Scleral-fixated Intraocular Lens Research Articles

Refractive and Visual Outcomes after Scleral Fixated Intraocular Lens Implantation in Children with Ectopia Lentis

This study was conducted to report the refractive and visual outcome after Scleral Fixated Intraocular Lens (SFIOL) implantation in children with nontraumatic ectopia lentis. Retrospective review of the medical records of 25 eyes of 15 patients who underwent SFIOL implantation in children with non-traumatic ectopia lentis. The mean best corrected visual acuity (BCVA) before SFIOL implantation was 1.07 ± 0.9 logMar units [median: 0.9, Interquartile range (ΙQR): 0.415 to 1.555] which improved to 0.41 ± 0.33 logMar units (median: 0.22, ΙQR: 0.180 to 1.555) at two months postoperative follow up. In phakic group, the mean spherical refraction preoperatively was -12.04 ± 7.82 DS (dioptre sphere) (IQR: +16 to -5.875) and postoperatively was +0.93 ± 2.67DS (IQR: -0.375 to +2). In aphakic group, the mean spherical refraction preoperatively was +12.22 ± 2.05 DS and postoperatively was +1.2 ± 1.9 DS. The mean total astigmatism preoperatively was -6.44 ± 4.95 DC (dioptre cylinder) (median: 6, IQR: -10.50 to +2) and postoperatively was -1.47 ± 0.98 DC (median: -1.5, IQR: -2 to - 0.625 ). The mean IOL induced astigmatism was -1.01 ± 0.95 DC (median -0.75, IQR: -1.33 to - 0.25). The spherical refractive equivalent was within 2 Diopter (D) of the target refraction calculated preoperatively in 20 eyes and in five eyes it was more than 2 D. SFIOL implantation is associated with good visual outcome with a significant improvement in the refractive error. However, a longer follow up is required to assess the change of refraction and the stability of the SFIOL.

Novel use of an adjustable single 8\u20130 polypropylene suture of scleral fixation without conjunctival dissection

BackgroundThis report serves to describe the use of a novel adjustable single 8–0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach.MethodsIn this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8–0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8–0 polypropylene sutures were inserted into the eye guided by 10–0 polypropylene sutures of a long straight needle. The 8–0 suture was then used to fix the haptic IOs. Finally, these 8–0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence.ResultsFor this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up.ConclusionsAn adjustable single 8–0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation.Trial registrationRetrospective case series study, not applicable. NCT04476264.

Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture.

To report intraoperative performance and long-term postoperative outcomes after scleral fixation of intraocular lenses (IOLs) with polytetrafluoroethylene suture (PTFE). Raghudeep Eye Hospital, Ahmedabad, India. Prospective, interventional case series. One hundred eyes undergoing scleral fixation of IOLs using PTFE suture (Gore-Tex) with 12 months or more postoperative follow-up were included. The primary outcome measures were occurrence of intraoperative and postoperative complications such as glaucoma, suture-related complications, and inflammation within the follow-up period. The secondary outcome measure was improvement in visual acuity (VA). Of the 100 eyes, posteriorly dislocated IOLs (53 eyes) followed by dropped nuclei (33 eyes) were the most common surgical indications. Mean follow-up was 23 months (range 12 months to 5 years). Seventy-one patients (77.17%) had 18 months or more follow-up; 21 eyes had a rise in intraocular pressure in the early postoperative period; 12 of them required glaucoma surgery. Early complications were vitreous hemorrhage in 13 eyes, retinal detachment in 6 eyes, and transient hyphema in 1 eye. Late postoperative complications were cystoid macular edema (9 eyes), epiretinal membrane (3 eyes), and bullous keratopathy (3 eyes). Mean VA improved from 0.92 ± 0.16 (SD) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.41 ± 0.27 logMAR. LogMAR at final follow-up was 0.41 ± 0.28 (P < .01). There were no cases of suture-related complications (erosion/breakage/granuloma) or IOL decentration throughout the follow-up period. Scleral fixation of IOLs with PTFE suture was found to be safe and well tolerated. All eyes had well-centered IOLs, with no suture-related complications during long-term follow-up. VA improved significantly with acceptable postoperative complications.

