, IOL, and position of haptics. Uncorrected visual acuity, BCVA, refraction, and keratometry values (corneal astigmatism) were noted. Cylindrical refraction denoted total astigmatism. The IOL astigmatism was derived by subtracting the corneal astigmatism from the total astigmatism.Results The difference in corneal astigmatism between the two groups was statistically significant at 1, 3, and 6 months postoperatively (P=0.004, 0.002, and 0.012, respectively). The final values at 6 months were 3.00±1.68 diopters (D) in the sutured SFIOL group and 2.08±0.56 D in the glued SFIOL group. The glued SFIOL group required less cylindrical correction till 6 months of follow-up. The BCVA, 6 months postoperatively, was 0.36±0.19 in Group 1 compared with 0.32±0.17 in Group 2, with no statistically significant difference (P=0.404).Conclusion Both techniques proved to be good options for the implantation of SFIOL, but glued SFIOL was better as it led to less astigmatism and hence the need for less spectacle correction.

Complications of Secondary Scleral-fixated Intraocular Lens Placement.

International Ophthalmology Clinics: Summer 2022 - Volume 62 - Issue 3 - p 93-102 doi: 10.1097/IIO.0000000000000429

Evaluation of the postoperative outcomes of patients with scleral-fixated intraocular lens implantation

Evaluation of the postoperative outcomes of patients with scleral-fixated intraocular lens implantation

Scleral-fixated intraocular lens opacification

Carlevale IOL is a hydrophilic acrylic single-piece lens specifically designed for intrascleral sutureless fixation. IOL opacification has not been reported for this lens, although there are no studies with long follow-up periods yet. We describe herein two cases of Carlevale IOL opacification six and ten months after surgery. Neither of the two patients had inherent risk factors for opacification, except for vitrectomy surgery in both and air tamponade in case 2. It is necessary for surgeons to report these cases in order to identify if opacification is a significant complication for this IOL.

A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation.

Purpose:To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques.Methods:In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared.Results:The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2).Conclusion:Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.