Scleral Fixation Research Articles

Efficacy of Sutureless Scleral Fixation of One-Piece T-Shaped Haptic Intraocular Lens in Maintaining Anterior Chamber Stability During Descemet Membrane Endothelial Keratoplasty in Vitrectomized Eyes: Leak Test and Iris Diaphragm Reconstruction

Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from −1.00 to −0.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 μm (range: 651 to 701) at baseline visit and 541.5 μm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction.

Research on the Z.S. technique for 8 − 0 polypropylene suture in scleral fixation of one-piece intraocular lens

BackgroundTo introduce a new flange technique (called the Z.S. fixation technique) for 8 − 0 polypropylene suture in scleral fixation of a one-piece intraocular lens (IOL) and evaluate its effectiveness and safety.MethodsAll surgeries were performed using two strategies. First, the Z.S. fixation technique was used to fix 8 − 0 polypropylene sutures to the sclera and the two haptics of a one-piece IOL, respectively. The one-piece IOL previously implanted in the anterior chamber was then relocated to the posterior chamber. Finally, the suture ends outside the sclera were cauterized into flanges and buried in the sclera. All effectiveness and safety data related to the Z.S. technique were recorded and compared.ResultsThe Z.S. fixation technique was employed in 16 eyes of 13 patients, with a follow-up duration of at least 6 months. Postoperative uncorrected distance visual acuity (UDVA) was greatly improved in most of the operated eyes (11/16). The mean log MAR UDVA after surgery was significantly improved compared with that before surgery (0.93 ± 0.72 vs. 1.53 ± 0.73, P = 0.002). IOLs in the vast majority of operated eyes (15/16) remained stable during half-year follow-up. No severe intra-/post-operative complications were observed in any of the operated eyes.ConclusionThe Z.S. fixation technique for 8 − 0 polypropylene suture in scleral fixation of one-piece IOL reduced surgical injuries and had ideal surgical effectiveness and safety.

Macular Outer Retinal Atrophy Following Vitrectomy and Hypotony: Two Cases.

To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy. Retrospective chart review of two patients' records between 2019 and 2023. Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week post-operatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the IOL dislocated and was exchanged with scleral fixation of a new IOL. On post-operative day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on post-operative day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable over years but resulted in reduced central vision. Hypotony following vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.

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.

New Approach to Secondary Implantation: Sutureless Scleral Fixation with the Carlevale FIL-SSF Implant (A Prospective Study Regarding 24 Cases)

The management of aphakia in the absence of capsular support is becoming increasingly common, largely due to the rising incidence of implant dislocations [1]. This scenario presents a significant surgical challenge, with several options available: anterior chamber implantation (using an angulated support lens or an iris-claw lens on the anterior surface of the iris), posterior fixation to the iris (with either an iris-claw lens or sutures), or scleral fixation (with or without sutures). Each approach has its own set of advantages, disadvantages, and potential complications. Despite the advancements in techniques reported by various authors in recent years [2, 3], there is still no consensus on the optimal approach. The Carlevale FIL-SSF implant, a novel hydrophilic lens specifically designed for sutureless scleral fixation and placement in the ciliary sulcus, has shown promising results in recent publications [4-6]. We conducted a prospective interventional study at the Intercommunal Hospital Center of Villeneuve-Saint-Georges, Île-de-France, Paris, including 24 eyes diagnosed with aphakia, subluxation or dislocation of an intraocular implant. All our patients consulted in the ophthalmology department between March 2023 and December 2023. Our patients underwent secondary implantation surgery by Sutureless scleral fixation technique (SSF) with a Carlevale-type lens (Soleko, Italy). The post-operative follow-up was adjusted to the evolution of each case, with a minimum of 6 months' follow-up. It included at each visit the assessment of the best corrected visual acuity (BCVA), refraction, Intra-ocular pressure, clinical ophthalmic examination, implant centering, endothelial cellularity count and the occurrence of peri- and post-operative complications. Seven women and seventeen men were included in the study. The mean age was 62.55 years. The surgical indications were posterior chamber implant dislocation in 11 cases, secondary implantation due to post-traumatic ......

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.

Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block

To compare clinical outcomes, reverse pupillary block (RPB) findings and anterior segment parameters in patients with and without intraoperative peripheral iridectomy during sutureless flattened flange intrascleral intraocular lens (IOL) fixation. Retrospective comparative case series. This study included 94 eyes of 82 patients who underwent IOL explantation due to vitreous-dislocated IOL at our clinic between March 2020 and September 2023, followed by flattened haptic-tipped IOL intrascleral fixation combined with pars plana vitrectomy (PPV). The patients were divided into two groups: Group 1 (n=54) underwent peripheral iridectomy during surgery, while Group 2 (n=40) did not undergo surgical peripheral iridectomy. Anterior chamber depth (ACD), anterior chamber angle (ACA) and white-to-white (WTW) distance were measured with Scheimpflug imaging. Visual outcomes, ACD, ACA, spherical equivalence (SE), intraocular pressure (IOP), complications, and secondary interventions were evaluated. There was no significant difference between the two groups preoperatively in terms of IOP, ACD, ACA, WTW distance, and axial length (p > 0.05). Postoperatively, the mean ACD was significantly less in Group 1 (3.79 ± 0.67 mm) than in Group 2 (4.11 ± 0.75 mm) (p = 0.03). Postoperative IOP was 15.51 ± 2.48 mmHg in group 1 and 18.20 ± 4.51 mmHg in group 2 (p < 0.001). The postoperative ACA was statistically significantly shallower in Group 1 (41.72 ± 3.47 degrees) than in Group 2 (52.45 ± 17.93 degrees) (p < 0.001). Postoperatively, RPB developed in 10 eyes (25.0%) in Group 2, while it was not observed in any patient in Group 1 (p < 0.001). In Group 2, pupillary capture developed in 4 cases (10%) in addition to RPB. Laser peripheral iridotomy was performed in cases with RPB. After laser peripheral iridotomy, mean IOP, mean ACA and ACD also decreased significantly (p < 0.001). Intraoperative peripheral iridectomy during scleral fixation surgery combined with PPV leads to significantly less RPB, a more stable anterior chamber, and fewer complications. Laser peripheral iridotomy was very useful in managing RPB that developed in the postoperative period.

Structural integrity of eyelets in a hydrophobic intraocular lens with four-point scleral fixation.

Structural integrity of eyelets in a hydrophobic intraocular lens with four-point scleral fixation.

A novel 4-point scleral fixation technique with a hydrophobic IOL: The LOTO technique.

to describe a new surgical technique that combines 4-point, flanged polypropylene scleral fixation with a hydrophobic IOL. Using the Envista MX60 and 6.0 polypropylene, scleral 4-point fixation was achieved using a flanged-suture technique 5 times in a model eye and in a case series of 8 patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration (LOTO: Loop to Optic and Trailing ends to Outside). Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy (SEM) at fracture sites were studied. Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the LOTO and the simple-pass technique (1.08 ± 0.52 N vs 1.09 ± 0.32 N), suggesting no safety compromise. SEM did not disclose cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3 to 19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity (BAPUCVA) of 20/25-20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9 degrees (range: 0 to 9.6; median: 2.9 degrees). Two patients developed post-operative CME treated topically. The first case developed flange extrusion that was readily repaired in clinic. This novel technique adds 2 main advantages to previously described flanged-suture techniques: 1) 4-point fixation of a hydrophobic IOL and 2) immediate application at the time of initial complicated cataract surgery since it requires no additional supply, IOL, or instrumentation.

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.

Incidence of Akreos AO60 intraocular lens opacification after concurrent or subsequent intraocular oil or gas use.

To report the incidence of opacification in a consecutive series of 10 eyes that underwent scleral fixated Akreos AO60 placement with concurrent or subsequent contact with gas or silicone oil. Consecutive case series. Three cases of IOL opacification were noted. Two cases of opacification occurred in patients that underwent subsequent retinal detachment repair with C3F8 and one with silicone oil. One patient underwent explanation of the lens due to visually significant opacification. Scleral fixation of the Akreos AO60 IOL is associated with risk of IOL opacification when exposed to intraocular tamponade. While surgeons should consider the risk of opacification in patients at high risk of requiring intraocular tamponade, only 1 in 10 patients developed IOL opacification significant enough to require explantation.

