Scleral-fixated Intraocular Lens Research Articles

Comparison of refractive outcomes in patients following scleral fixated intraocular lens implantation with Yamane and Z-suture techniques.

To compare visual and refractive outcomes in aphakic patients who underwent scleral fixated intraocular lens (SF-IOL) implantation with Yamane and Z-suture techniques. Retrospective study. Patients who underwent SF-IOL implantation with Yamane and Z-suture techniques due to aphakia between 2021 and 2023 were analyzed. Preoperative and postoperative 6. month best corrected visual acuity (BCVA-LogMAR), preoperative and postoperative spherical error, cylindrical error and postoperative mean absolute error (MAE), corneal endothelial and topographic parameters, 3 mm-6 mm pupil diameter corneal higher-order aberrations (HOAs) were evaluated. Seventy-seven eyes of 77 patients who underwent SF-IOL implantation with Yamane and Z-suture techniques were included in the study. Yamane technique was performed in 38 (49.4%) and Z-suture technique in 39 (50.6%) patients. Postoperative BCVA was 0.44 ± 0.40 in Yamane technique and 0.47 ± 0.44 in Z-suture technique (p = 0.73). Postoperative MAE was 0.84 ± 0.70 D in Yamane technique, 1.02 ± 0.88D in Z-suture technique (p = 0.33). Postoperative CCT-preoperative CCT (ΔCCT) was 3.76 ± 27.62 µm in Yamane technique and 3.02 ± 15.58 µm in Z-suture technique (p = 0.88). A significant difference was found between Yamane and Z-suture techniques only in the ΔTrefoil value at 6-mm pupil diameter in corneal HOAs. ΔTrefoil was significantly lower in Yamane technique (p = 0.04). Except ΔTrefoil value at 6-mm pupil diameter, although no significant difference was found, corneal endothelial and topographic parameters were less affected in Yamane technique compared to Z-suture technique.

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

To compare the refractive outcomes and the complications of implantation surgery by the Carlevale IOL to the Artisan iris-claw IOL. Retrospective comparative study of consecutive surgical cases between 2019 and 2021 in our tertiary centre in Paris, France. We included 142 eyes in the Artisan group and 63 in the Carlevale group. Post-operative astigmatism at one month was 2.3 ± 1.6 D in the Carlevale group, 3.3 ± 2.5 D in the Artisan group with corneal incisions, and 1.8 ± 1.4 D in the Artisan group with scleral incisions (p = 0.015). Surgery duration was higher (p = 0.007) with the Carlevale IOL (70.8 ± 31.3 min) than with the Artisan IOL (58.3 ± 23.2 min). The complication rates were similar at one month between the two groups (25.4% in Artisan, 27% in Carlevale). The mean follow-up was longer in the Artisan group (234.5 days vs. 77 days, p < 0.001). Artisan iris-claw IOL seems to induce higher astigmatism than Carlevale sutureless scleral-fixated IOL at one month when injected through a corneal incision, but not when injected through a scleral incision. Therefore cataract surgeons should avoid wide corneal incisions in implantation surgery whenever possible.

Outcomes in eyes with retained lens fragments undergoing pars plana lensectomy and scleral-fixated intraocular lens insertion.

To report the visual outcomes and complications in eyes with retained lens fragments (RLF) following cataract surgery undergoing pars plana lensectomy (PPL) and scleral-fixated intraocular lens insertion (SFIOL). Patients with RLF who underwent pars plana vitrectomy (PPV), PPL, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity (VA) outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of PPV and PPL versus those undergoing SFIOL insertion during a subsequent surgery. 65 eyes of 65 patients were included. Median (interquartile range) pre-operative logarithm of the minimum angle of resolution (logMAR) VA was 2.3 (2-2.3; Snellen: HM). The median logMAR VA improved to 0.14 (Snellen: 20/100), at the most-recent follow-up (p<0.001, Hodges-Lehmann estimator:1.56, 95% confidence interval -1.30 to -1.71). There was no statistically significant difference in VA outcomes and the complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion. In this retrospective study with small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.

Postoperative complication rates in intraocular lens placement and fixation methods for inadequate capsular bag support: a review and meta-analysis.