Iris-claw intraocular lens, scleral-fixated intraocular lens, and angle-supported anterior chamber intraocular lens in Hospital Melaka: a four-year retrospective analysis

Introduction: Cataract surgery with insufficient capsular support has become an intense challenge to surgeons in intraocular lens (IOL) selection. Anterior chamber IOL (ACIOL), iris-claw (Artisan) IOL, and scleral-fixated IOL (SFIOL) are the three common types of IOL used. However, each type of IOL has its own characteristics and different clinical requirements. IOL selection is important in ensuring good visual outcome.&#x0D; Purpose: The purpose is to compare the duration or surgery, visual outcomes, and complications among ACIOL, Artisan IOL, and SFIOL.&#x0D; Study design: Retrospective comparative analysis.&#x0D; Material and methods: This is a four-year retrospective analysis of patients who underwent either ACIOL, Artisan IOL, or SFIOL implantation between January 2014 and January 2018. Patients were divided into ACIOL, Artisan, and SFIOL groups. Demographic data, duration of surgery, preoperative and postoperative visual acuity, and postoperative complications were identified and compared among the different groups.&#x0D; Results: Sixty-four eyes from 58 patients were analysed: twenty (31.3%) eyes with ACIOL, 28 (43.8%) eyes with Artisan, and 16 (25%) eyes with SFIOL. Mean surgery times for ACIOL, Artisan, and SFIOL were: 61 ± 27.8, 64 ± 26.9, and 104.1 ± 46.8, respectively. SFIOL showed significantly longer surgery time than the ACIOL and Artisan groups (p &lt; 0.05). There was no significant difference in surgery time between the ACIOL and Artisan groups (p &gt; 0.05). The Artisan group showed significantly better visual recovery at postoperative 1 week than both the ACIOL and SFIOL groups (Artisan vs ACIOL: 6/18 vs 6/24, p &lt; 0.05; Artisan vs SFIOL: 6/18 vs 6/60, p &lt; 0.05). However, final best-corrected visual acuity (BCVA) at two months was comparable among all three groups with a median BCVA of 6/9. Elevated intraocular pressure occurred in all IOL groups, retinal detachment developedin the Artisan and SFIOL groups, epiretinal membrane developed in the ACIOL and SFIOL groups, corneal decompensation developed in the ACIOL group only. Cystoid macular oedema and IOL tilt occurred in SFIOL only.&#x0D; Conclusions: All three groups of IOL showed comparable good visual outcomes. The decision of IOL selection should be based on patients’ clinical condition and availability of surgical skill and resources.

Outcomes and complications in scleral-fixated intraocular lens implantations.

This study compares outcomes and complications of scleral-fixated intraocular lens implantation between 2 levels of surgeons. A retrospective case series of patients undergoing scleral-fixated intraocular lens implantation at Prince of Wales Hospital, Hong Kong, between May 2012 and April 2017 were reviewed. Data collected included age, gender, affected eye, preoperative and postoperative visual acuities, refractive target and outcome, surgeon profile, operative details including method of scleral fixation, intraoperative and postoperative complications and length of follow-up. Ninety eyes of 90 patients were included for analyses. The mean LogMAR visual acuities were 1.17 ± 0.70 at postoperative week 1, 0.81 ± 0.56 at 1 month, 0.66 ± 0.55 at 3 months, 0.56 ± 0.59 at 6 months, and 0.51 ± 0.60 at 1 year, respectively. After adjusting for age at operation, operative time, axial length, subspecialty of the surgeon and preoperative LogMAR, surgeon seniority was not significantly associated with final visual outcomes. There was no statistically significant difference between the mean improvement in visual acuities between eyes operated by consultants and fellows under direct supervision of a senior surgeon. Scleral-fixated intraocular lens implantation is safe and effective in improving visual acuity in aphakic adults without capsular support. Under good supervision, fellows were able to produce comparable results compared with experienced specialists.

Explantation of Cloudy Oculentis Intraocular Lens With Primary Pars Plana Vitrectomy and Deflooring of the Capsular Bag.