Modified technique for sutured scleral fixated intraocular lens in a patient with post-traumatic aniridia and aphakia: a case report

BackgroundA modified surgical technique of sutured scleral fixated intraocular lens (SSF-IOL) was applied in a patient with post-traumatic aniridia and aphakia.Case presentationA 51-year-old man was referred to our clinic with decreased vision (finger count) in his right eye. This patient had previously undergone primary repair of the ruptured globe and pars plana vitrectomy to manage ocular trauma in the same eye. On presentation, the best corrected visual acuity in his right eye was 20/40. The slit lamp examination of his right eye revealed loss of total iris and lens. Corneal endothelial cell density was 1462 cells/mm2. Fundoscopic examination of the right eye revealed a retinal attachment. For IOL implantation, a rigid poly methyl methacrylate IOL was used with a 2-point scleral fixation performed using a polypropylene suture. One year postoperatively, the uncorrected distance visual acuity was 20/32, and the manifest refraction was − 0.5/–1.5 × 130 (20/20). Pentacam revealed that the astigmatism of the anterior corneal surface and the total cornea was 1.1 D (axis: 59.8°) and 1.0 D (axis: 35.6°), respectively. The horizontal (3°–183°) cross-section image displayed an IOL with a 1° tilt and 0.425 mm decentration. The patient reported no dysphotopsia or photophobia and was satisfied with the visual results. OPD-scan III revealed that higher-order aberrations in the right eye were slightly higher than those in the left eye. No suture-related or other serious complications were observed.ConclusionThe modified SSF-IOL technique can offer improved visual quality for patients with aniridia and aphakia by ensuring proper IOL positioning and reducing astigmatism.

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.

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.].

Anterior Chamber Intraocular Lens Implantation Versus Four-Flanged Scleral Fixation Technique for Patients With Loss of Capsular Support During Routine Cataract Surgery.

To compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment. Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group (P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group (P = .04). This association remained significant using survival analysis (P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group (P = .042). In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [J Refract Surg. 2024;40(8):e520-e526.].

SING IMT in pseudophakic eyes: Results of the first experiences

PurposeTo evaluate the feasibility and outcomes of implanting the Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT) in pseudophakic patients affected by late-stage dry AMD. SubjectsFive pseudophakic patients’ eyes with stable dry AMD were suitable for SING IMT implantation. Four eyes were excluded because of previous YAG laser capsulotomy. Patients underwent preoperative assessments, including visual acuity measurements and OCT scans. MethodsSurgical procedures were performed under peribulbar anesthesia, with careful IOL removal and SING IMT implantation. Postoperative follow-up was conducted at regular intervals to monitor visual acuity, device positioning and complications. ResultsPostoperative outcomes demonstrated improvements in visual acuity for most patients with an average gain in CDVA (Corrected Distance Visual Acuity) and CNVA (Corrected Near Visual Acuity) of 16,8 ± 10,2 and 13,8 ± 7,4 ETDRS letters, respectively. Limited complications have been observed. In one case, we observed dislocation of the device into the vitreous chamber, which we managed through vitrectomy and scleral fixation of the SING IMT using GoreTex suture. ConclusionsDespite being traditionally contraindicated for pseudophakic patients, SING IMT implantation in selected cases yielded favorable outcomes, indicating potential benefits for this population. Further research with larger sample sizes and longer follow-up periods is warranted to refine patient selection criteria and optimize surgical techniques.

Long-Term Postoperative Outcomes Following Cionni Ring and In-the-Bag Intraocular Lens Implantation in Eyes With Subluxated Lenses

Evaluate long-term outcomes following Cionni modified capsule tension ring (MCTR) and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. Retrospective case series. Forty-one eyes of 31 patients from Raghudeep Eye Hospital, India, with subluxated lenses who had completed a minimum of 5 years' postoperative follow-up were included. Lens extraction, capsular bag fixation with MCTR using 9-0 polypropylene suture, and in-the-bag IOL implantation were performed in all eyes. Corrected distance visual acuity (CDVA), IOL centration, posterior capsule opacification, glaucoma, and retinal complications were documented at final follow-up. The mean age of the cohort was 20.48 ± 16.46 (SD) years. Twenty-four eyes (58%) were below 15 years of age at the time of surgery. Marfan syndrome accounted for 37% cases. Mean follow-up was 9.89 ± 3.81 (SD) years. Thirty-two eyes (74%) had a CDVA of ≥0.3 logMAR at final follow-up. IOL decentration was noted in 7 eyes (17%), requiring a secondary surgery. The mean duration from primary surgery to resurgery was 8.79 years. Seventeen eyes (41%) required a laser capsulotomy, 88% of which were pediatric eyes. Retinal detachment occurred in 4 eyes (10%), 3 of which had Marfan syndrome. Capsular bag fixation with an MCTR using 9-0 polypropylene and in-the-bag IOL implantation had good long-term visual outcomes with an acceptable rate of serious postoperative complications in eyes with subluxated lenses. This approach allows preservation of the natural compartments of the eye and placement of an IOL in its most physiological position. However, considering a 17% rate of IOL decentration requiring surgical intervention, long-term stability with nonbiodegradable suture materials such as polytetrafluoroethylene as well as decentration rates following sutured or sutureless scleral fixation should be compared.

Comparison of outcomes between modified double-flanged sutureless scleral fixation and conventional sutured scleral fixation

This retrospective study aimed to compare the outcomes of modified double-flanged sutureless scleral fixation versus sutured scleral fixation. Medical records of 65 eyes from 65 patients who underwent double-flanged scleral fixation (flange group) or conventional scleral fixation (suture group) between 2021 and 2022 were reviewed. Visual and refractive outcomes, as well as postoperative complications, were compared 1, 2, and 6 months after surgery. We included 31 eyes in the flange group and 34 eyes in the suture group. At 6 months postoperatively, the flange group showed better uncorrected visual acuity (0.251 ± 0.328 vs. 0.418 ± 0.339 logMAR, P = 0.041) and a smaller myopic shift (− 0.74 ± 0.93 vs. − 1.33 ± 1.15 diopter, P = 0.007) compared to the suture group. The flange group did not experience any instances of iris capture, while the suture group had iris capture in 10 eyes (29.4%; P < 0.001). In the flange group, all intraocular lenses remained centered, whereas in the suture group, they were decentered in 8 eyes (23.5%; P = 0.005). The double-flanged technique not only prevented iris capture and decentration of the intraocular lens but also reduced myopic shift by enhancing the stability of the intraocular lens.

Gonioscopy-assisted transluminal trabeculotomy (GATT) with scleral or iris fixation for subluxated intraocular lenses and glaucoma.

This retrospective chart review aims to report a combined surgical approach of intraocular lens (IOL) fixation and gonioscopy-assisted transluminal trabeculotomy (GATT) for the treatment of subluxated IOLs and glaucoma or ocular hypertension. Charts of patients who underwent IOL fixation combined with GATT between November 2019 and July 2023 were reviewed. The main outcome measure was surgical success, defined as a well-centered IOL and an IOP of 18 mmHg or lower and either a 30% IOP reduction or a reduction in medications as compared to baseline. Complications and the need for reoperation were recorded. Eleven patients who underwent GATT with IOL fixation were included. The mean age was 80.45 years (range: 73-90). IOL subluxation was associated with pseudoexfoliation in all cases. Seven patients underwent scleral fixation, and four underwent iris fixation. The mean follow-up was 15.36 (range: 2.7-26.6) months. The success rate was 72.73%. The mean baseline IOP was 20.63 ± 6.56 mmHg on 2.81 ± 1.53 medications. Four patients were on oral carbonic-anhydrase inhibitor (CAI) before surgery. The mean IOP at the end of the follow-up was 13.86 ± 3.5 mmHg on 1.36 ± 1.57 medications, and none were on oral CAIs. No intraoperative complications occurred, and transient hyphema and vitreous hemorrhage were the most common postoperative complications. All patients had a well-centered IOL. No patients needed additional surgery for IOL position or IOP control. The mean corrected distance visual acuity was 0.634 ± 0.62 logMAR at baseline and 0.36 ± 0.38 at the end of follow-up. GATT can be combined with IOL fixation to the sclera or iris to effectively reduce IOP and medication usage.