To evaluate the complication rates of different IOL placement methods in adults with inadequate capsular bag support. The surgical correction of inadequate capsular bag support for the intraocular lens (IOL) harbors several challenges, and there is a wide-range of surgical procedures. For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (i) AC placement, (ii) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL (iii) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of two or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557). Fifteen studies were included in the final analysis, which reported results of 1,247 eyes. The overall complication rate was non-significantly lower in iris fixation (4.4%; 95%CI: 3.6-5.4%, P=0.150) than in AC placement (7.4%; 95%CI: 6.4-7.9%) and scleral fixation (7.4%; 95%CI: 6.5-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95%CI: 2.4-57.5%, P<0.001), compared to scleral fixation (11.9%; 95%CI: 2.6-21.2%) and iris fixation (4.1%; 95%CI: 0.8-7.3%;). Vitreous hemorrhages were more frequently reported following scleral fixation (8.5%; 95%CI: 6.3-11.2%, P=0.006) than in AC placement (5.4%; 95%CI 3.4-8.5%) and iris fixation, 1.4%; 95%CI 0.4-4.2%), and so was IOL decentration/dislocation (8.9%; 95%CI: 6.7-11.8%, P=0.047 compared to 1.1%; 95%CI: 0.4-3.4% and 4.0%; 95%CI: 2.2-7.3%, respectively). The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.

6/0 prolene double-flanged IOL sutureless scleral fixation with a 27-gauge needle for intraocular lens surgery.

To report our initial experience of a modified intraocular lens (IOL) scleral fixation technique using 6/0 prolene in a double-flanged sutureless technique with a 27-gauge needle. 29 consecutive patients with IOL surgery were retrospectively reviewed between December 2021 and October 2023. Early Treatment Diabetic Retinopathy Study (ETDRS) letters, spherical equivalent (SE), astigmatism axial degree and intraocular pressure (IOP) were evaluated at baseline, and 1, 2, 3, and 6 months postoperatively. Surgery-related complications were evaluated during follow-up. ETDRS letters or SE at 1, 2, 3, and 6 months postoperation was significantly improved compared to baseline levels. Patients with younger (estimate [SE] = 8.011 [2.485], p = 0.006), preoperative lens drop (estimate [SE] = 8.621 [2.906], p = 0.009), idiopathic cataract (estimate [SE] = 6.021 [2.099], p = 0.048), high baseline ETDRS letters (estimate [SE] = 15.449 [2.352], p < 0.001), or low baseline SE (estimate [SE] = 6.357 [2.406], p = 0.018) had the greatest improvement in ETDRS letters during follow-up. Patients with preoperative lens or IOL dislocation had a greater postoperative SE improvement than those with preoperative lens or IOL subluxation (dislocation vs. subluxation: estimate [SE] = -189.235 [70.692], p = 0.016). There were no cases of vitreous hemorrhage, cystoid macular edema, endophthalmitis, subluxation or dislocation were observed during the 6-month follow-up. Our modified IOL scleral fixation technique is a simple, safe, efficient method that avoids haptic manipulation and slippage, reduces postoperative complications, achieves completely sutureless surgery, and results in an achievement of surgical refractive goals.

Refining delivery and positioning: A modified approach to FIL SSF intraocular lens implantation using the "full reverse" technique.

To present a modified surgical technique for implantation of the sutureless scleral-fixated hydrophilic intraocular lens (FIL SSF). Single surgeon retrospective case series and review of surgical videos with step-by-step technique analysis. Uncorrected and best corrected visual acuity (UCVA and BCVA), refractive error (spherical equivalent), full clinical examination with intraocular pressure (IOP) measurement, endothelial cell density on corneal specular microscopy and macular optical coherence tomography (OCT) were recorded at baseline, 1, 4 and 8 weeks postoperatively. The FIL SSF IOLs were successfully implanted using the so-called "full reverse" technique, having the lens loaded in the injector in an upside-down fashion, as opposed to IOL technical specifications. In all cases, the FIL SSF IOL was properly placed in the ciliary sulcus, well-centered and without signs of tilt. Follow up figures at 2 months are consistent with published data, confirming the potential benefits of the new implantation technique. In our preliminary experience, the "full reverse" technique of the FIL SSF IOL has proven effective in preventing incorrect IOL orientation in 100% of cases. However, larger prospective controlled studies and longer follow up are required to either support or disprove our results.