To report a novel technique for explantation of cloudy Oculentis intraocular lens (IOL). A retrospective review of patient's electronic records was performed. The technique includes pars plana vitrectomy, deflooring (large posterior capsulectomy) of the capsular bag, IOL explantation with preserving the anterior capsule, and a secondary IOL placement. Twenty eyes of 19 symptomatic patients were studied. Preoperative Snellen visual acuity ranged from 6/60 to 6/6; 15 eyes (75%) had visual acuity of 6/12 or better. Postoperative visual acuity ranged from 6/60 to 6/6; 18 eyes (90%) had visual acuity of 6/12 or better, and 2 eyes (10%) had visual acuity worse than 6/12. Among these eyes, 13 eyes (65%) had sulcus-fixated IOL, 5 eyes (25%) had sutureless scleral-fixated IOL, and 2 eyes (10%) had retropupillary iris clip IOL. Perioperative surgical complications included localized choroidal detachment in one eye and retinal detachment in another eye. In addition, most patients reported significant improvement in their postoperative vision satisfaction. Our new technique for explantation of cloudy Oculentis IOL provides a standard surgery allowing a safe predictable and repeatable removal of these lenses comparing with the anterior segment approach. This technique could also be used for removal of other IOLs.

Scleral Fixated IOLs - an experience

Scleral fixation of IOL is the procedure of implanting a posterior chamber IOL in the sulcus in absence of posterior capsular support as in prior cataract extraction or Aphakia, Traumatic cataract, subluxation/dislocation of natural lens. To study the outcome of 68 Aphakic eyes which underwent Sutured Scleral Fixation of IOLs.Results in terms of Intraoperative difficulties, Postoperative complications and Visual recovery were noted. Prospective Interventional Study. 68 eyes of 68 patients were subjected to Sutured Scleral fixation of Posterior chamber IOL surgery in Dept. of Ophthalmology in a tertiary Government teaching institute, either primary or as secondary surgery. Good Best Corrected Visual Acuity and a quiet eye with no fundus abnormality were the prerequisites. Two point fixation was done using 10-0 Prolene straight needle suture by a single surgeon. Intraoperative difficulties encountered were Hypotony, hyphaema, and suture entangling. Postoperative complications like Hyphaema and Iritis were seen. Postoperative Best Corrected Visual Acuity in 92% cases was 6/6 to 6/18. No special IOL or instruments were required in this technique. Sutured Scleral fixation is the best option for Aphakic patients without capsular support in the hands of a careful surgeon.

Refractive outcomes and accuracy of IOL power calculation with the SRK/T formula for sutured, scleral-fixated Akreos AO60 intraocular lenses.

Scleral fixation of intraocular lenses has become a popular procedure for treating aphakia in the absence of capsular support. However, the lens formulas used to predict refractive outcomes were designed for in-the-bag lens placement. This study evaluates the accuracy of the SRK/T formula in predicting a target postoperative refraction when suturing a scleral-fixated intraocular lens (IOL) implant 3mm posterior to the limbus. This is a retrospective, case series including 20 eyes of 20 patients who underwent scleral fixation of Akreos AO60 IOLs (Bausch & Lomb, Rochester, NY) by a single surgeon at the OSU Wexner Medical Center. Preoperative measurements were performed with optical biometry, and IOL power was calculated with the SRK/T formula. Following surgery, the actual refractive spherical equivalent (SE) was performed and compared with the preoperative prediction. Prediction error (PE), defined as the deviation of actual postoperative SE refraction in diopters (D) from preoperative predicted SE refraction, was the primary outcome measure. The mean attempted (predicted) SE was - 1.12 D (± 0.87). Mean achieved SE was - 0.96 D (± 1.04). Mean PE (actual postoperative SE versus predicted preoperative SE) was 0.16 D (± 0.69). A total of 9 eyes (45%) were within ± 0.5 D of the predicted SE, 16 eyes (80%) were within ± 1.0 D, and all 20 eyes (100%) were within ± 1.5 D. IOL power calculation using the SRK/T formula with optical biometry demonstrates reliable postoperative refractive outcomes in patients undergoing scleral fixation of an IOL (Akreos AO60). Further studies are needed to refine the predictive value of the SRK/T and other formulas for application in scleral fixation of IOLs.

