Scleral-sutured Posterior Chamber Research Articles

Refractive outcomes of scleral-sutured posterior chamber intraocular lenses in post-traumatic eyes.

To evaluate the refractive outcomes of scleral-sutured IOL 2mm posterior to the limbus in post-traumatic eyes using SRK/T formula. This single-center retrospective case series included 35 eyes from 35 post-traumatic patients undergoing scleral-suture of ErgomaX IOLs by a single experienced surgeon. Preoperative predicted refraction, procedure-related complications, and postoperative spherical equivalent (SE) at least 1month after surgery were recorded. The prediction error (PE) was calculated as the difference between the postoperative SE and preoperative predicted refraction. Of the 35 post-traumatic patients, 28 patients were aphakia without capsular support, and 7 patients were traumatic lens dislocation or subluxation. The mean age at surgery was 56.03 ± 14.56years and 28 patients were men (80%). The mean postoperative spherical equivalent (SE) and postoperative astigmatism were - 1.23 ± 0.82 D and 1.57 ± 1.14 D, respectively. The mean prediction error (ME) of SRK/T formula was - 0.17 D. The mean absolute error (MAE) was 0.48D. The prediction accuracy was 60.0% for refractive errors of ± 0.50 D and 85.7% for refractive errors of ± 1.00D. Multiple linear regression analyses revealed that IOL power has positive correlation with PE. Assumption of in-the-bag IOL position when calculating IOL (52501TY, ErgomaX) power for standardizing scleral-sutured IOL 2mm posterior to the limbus demonstrates acceptable refractive outcomes. The accuracy of IOL power calculation using the SRK/T formula for eyes needing low IOL power or high IOL power may be affected by the uncertain position of postoperative IOL and further studies are needed.

Angle-supported intraocular lens versus scleral-sutured posterior chamber intraocular lens in post-cataract surgery aphakic patients: two-year follow-up cost-effectiveness analysis.

To compare visual, anatomical and economical outcomes of patients with secondary anterior chamber intraocular lens (AC-IOL) implantation and secondary scleral fixated intraocular lens (SF-IOL) implantation. In this retrospective observational study, 38 aphakic patients after complicated phacoemulsification divided in two groups, AC-IOL group (17 patients receiving AC-IOL implantation) and SF-IOL group (21 patients receiving SF-IOL implantation). Corrected distance visual acuity (CDVA), patient reported visual outcome (VF-14) and endothelial cell density (ECD) were measured at baseline and two-year follow-up. Complication rate was registered. The global cost of each procedure and the incremental cost-effectiveness ratio (ICER) were calculated. No statistically significant difference was found in CDVA (logMAR 0.24 ± 0.17 vs. 0.32 ± 0.26, p = 0.27), VF-14 (68 ± 18 vs. 61 ± 20, p = 0.24), ECD (1456.48 ± 525.15 vs. 1341.71 ± 374.33, p = 0.48) and overall complication rate (p = 0.79) postoperatively between the SF-IOL group and the AC-IOL group. The ECD loss rate was significantly higher in the AC-IOL group (15.5% vs. 3.5%, p = 0.004). The average global cost of the two procedures was higher in the SF-IOL group (p < 0.005) and ICER showed an additional payment of 693 € for each patient in SF-IOL group against a saving of 186 endothelial cells 2 years postoperatively. AC IOL and SF-IOL implantation showed similar outcomes in terms of visual function and safety profile. Higher ECD loss was found in AC-IOL group. The global cost of implantation was significantly lower for AC-IOL, but the ICER seems to justify the SF-IOL implantation in patients with low ECD.

Secondary Intraocular Lenses by the Retinal Surgeon: from Sclerotomies to Sutures

In an eye without capsular support, there are several options for the ophthalmologic surgeon including anterior chamber IOLs (ACIOLs), iris-sutured IOLs, scleral-sutured posterior chamber IOLs (SSIOLs), and sutureless scleral-fixated posterior chamber IOLs (SFPCIOLs). This review aims to discuss the advent and advancement of each of these devices along with the newest techniques for the retinal surgeon to use when specifically placing SSIOLs and SFPCIOLs. Surgical comfort limits the use of newer SSIOLs and SFPCIOLs but they are equally successful in addressing aphakia in eyes without capsular support when compared to earlier ACIOLS and iris-sutured IOLs. Modern techniques have propelled the use of SSIOLs and SFPCIOLs especially amongst retinal specialists, but all lenses can be used effectively in the appropriate clinical situations.