Surgical management of traumatic dislocated lens with CM T Flex IOL implantation: A sutureless, glueless, T-haptic scleral fixated intraocular lens

Scleral fixated intraocular lenses (SFIOLs) have revolutionized aphakia management with compromised capsular support. Previous techniques, predominantly sutured SFIOLs, exhibited durability but were plagued by suture-related issues, necessitating advancements in fixation methodologies. In this case, a patient with lens dislocation post-ocular trauma underwent a vitrectomy with nucleus removal using the vacuum-assisted levitation method. Subsequently, the implantation of a novel CM T Flex IOL with a distinctive T-shaped haptic design was performed, obviating the need for haptic tucking or suturing. The surgical approach showcased heightened efficiency, minimized tissue handling, and a decreased risk of complications, collectively contributing to improved postoperative outcomes.

Retrolental cohesive ophthalmic viscoelastic injection for severe subluxated cataracts: a prospective study

BackgroundTo assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection (“Viscolift technique”) in patients with severely subluxated cataracts.MethodsIn the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery.ResultsThirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The “Viscolift technique” resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p < 0.001) at the last follow-up. No major complications were noted.ConclusionsThe “Viscolift technique” proved to be a safe and effective surgical approach for recentering and elevating subluxated cataracts, thus allowing the surgeon to perform an easier and better-centered capsulorhexis.

The Surgical Outcomes of Modified Intraocular Lens Suturing with Forceps-Assisted Haptics Extraction: A Clinical and Basic Evaluation.

Background/Objectives: Postoperative intraocular lens (IOL) tilt is a risk associated with IOL scleral fixation. However, the cause of IOL tilt during IOL suturing remains unclear. Therefore, this study aimed to evaluate the surgical outcomes of a modified IOL suturing technique and investigate the factors contributing to postoperative IOL tilt and decentration. Methods: We included 25 eyes of 22 patients who underwent IOL suturing between April 2018 and February 2020. A modified IOL suturing technique that decreased the need for intraocular suture manipulation was used. Factors contributing to IOL tilt and decentration were investigated using an intraoperative optical coherence tomography (iOCT) system. Results: The mean postoperative best-corrected visual acuity improved from 0.15 ± 0.45 to -0.02 ± 0.19 (p = 0.02). The mean IOL tilt angle at the last visit after surgery was 1.84 ± 1.28 degrees. The present study reveals that the distance of the scleral puncture site from the corneal limbus had a stronger effect on IOL tilt; meanwhile, the suture position of the haptics had a greater effect on IOL decentration. Conclusions: The modified IOL suturing technique, which avoids intraocular suture handling, had favorable surgical outcomes with improved postoperative visual acuity and controlled IOL tilt and decentration. Accurate surgical techniques and careful measurement of distances during surgery are crucial for preventing postoperative IOL tilt and decentration.

High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome

AimsTo predict high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence in eyes with pseudoexfoliation (PXF) syndrome.Methods315 eyes of 315 consecutive patients with PXF scheduled...

Two-year follow-up of a post-traumatic choroidal rupture with a lens luxation patient: a case report

Background: A choroidal rupture is a break in the choroid, Bruch membrane, and retinal pigment epithelium (RPE) that occurs most commonly as a result of blunt ocular trauma. It may be a secondary effect of direct or indirect trauma. This case illustrates an indirect post-traumatic choroidal rupture with lens luxation. Three months following the incident, the patient presented with impaired vision. The posterior segment was found to have a luxated lens during the objective examination of the eye. The funduscopy revealed a white, curvilinear, crescent-shaped streak that was concentric to the optic nerve. Case description: A 45-year-old male from East Java visited the ophthalmology outpatient clinic with a chief complaint of blurred vision in the left eye for three months, followed by pain in the left eye. On examination, the visual acuity was a one-meter counting finger. The lens was luxated to the posterior. The funduscopy examination revealed a curvilinear crescent-shaped streak. Vitrectomy and lensectomy were implemented. After four months of aphakia, the patient underwent a scleral fixation intraocular lens (IOL) implantation. The visual acuity was satisfactory, and no complications were observed during the two-year follow-up. Conclusion: We reported a post-traumatic choroidal rupture and a lens luxation with an optimal outcome after a two-year follow-up.