A different surgical approach to cases with zonular weakness or dialysis: sutureless transscleral fixated intraocular lens implantation and stabilization of lens capsule.

To evaluate the effect of sutureless transscleral fixated intraocular lens (IOL) implantation and capsule stabilization of IOL optics on postoperative visual outcomes in cases with zonular dialysis in excess of 70°. Fifteen eyes of thirteen patients with > 70° zonular dialysis and endothelial cell counts higher than 1500cells/mm2 who had been followed for at least 6months were included. A modified surgical approach was applied to these eyes with sutureless transscleral fixated IOL implantation and the IOL was secured to the capsulorhexis to stabilize the lens capsule (optic capture). The mean best-corrected visual acuity (BCVA) was 0.21 ± 0.2 on the first day, 0.45 ± 0.33 on the first week, 0.60 ± 0.32 on the first month, 0.80 ± 0.26 on the third month, and 0.82 ± 0.27 on the sixth month. When preoperative BCVA and postoperative BCVA were compared, a statistically significant increase was observed in postoperative BCVA beginning from the seventh postoperative day. There was a statistically significant (p = 0.038) decrease in endothelial cell count at postoperative third and sixth months (1895 ± 65, 1872 ± 376, respectively) compared to preoperative values. The use of this new surgical modification that utilizes capsular tension rings combined with a procedure that secures the sutureless scleral IOL fixation to the capsulorhexis for the treatment of eyes with zonular dialysis in excess of 70° was found to be very successful in the 6months of follow-up. More cases and longer follow-up periods are required to provide an idea as to whether different complications will develop in such patients.

27-gauge trocar-assisted transconjunctival sutureless intraocular lens scleral fixation.

To present the surgical outcome of posterior chamber intraocular lens scleral fixation using a 27-gauge trocar-assisted transconjunctival sutureless technique in aphakic patients due to cataract surgery complications with inadequate capsular support. Six consecutive patients with aphakia due to cataract surgery complications with inadequate capsular bag support were operated by two surgeons. Intraocular lens scleral fixation was performed with a 27-gauge trocar-assisted transconjunctival sutureless technique. Patients were followed-up for 12 months. Preoperative and postoperative best-corrected visual acuities were assessed with Early Treatment Diabetic Retinopathy Study charts and expressed in decimals. All patients showed statistically significant best-corrected visual acuity improvement and excellent anatomic results. Mean preoperative best-corrected visual acuity was 0.17 (range of 0.1-0.2). Mean postoperative best-corrected visual acuity was 0.84 (range of 0.63-1.00). Mean initial spherical equivalent refractive error was +11.85 (range of +9.00 to +15.00). Mean final spherical equivalent refractive error was -0.25 (range of -1.25 to +2.25). There were no postoperative complications during the whole follow-up. Fixation of a posterior chamber intraocular lens using a 27-gauge trocar-assisted transconjunctival sutureless intrascleral technique is an excellent option for aphakic patients secondary to cataract surgery complications with inadequate capsular support.

Post-cataract Surgery Fungal Endophthalmitis: Management Outcomes and Prognostic Factors

ABSTRACT Purpose: To describe the clinical and microbiological features, management outcomes, and prognostic factors of visual improvement in post-cataract surgery fungal endophthalmitis. Methods: We evaluated 17 patients with culture-confirmed fungal endophthalmitis following cataract surgery. Data were collected regarding intravitreal antibiotics and antifungals, pars plana vitrectomy (PPV), intraocular lens (IOL) explantation, and scleral-fixated IOL (SFIOL) implantation. Clinical outcomes were recorded in terms of visual acuity and management strategies. Results: PPV was performed as a primary procedure at first presentation in three eyes. Fourteen eyes (82.3%) received intravitreal voriconazole. IOL explantation was performed in four eyes, followed by an SFIOL implantation in three eyes. Six eyes additionally presented with keratitis. At the final follow-up, cases having visual acuity ≥6/60 doubled from 17.6% to 35.3%. Eyes receiving antifungals had a trend toward worse visual outcome. Conclusions: Corneal involvement in addition to endophthalmitis and the presence of Aspergillus terreus were found to be poor prognostic markers.