Reverse pupillary block after implantation of a scleral-sutured posterior chamber intraocular lens: a retrospective, open study

BackgroundTo report the clinical features of patients with reverse pupillary block (RPB) after scleral-sutured posterior chamber intraocular lens (PC IOL) implantation and biometric changes after laser peripheral iridotomy (LPI).MethodsEight patients attending our hospital’s ophthalmology outpatient clinic, who developed RPB after implantation of a scleral-sutured PC IOL due to subluxation of the crystalline lens or IOL, were investigated in this retrospective, observational study.ResultsPreoperative evaluations showed angle pigmentation in all cases and iridodonesis in 2 cases. Two subjects had used an α1A-adrenoceptor antagonist for benign prostatic hyperplasia. Pars plana or anterior partial vitrectomy was performed in all cases. All eyes showed an extremely deep anterior chamber, a concave iris configuration, and contact between the IOL optic and the iris at the pupillary margin. Pupil capture was detected in 2 cases. The mean (± SD) anterior chamber angle (ACA) was 89.91 ± 10.06°, and the anterior chamber depth (ACD) was 4.42 ± 0.16 mm before LPI. After LPI, the iris immediately became flat with a decreased ACA (51.70 ± 2.59°; P = 0.018) and ACD (4.14 ± 0.15 mm; P = 0.012). After LPI, the intraocular pressure decreased from 19.75 ± 3.77 mmHg to 15.63 ± 4.30 mmHg (P = 0.011), and the spherical equivalent decreased from -0.643 ± 0.385 D to − 0.875 ± 0.505 D (P = 0.016).ConclusionConcomitant vitrectomy, angle pigmentation, and iridodonesis may be risk factors for RPB after scleral-sutured PC IOL implantation. LPI is effective for relieving the RPB.

Anterior Chamber Stabilization in Combined Penetrating Keratoplasty With Scleral-Sutured Posterior Chamber Intraocular Lens Implantation.

To describe a novel technique for a stabilized penetrating keratoplasty procedure with implantation of a scleral-sutured posterior chamber intraocular lens in which the anterior chamber (AC) is maintained and the globe stabilized without using a Flieringa ring. In this procedure, a deep anterior corneal lamella separation was created. Four small incisions were made in each quadrant along the outer edge of the trephination groove of the residual stromal bed (RSB). The first incision at the 9-o'clock position was advanced with scissors in both clockwise and counterclockwise directions. This procedure was repeated in the remaining 3 quadrants, creating 4 small bridges between the RSB and corneal rim. A donor corneal button coated with a viscoelastic material was sutured at 3 incision sites leaving 1 quadrant sutureless to allow sufficient incision width for IOL insertion for scleral fixation. Scleral fixation of a 1-piece polymethyl methacrylate (PMMA) IOL was performed. After sequential cutting of the bridges, the RSB was removed from the AC. Ten eyes of 10 patients underwent this procedure without significant complications. There were no complications related to the open-sky procedure. Globe stabilization was achieved in all surgeries. Endothelial cell loss, visual acuities, and graft failure rates were comparable with the reports of AC-protecting penetrating keratoplasty surgeries. This technique provides a secured AC and stabilized globe without the use of a Flieringa ring and increases the surgical safety without a significant reduction of the graft endothelial cell density.

Long-Term Outcome of Combined Penetrating Keratoplasty With Scleral-Sutured Posterior Chamber Intraocular Lens Implantation

To evaluate the long-term outcomes of combined penetrating keratoplasty (PKP) with scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. Medical records from patients with aphakic and pseudophakic bullous keratopathy were retrospectively reviewed for preoperative indications and postoperative results of 105 consecutive patients (105 eyes) who underwent combined PKP and scleral-sutured PC-IOL implantation over a 13-year period. Main outcomes measures were graft survival rate, visual acuity, and intraoperative and postoperative complications. The principal indications for PKP were pseudophakic and aphakic corneal edema. Graft survival rates were 97% at 1 year, 91% at 2 years, 75% at 5 years, and 68% at 7 years. Mean postoperative follow-up was 44.8 +/- 37.0 months (range 1-156). The best-corrected visual acuity improved at least 1 line on the Snellen chart in 59.0% of the patients, with 42.9% of the eyes achieving acuities of 20/100 or better. Postoperative complications included new glaucoma in 21.4%, worsening of pre-existing glaucoma in 28.6%, cystoid macular edema in 17%, infectious endophthalmitis in 3.8%, and intraocular lens dislocation in 1.9%. No intraoperative complications were encountered. PKP combined with scleral-sutured PC-IOL implantation can achieve acceptable outcomes with a low rate of intraocular lens dislocation, but may be associated with significant short and long-term complications.

Limbal Lensectomy with or without Anterior Vitrectomy for the Management of Lens Subluxation

Purpose : This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. Materials and Methods : The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. Results : All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. Conclusion : Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.