Outcomes of sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty

BackgroundThe purpose of the study was to assess visual outcomes, complications, intraocular lens (IOL) stability, and corneal status after sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty (PKP).MethodsThis retrospective single-arm cohort study included patients who underwent PKP and sutured scleral-fixated intraocular lens implantation between 2013 and 2018 at the Dhahran Eye Specialty Hospital. The eyes were examined postoperatively at 1, 3, 6, 12, and 24 months. Corneal status, complications, and IOL status were also evaluated periodically, and the number of eyes with a BCVA of > 20/200 was recorded.ResultsTwenty-two eyes from 22 patients were included. The median duration of follow-up was 3 (IQR 1.8; 4.4) years. Reasons for surgery were traumatic globe rupture (six eyes, 27.3%), bullous keratopathy (nine eyes, 40.1%), failed previous graft (five eyes, 22.7%), and corneal scarring (two eyes, 9.1%). Twelve (54.5%) eyes showed a BCVA of > 20/200 (non-blind) at 12 months after surgery and only five (22.7%) before surgery. Twelve months after surgery, 13 patients showed an improvement in BCVA in two lines (59.1%), seven remained the same (31.8%), and 2 deteriorated (9.1%). The indication for surgery (p = 0.2) and the stability of the sutured-scleral fixated IOL (p = 0.8) were not associated with an improvement in BCVA at the final follow-up. The corneal graft remained clear in nine eyes (40.9%) at a median duration of 3 years. The overall average survival period for all corneal grafts was 42.9 months.ConclusionsThe combination of sutured scleral-fixated intraocular lens implants and PKP is an effective intervention for preserving visual acuity in patients with complex cases. However, the risk of graft failure and then need for repeat transplantation should be taken into consideration.

Refractive Outcomes After Scleral Fixation of the Carlevale Intraocular Lens.

To assess the refractive predictability of the Carlevale sutureless scleral fixation intraocular lens (IOL) (Sole-ko IOL Division) power calculation. This retrospective, non-comparative, interventional case series included patients without a capsular support having undergone sutureless scleral fixation IOL implantation in two French hospitals between October 2019 and April 2022. IOL calculation was performed with the Barrett Universal II, Hoffer Q, Holladay 1, and SRK/T formulas with constant optimization to achieve a mean arithmetic prediction error equal to zero. The main outcomes were prediction error (PE) and its standard deviation (SD-PE), the median absolute error (MedAE), the mean absolute error (MAE), and the percentage of eyes with PE within ±0.50, ±1.00 and ±2.00 diopters (D) 6 months after surgery. Thirty eyes of 30 patients were included in the study. The mean age was 66.6 years, the mean axial length was 24.31 mm, and the mean keratometry was 43.07 D. SDPE ranged from 0.73 to 0.87 D depending on the formula. MedAE ranged from 0.38 to 0.61 D, and MAE from 0.52 to 0.68 D. Between 46.7% and 56.7% of eyes were within ±0.50 D, 76.7% and 90.0% were within ±1.00 D, and 96.7% were within ±2.00 D of target equivalent. No statistically significant difference was observed between the four formulas for any outcomes. This study confirmed that the design of the Carlevale sutureless scleral fixation IOL provides satisfactory refractive results. [J Refract Surg. 2024;40(8):e527-e532.].

Cross-Sectional Survey of Vitreoretinal Surgery Fellowship Training in Secondary Intraocular Lens Placement.