Flattened flanged intrascleral intraocular lens fixation technique

To evaluate the visual outcomes of the patients who had undergone sutureless scleral fixated IOL implantation operation in which a new modified Yamane technique called flattened flanged intrascleral intraocular lens fixation technique was applied. Forty-two eyes of 42 patients who had undergone scleral IOL fixation operation with Yamane technique comprised Group 1. The mean age of this group was 60.24 ± 14.3 (20-77) years. Out of 42 patients, 25 of them (60%) were males and 17 of them (40%) were females. Forty-three eyes of 43 patients who had undergone scleral IOL fixation operation with flattened flange technique comprised Group 2. The mean age of this group was 55.35 ± 15.77 (18-79) years. Out of 43 patients, 23 (53.4%) of them were males and 20 (46.6%) were females. There were no significant differences between two groups in respect to mean preoperative UCVA, postoperative UCVA, preoperative BCVA, and postoperative BCVA (p values 0.35, 0.11, 0.28, and 0.16, respectively). The mean postoperative UCVA and preoperative BCVA were significantly higher than those of preoperative values in both groups (p < 0.05). Intraoperative haptic sliding occurred in three eyes (7%) in the first group, and there was no intraoperative haptic sliding in the second group (0%) (p = 0.05). Postoperative IOL dislocation occurred in one eye (2.5%) in the first group, and there was no postoperative IOL dislocation in the second group (0%) (p = 0.32). In conclusion, this technique does not require sutures, decreases intraoperative haptic sliding, may provide more IOL stability and less tilt, and facilitates the implantation of the second haptic. For long-term results, further studies should be conducted.

Long-term results of aphakia management by scleral fixation intraocular lens placement with knotless transscleral Z-suture method

To evaluate the long-term refractive outcomes and complications of posterior chamber intraocular lens placement by scleral fixation surgery (SF-IOL) with the knotless Z-suture method. The authors retrospectively reviewed the medical records of patients who underwent SF-IOL placement with the Z-suture method between January 2010 and December 2018 and who attended a follow-up after at least 1year. Preoperative and postoperative best-corrected visual acuity (BCVA), anterior segment biomicroscopy, fundus examinations, and postoperative complications were evaluated. Lenticular astigmatism was calculated through the vector analysis method. One hundred thirty-six eyes of 136 patients (mean age 57.78 ± 22years, 98 male/38 female) were included in the study. Of the 136 patients, 67 (49.3%) had a complicated cataract, 50 (36.8%) had pseudoexfoliation syndrome, and 19 (14%) had a trauma history. The mean follow-up period was 50.83 ± 27months. The mean preoperative BCVA was 0.65 ± 0.24 LogMAR, and the postoperative BCVAs were: 0.40 ± 0.30 (p < 0.001) at 1year; 0.40 ± 0.30 (p < 0.001) at 2years; 0.41 ± 0.31 (p < 0.001) at 3years; 0.43 ± 0.32 (p < 0.001) at 5years; and 0.47 ± 0.24 (p = 0.03) at 8years. Complications included retinal detachment in 2 patients (1.5%), cystoid macular edema in 4 patients (2.9%), increase in intraocular pressure in 5 patients (3.6%), suture loosening in 3 patients (2.2%), and IOL dislocation in 3 patients (2.2%). Scleral fixation of IOL with knotless Z-suture technique is an effective method to correct aphakia, with reliable long-term results.

Trocar-assisted, flanged sutureless scleral-fixated intraocular lens implantation combined with silicone oil injection after penetrating keratoplasty surgery.

We describe a combined technique of trocar-assisted sutureless scleral-fixated intraocular lens implantation and silicone oil injection at the same session. Two 3 mm scleral tunnels were created 2 mm away from and parallel to the limbus with the 23-gauge vitrectomy trocars entering the sclera transconjunctivally at an angle of approximately 10° at the 3 o’clock and 9 o’clock meridians. After the 3-piece foldable IOL was delivered to the anterior chamber through the corneal incision, the tip of one of the IOL haptics was grasped with a 23-gauge serrated retinal forceps entered through the trocar located at the 3 o’clock meridian. Then the haptic was removed from the scleral tunnel together with the trocar out of the globe. The same procedure was applied to the other haptic. A transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. The ends of the haptics were cauterized to make a flange. The resultant flanges of the haptics were pushed back and fixed into the scleral tunnels. Perfluorooctane was taken out of the eye with vitreoretinal surgery and the silicone was injected into the eye to prevent hypotonia. No complications were seen intraoperatively or postoperatively. After 1-month follow-up period, IOL was seen stabilized.