Late dislocation of scleral-sutured posterior chamber intraocular lenses

To examine a recent series of late scleral-sutured posterior chamber intraocular lens (PCIOL) dislocations to identify possible causes and preventive measures. Price Vision Group, Indianapolis, Indiana, USA. In this retrospective non-comparative interventional case series, 5 consecutive patients received treatment for dislocated scleral-sutured PCIOLs between July 2002 and March 2004. Dislocated lenses were resutured or replaced with another scleral-sutured PCIOL. Dislocation of scleral-sutured PCIOLs occurred 7 to 14 years after implantation. Four dislocations were spontaneous, and 1 was precipitated by trauma. In each case, the suture affixing 1 or both haptics failed. There was no evidence that the suture had eroded through the tissue or that the knot had untied. Microscopic analysis of an explanted IOL with remnants of the suture attached showed localized degradation and cracking of the polypropylene suture material where it had been embedded in the scleral tissue. Suture-fixated PCIOLs can dislocate due to degradation of the suture material over time. The use of larger diameter (9-0 instead of 10-0) polypropylene suture material and placement of the haptic and sutures in the ciliary sulcus to promote attachment of scar tissue may enhance the long-term stability of scleral-fixated PCIOLs.

Intraocular lens implantation in the absence of capsular support: A report by the American Academy of Ophthalmology

Objective This review was conducted to determine the safety and efficacy of open-loop anterior chamber, scleral-sutured posterior chamber, and iris-sutured posterior chamber intraocular lenses (IOLs) in eyes with inadequate capsular support for posterior chamber implantation in the capsular bag or ciliary sulcus. It also attempted to determine whether there is a preferred IOL or fixation site of choice in eyes with inadequate capsular support. Methods A literature search conducted for the years 1980 to 2001 yielded 189 citations related to IOL implantation in the absence of capsular support. An update search, conducted in March 2002, yielded an additional 28 articles. The Anterior Segment Panel members reviewed these abstracts and selected 148 articles of possible clinical relevance for review. Of these, 89 were considered sufficiently clinically relevant for the panel methodologist to review and rate according to the strength of evidence. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating was assigned to well-designed cohort and case-control studies; and a level III rating was assigned to case series. Articles comparing the safety and efficacy of the IOL type and fixation site were further evaluated for the quality of the statistical methods used in the study. Studies with a rating of A or B were considered acceptable, C was borderline, and D and F were considered unacceptable as medical evidence. Results Forty-three articles with data concerning outcome of IOL insertion in eyes with inadequate capsular support had an evidence rating of level III or higher and were used in the final review of the safety and efficacy of one or more lens types and/or fixation sites. Seven articles had data about more than one lens type. Six had a statistical method rating of C or higher and were used to evaluate differences in visual outcomes and complication rates between lens types and fixation sites. Conclusions The literature supports the safe and effective use of open-loop anterior chamber, scleral-sutured posterior chamber, and iris-sutured posterior chamber IOLs for the correction of aphakia in eyes without adequate capsular support for placement of a posterior chamber lens in the capsular bag or ciliary sulcus. At this time, there is insufficient evidence to demonstrate the superiority of one lens type or fixation site. Precise determination of small differences in visual outcome or complication rates will require a large prospective, randomized clinical trial.

Implantation of Scleral-sutured Posterior Chamber Intraocular Lenses During Penetrating Keratoplasty

To evaluate the clinical outcome in 29 patients (29 eyes) who underwent penetrating keratoplasty and scleral-fixation of an intraocular lens. The indications for penetrating keratoplasty with scleral-fixation of an intraocular lens were anterior chamber pseudophakic corneal edema, aphakic corneal edema, trauma, and corneal scars. Patients with pseudophakic corneal edema underwent IOL exchange and penetrating keratoplasty and patients with lens subluxation underwent cataract extraction and penetrating keratoplasty in the same operation session. Preoperative spectacle-corrected visual acuity was hand motion in 13 eyes (44.8%) and 20/400 in 18 eyes (61.5%). Postoperative spectacle-corrected visual acuity of 20/400 or better was observed in 25 eyes (86.2%). At last follow-up, 26 corneal grafts (89.7%) remained clear. Three grafts (10.3%) failed, two because of glaucoma and one because of endophthalmitis. Glaucoma was observed in 7 eyes. Trans-scleral fixation of intraocular lenses combined with penetrating keratoplasty was a useful surgical technique in eyes with keratopathy and lacking posterior capsular support.

P 182 Secondary implantation with open loop intra ocular lens in the anterior chamber versus scleral sutured posterior chamber lens during penetrating keratoplasty (PK)

P 182 Secondary implantation with open loop intra ocular lens in the anterior chamber versus scleral sutured posterior chamber lens during penetrating keratoplasty (PK)

Secondary implantation with open loop intra ocular lens in the anterior chamber versus scleral sutured posterior chamber lens during penetrating keratoplasty (PK)

Secondary implantation with open loop intra ocular lens in the anterior chamber versus scleral sutured posterior chamber lens during penetrating keratoplasty (PK)