Purpose: To assess current trends in vitreoretinal surgical fellowship training for placement of secondary intraocular lenses (IOLs). Methods: A cross-sectional survey was administered to vitreoretinal surgical fellowship graduates who completed their program between 2019 and 2023. Results: Completed responses were obtained from 70 (22.5%) of 311 eligible recipients. Training settings included academic (80%), hybrid academic/private practice (15%), and private practice (5%). During their fellowship, the majority of respondents reported 10 or fewer cases using anterior chamber (AC) IOLs (69%), 5 to 50 cases using scleral-sutured IOLs (64%), and 5 to 25 cases using sutureless scleral-fixated IOLs (52%). Most fellows (79%) did not have exposure to iris-fixated IOL placement during fellowship training. The Akreos AO60 (78%) and Envista MX60 (10%) IOLs were the most common choice for scleral-sutured placement. Most fellows (67%) placed fewer than 10 secondary IOLs through scleral tunnels. Overall, scleral-sutured IOL placement (Akreos Gore-Tex [polytetrafluoroethylene] sutured, 49%) and scleral-fixated IOLs (modified Yamane, 45%) were the preferred and most comfortable surgical techniques for recent graduates after completing training. There was a significant association between surgical case volume during fellowship training and self-reported competency for each type of secondary IOL (P ≤ .005). Conclusions: The majority of vitreoretinal surgical fellows receive limited training in the placement of AC IOLs or construction of scleral tunnels during their fellowship. Aligned with their experience during fellowship, recent graduates generally prefer implanting scleral-fixated or scleral-sutured IOLs. Analysis of trainees' exposure to various techniques and postgraduate surgical preferences may identify areas for improvement in surgical education.

Triple tunnel and triple intraocular lenses (IOL): Modified scleral fixated IOL in a case of double dislocated IOL

Abstract We present a challenging case of a 60-year-old female who underwent cataract surgery in the right eye (RE) 10 years back. On presentation, visual acuity in RE with aphakic correction was 6/18, and the patient had a superior corneal scar with iris incarceration. Fundus examination revealed an attached retina and healthy optic nerve head with two dislocated rigid intraocular lenses (IOLs). The patient underwent vitrectomy with temporal scleral tunnel for explanting the IOLs. The same tunnel was used for scleral fixation of IOL whose haptics were buried into two opposite-facing scleral partial thickness scleral tunnels made at 12 and 6 o’clock. Thus, we describe a newer technique of sutureless scleral fixated IOL where scleral pockets are used for fixating three-piece IOL without the use of any suture, glue, or specialized IOL.

Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes

PurposeEvaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation.MethodsA total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior–posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany).ResultsThere was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively).ConclusionIn this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.

CM T flex scleral fixated intraocular lens short-term outcomes in different clinical scenarios

Objective: The purpose is to report the visual outcomes of a “T”-shaped haptic scleral fixated intraocular lens (SFIOL) implanted using the sutureless technique in different clinical scenarios. Material and Methods: A retrospective case series, where patients implanted with “T”-shaped haptic SFIOL between September 2022 and February 2023, were included in the study. Subjects with missing data were excluded from the study. All surgeries were performed by a single surgeon. Pre- and post-surgery follow-up visual acuity and intraocular pressure were noted. Post-operative centration of intraocular lens (IOL), haptics condition, and occurrence of any complication were noted. Results: Overall, 20 eyes of 19 patients were implanted with “T”-shaped haptic SFIOL and had a mean age of 54.15 ± 15.99 years. None of the patients had any intraoperative IOL damage or any other intraoperative complication. There was a significant improvement in visual acuity post-SFIOL implantation (Paired t-test, P &lt; 0.001), which was noted. Corneal edema was noted in one patient. IOL was stable and well-centered in all patients. No haptic-related complications were encountered. Conclusions: SFIOL with “T”-shaped haptic is a viable option for aphakic cases with inadequate capsular support. IOL implantation with “T”-shaped haptic is sutureless, less damaging to ocular structures and has a shorter learning curve making it easier for implantation.

Nucleus drop following phacoemulsification surgery: Incidence, risk factors and clinical outcomes.