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

Introduction: The modern cataract surgery is involved in implanting the posterior chamber intraocular lens (PCIOL) in the intact posterior capsule. However, the implantation of PCIOL is not possible in case of weak or no capsular support. In such situations, iris-claw lens (ICIOL) and scleral-fixated intraocular lens (SFIOL) remain as treatment options. Objective: The objective was to analyze the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications. Materials and Methods: It was a prospective study with 30 aphakia patients fulfilling inclusion criteria. These patients were divided into two groups with 15 in each group. Group I patients underwent ICIOL and other 15 patients in Group II underwent SFIOL implantation. Patients with preexisting ocular pathologies were excluded. The preoperative and postoperative evaluation was done for the follow-up period of 6 months. Results were analyzed with Chi-square test and t-test using SPSS software. Results: In ICIOL group, 86.67% of patients and 80.6% of SFIOL patients had final best-corrected visual acuity (BCVA) 6/18–6/6. The mean logMAR BCVA in both groups was comparable. The surgical time in ICIOL was significantly less than SFIOL group (P = 0.00). Suture-related complications were significantly more in the SFIOL group. Complications found in the ICIOL group were harmless. Conclusion: The visual outcome was found to be comparable in both groups. ICIOL requiring less surgical time with fewer complications was found to be a good alternative to SFIOL in correction of aphakia.

Scleral fixation of intraocular lenses.

To review current, effective and more popular techniques for scleral fixation of intraocular lens (IOLs) and IOL-capsular bag complex. Scleral fixation of IOLs became popular, originally with sutured scleral fixated IOLs and later the Scharioth technique of intrascleral haptic fixation. This was further developed as the Glued IOL technique which enjoys widespread adoption all over the world. Recently the Yamane technique has also become popular and is being widely adopted as well. Scleral fixated IOLs have evolved in the last 2 decades with technical modifications, extended indications and improvised instrumentation. Though sutured and sutureless techniques have been growing equally, the sutureless scleral fixation techniques have attracted special interest. Reduced suture-related complications, technical ease and high-quality functional outcomes may be possible reasons. Sutureless capsular bag fixation also has distinct advantages.

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.

Kill with cold.

We describe 2 cases of fungal ciliary body granuloma, and its effective management. Case 1: A 13-year-old boy, post corneal tear repair presented with endophthalmitis with superior ciliary body granuloma [Fig. 1]. Though pars plana vitrectomy (PPV) with amphotericin-B cleared the vitreous, the granuloma persisted. Systemic fluconazole 50 mg BD (3 weeks) had no effect. Microbiologically it was dematiaceous fungi.[1] Triple freeze thaw cryotherapy was applied under direct visualization excluding iris or the retinal surface. Patient showed a good response with complete regression in 3 days [Fig. 2]. He underwent secondary intraocular lens (IOL) implantation with best-corrected visual acuity (BCVA) of 20/80 after 8 weeks.Figure 1: Black arrows show yellowish granulomas hanging from the ciliary body superiorly behind the iris with vitreous exudates and green arrow shows site of corneal tear repairFigure 2: Postop 3 months, granuloma regressed completelyCase 2: A 36-year-old lady of 6 weeks postpartum, presented with the features suggestive of endogenous endophthalmitis. She underwent PPV and was found to have retinal detachments (RD) with subretinal exudates and a large granuloma arising from the ciliary body with posterior extension [Fig. 3]. Laser around necrotic areas with silicon oil infusion was done to reattach the retina. Though the vitreous aspirate had a negative yield, we continued systemic antifungal (voriconazole 200 mg BD × 2 weeks) in view of clinical profile.[23] Since her ocular condition deteriorated with enlarging granuloma, triple freeze thaw cryotherapy was applied directly over the granuloma. The lesion regressed completely. Visual rehabilitation with scleral fixated intraocular lens (SFIOL) was done 3 months later with a BCVA of 20/200.Figure 3: Fundus image after clearing of vitreous exudates at the first surgery shows an oil filled eye and outlined area depicts location of suspected granuloma to which cryotherapy was applied laterDiscussion The fungal infection of the eye, particularly of the posterior segment is difficult to treat. They usually follow a relapsing course with recurring infiltration and exudates, ultimately leading to phthisis bulbi. Cryotherapy has been previously mentioned in literature as salvage therapy for resistant fungal infiltrates of anterior segment and transplanted cornea.[45678] We similarly applied cryo probe for 8 to 10 s [Figs. 4 and 5] and allowed it to thaw for 1 whole min before refreezing. In conclusion, fungal granuloma of the ciliary body can be safely and effectively treated with triple freeze thawing.Figure 4: (a) Fundus image of the oil filled right eye after cryotherapy was applied to suspected granuloma area shown in Figure 3. (b) Area of scarring after triple freeze thaw cryotherapy and complete resolution of the granulomaFigure 5: Demonstrates technique of triple freeze thaw cryotherapy for intraocular fungal granuloma. Cryoprobe is applied over the area of ciliary body granuloma to freeze for 8–10 s and is allowed to thaw for 1 whole min before refreezing, cycle is done totally for three timesDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Clinical Outcomes of Iris vs. Scleral Intraocular Lens Fixation

Background: We aimed to compare the safety and efficacy of two techniques for the correction of subluxated posterior intraocular lens (IOL): scleral fixation (SFIOL) and iris fixation of IOL (IFIOL). Methods: 112 eyes of 105 patients that underwent SFIOL or IFIOL at the Kaplan Medical Center between 2008 and 2018 were retrospectively included, 73 eyes had SFIOL and 39 eyes had IFIOL. The main outcome measures were: operation time, postoperative visual acuity and intra and post-operative complications. Results: There was no significant difference in the mean operation time between SFIOL and IFIOL. The mean follow-up time was significantly longer for the IFIOL compared with the SFIOL (34 ± 31 vs. 14 ± 20 months, respectively [p>0.001]).Postoperative distance corrected visual acuity (DCVA) at the last follow-up was significantly better than the preoperative DCVA in both groups (SFIOL: 0.52 ± 0.49 vs. 1.20 ± 0.84, [p<0.001], and IFIOL: 0.75 ± 0.88 vs. 1.31 ± 0.81 [p<0.001], respectively [LogMar]). No difference in DCVA was found between the groups. Irregular pupil was found in 59% IFIOL vs. 20.5% of the SFIOL [p<0.001] and corneal edema was found in 10.3% of the IFIOL vs. 1.4% of the SFIOL [p=0.05]. No other differences in intra and post-operative complications were found between the two groups. Conclusion: Both IFIOL and SFIOL are effective and safe for the secure of IOL in the absence of adequate capsular support. Both techniques resulted in a significant improvement in DCVA. Pupil ovalization and corneal edema were more common in the IFIOL group. Longer follow-up was noticed at the IFIOL group.

A novel device for safe exteriorization of haptic in scleral fixation intraocular lens surgery.

The aim of this study was to describe a novel device that has been designed to facilitate anterior segment and novice surgeons to perform extraocular needle-guided haptic insertion technique (X-NIT) for scleral fixation intraocular lens surgery (SFIOL). We performed SFIOL surgery using X-NIT device in 21 eyes of 21 patients. The mean preoperative best-corrected visual acuity (BCVA) was 0.5 ± 0.2 logarithm of minimum angle of resolution (log MAR), which improved by one or more lines postoperatively in all eyes. There were no intraoperative complications. Postoperatively, we noted minimal corneal edema in one patient and dispersed vitreous hemorrhage in one patient. The sharpness and angulation of the needle and the haptic holding ability of silicone stopper were found to be satisfactory. The X-NIT device may potentially improve the safety of SFIOL procedures by minimizing intraocular maneuvers.