To determine the incidence, risk factors and clinical outcomes in patients with nucleus drop (ND) following phacoemulsification surgery at a tertiary care ophthalmic institute. Medical records of patients with ND during phacoemulsification between January'2019 and December'2022 were reviewed retrospectively. Incidence of ND was calculated overall, and according to surgical expertise levels and surgical steps. Associated pre- and intra-operative risk factors were assessed. Clinical outcome parameters [best-corrected visual acuity (BCVA) and intraocular pressure (IOP)] were compared with respect to timing of PPV (immediate vs early vs delayed), location (sulcus vs scleral fixated-IOL) and timing of IOL placement (primary vs secondary). Among 93,760 phacoemulsifications, ND was noted in 130 patients (0.1%). Significant direct and associated pre-operative risk factors were advanced cataract, glaucoma, posterior polar cataract, and diabetes mellitus. Junior medical consultants had 40 ND (mostly in non-complex cases), whereas senior medical consultants had 90 ND (mostly in complex cases). ND most frequently occurred during emulsification of nuclear fragments. Sulcus placement of IOL during primary surgery yielded significantly better visual outcome compared to secondary procedures, although timing of PPV had insignificant effect. 77.1% had BCVA of 6/12 or better at final follow-up. Timing of IOL implantation, PPV, and type of IOL did not have any significant effect on IOP. Though the incidence of ND is low, it is a dreaded complication. Accurate pre-operative evaluation, risk stratification, distribution of cases among surgeons based on their surgical expertise, and immediate or early management of ND yields better anatomical and functional outcomes.

Pars plana vitrectomy and scleral-fixated intraocular lenses: comparison of Gore-Tex suture and flanged intrascleral haptic fixation techniques

ObjectiveTo compare clinical outcomes of combined pars plana vitrectomy (PPV) and secondary scleral fixation of an intraocular lens (IOL) using Gore-Tex suture versus flanged intrascleral haptic fixation (FIHF) using double needles. DesignSingle-centre retrospective cohort series. ParticipantsEyes undergoing PPV with simultaneous scleral fixation of an IOL. MethodEyes that underwent fixation of a Bausch & Lomb Akreos AO60 or enVista MX60E IOL using Gore-Tex suture or a Tecnis ZA9003 or Zeiss CT LUCIA 602 IOL using FIHF were included. The primary outcome was change from baseline visual acuity to postoperative month 3. Secondary outcomes included deviation from refractive target aim and rates of postoperative complications. ResultsSeventy-nine eyes of 72 patients were included. Mean (±SD) follow-up was 16 ± 10.5 months (range, 4.5–45.2 months). Fifty-three eyes (67.1%) underwent Gore-Tex suture fixation, and 26 eyes (32.9%) underwent FIHF. Across all eyes, mean visual acuity improved from 1.30 ± 0.74 logMAR (20/399 Snellen equivalent) preoperatively to 0.36 ± 0.36 logMAR (20/45 Snellen equivalent) at 3 months (p < 0.001). No difference in visual acuity at month 3 was noted between the 2 techniques (p = 0.34). Mean deviation from refractive target aim was not significantly different between the Gore-Tex and FIHF groups (+0.14 ± 1.33 D vs –0.16 ± 0.88 D; p = 0.45). Reoperation rates were similar between groups (2 of 53 eyes in the Gore-Tex group vs 3 of 26 eyes in the FIHF group; p = 0.32). ConclusionCombined PPV and scleral fixation of IOLs with Gore-Tex suture and FIHF resulted in similar improvements in visual acuity. No significant differences in refractive outcome and postoperative complication profiles were noted.

Factors predicting redislocation or suture break in eyes after scleral-fixated intraocular lens.

To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation after secondary scleral-fixated IOL (SF IOL) surgery. 2 tertiary referral hospitals. Retrospective case series. Patients undergoing SF IOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SF IOL surgery between June 2014 and December 2019 at 2 tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded. 237 eyes of 225 patients (169 [75.1%] men) were included. The redislocation group was more likely to have a younger mean age at the initial SF IOL surgery (redislocation vs no-redislocation, 55.4 vs 62.0 years, respectively; P = .008), have a prior history of a previous suture break (23 eyes, 52.3% vs 1 eye, 0.5%; P < .001), and have undergone the initial SF IOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P = .002) than was the no-redislocation group. In addition, the redislocation group had a higher occurrence of complications ( P < .001). Multivariate regression revealed that younger age, left eye involvement, aphakic status before the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P < .05) associated with redislocation. Younger age, left eye involvement, postoperative complications such as ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions.