Sulcus-fixated Intraocular Lens Research Articles

Polypseudophakia: from "Piggyback" to supplementary sulcus-fixated IOLs.

Polypseudophakia, the concept of using a second intraocular lens (IOL) to supplement an IOL that has already been placed in the capsular bag, was first used as a corrective measure where the power requirement was higher than that of available single IOLs. Subsequently, the technique was modified to compensate for post-operative residual refractive errors. In these early cases, an IOL designed for the capsular bag would be implanted in the sulcus.Although these approaches were less than ideal, alternative means of correcting residual refractive errors were not without their limitations: IOL exchange can be traumatic to the eye and is not easily carried out once fibrosis has occurred, while corneal refractive surgical techniques are not suitable for all patients.Piggyback implantation was the term first coined to describe the use of two IOLs, placed together in the capsular bag. The term was later extended to include the procedure where an IOL designed for the capsular bag was placed in the sulcus. Unfortunately, the term piggyback has persisted even though these two approaches have been largely discredited.Intraocular lenses are now available which have been specifically designed for placement in the ciliary sulcus. As these newer IOLs avoid the many unacceptable complications brought about by both types of earlier piggyback implantation, it is time to employ a new terminology, such as supplementary IOL or secondary enhancement to distinguish between the placement of an unsuitable capsular bag IOL in the sulcus and the implantation of an IOL specifically designed for ciliary sulcus implantation.In addition to minimising possible complications, supplementary IOLs designed for the sulcus have expanded the options available to the ophthalmic surgeon. With these new IOLs it is possible to correct presbyopia and residual astigmatism, and to provide temporary correction of refractive errors in growing, or unstable, eyes. This article aims to review the literature available on supplementary IOL implantation in the ciliary sulcus and to summarise the evidence for the efficacy and safety of this intervention. KEY MESSAGES: What is known Polypseudophakia has been used for over 30 years to correct hyperopia or residual refractive error, but early techniques were associated with significant complications. What is new The development of specially designed sulcus-fixated supplementary IOLs significantly reduces the risks associated with these procedures, and has also opened up new opportunities in patient care. The reversibility of the procedure allows patients to experience multifocality, and to provide temporary and adjustable correction in unstable or growing eyes. The terms "secondary enhancement" or "DUET" to describe supplementary IOL implantation are preferential to "piggyback".

Surgical outcomes of intraocular lens iris suture fixation in eyes with residual capsule support

Purpose: To evaluate the safety and refractive outcomes of eyes after intraocular lens (IOL) iris suture fixation (ISF). Setting: Private practice, Los Angeles, California. Design: Nonrandomized and unmasked retrospective chart review. Methods: Eyes that underwent IOL exchange or repositioning with ISF with at least 270 degrees of capsular support were included. Eyes with less than 270 degrees of capsular support and eyes with iris damage were excluded. The primary outcome measures included incidence of cystoid macular edema (CME), IOL dislocation requiring refixation, and chronic inflammation. Secondary outcome measures included worsening intraocular pressure (IOP) control, retinal tear or detachment, worsening of corrected distance visual acuity (CDVA), and corneal decompensation. Refractive outcomes for 26 subgrouped eyes included mean and median spherical equivalent refraction accuracy (SERA), and percentage of eyes within 0.5 diopter (D) and 1 D of the refractive target. Results: The study included 53 eyes of 50 patients. CME: 2/53 (3.8%), IOL dislocation requiring refixation: 2/53 (3.8%), chronic inflammation: 1/53 (1.9%), worsening IOP control: 5/53 (9.4%), retinal tear or detachment: 2/53 (3.8%). No patient experienced worsening of CDVA from baseline or corneal decompensation. Mean SERA ± SD −0.35 ± 0.29 D, median SERA −0.37 D. Of the 26 eyes subgrouped for refractive analysis, 73% were within 0.5 D and 100% were within 1 D of the desired refractive outcome. Conclusions: ISF can offer stability for sulcus-fixated IOLs provided there is some residual capsule support. Although there are measurable complications, there is a relatively low side effect profile. The refractive error tended to be myopic, indicating the need for further refinement of IOL power predictive formulas.

Simulations of Decentration and Tilt of a Supplementary Sulcus-Fixated Intraocular Lens in a Polypseudophakic Combination Using Ray-Tracing Software

This study aimed to assess image quality after the tilt and decentration of supplementary intraocular lenses (IOLs) in a two-lens configuration. One was designed for sulcus fixation with a nominal power range of 1D–10D and was combined with a capsular fixation 20D IOL. The optical performance of a ray-tracing model was tested under IOL misalignment through the area under the modulation transfer function (MTFa) and wave aberrations. Tilting by 10° resulted in a 4% reduction of the MTFa for a 10D IOL as compared to 9% for the 20D lens. The two models demonstrated good tolerance to a 1 mm decentration; as for the 10D sulcus-fixated lens, the MTFa loss was 2%, and 4% for the capsular fixation lens. Coma and astigmatism increased three- and four-fold, respectively, after a 10° tilt compared to the aberration level induced by the 1 mm decentration. Both analyses showed a trend towards a lower MTF impact and fewer optical errors with decreasing nominal power. In conclusion, when misaligned, low-power sulcus-fixated IOLs might retain their good optical quality. An extreme tilt of 10° has a more detrimental effect on the IOL performance than a 1 mm decentration. The proper alignment of a high-power capsular fixation lens is important in achieving a desirable postoperative outcome.

Visual Outcomes and Patient Satisfaction After Bilateral Sequential Implantation of a Capsular Bag IOL and a Supplementary Sulcus-Fixated Trifocal IOL.

To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL. All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively. Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients. Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.].

Safety of piggyback intraocular lenses (polypseudophakia) in children: long-term outcomes of a 15-year, single-surgeon study

To report the outcomes of piggyback (PB) intraocular lens (IOL) implantation, or temporary polypseudophakia, in children who have undergone cataract surgery and to assess their safety in pediatric patients. The medical records of consecutive patients who underwent PB IOL implantation at a single institution over a period of 15years were reviewed retrospectively. Outcome measures were reoperation rate, complications, and outcome of planned explantation. A total of 48 eyes of 38 children received PB IOL implantation: 40 eyes at the time of cataract surgery and 8 eyes as a later secondary procedure. Of these, 38 eyes of 31 patients with primary PB IOL implantation had follow-up of >3years and were included in the present analysis. Median age at cataract surgery with PB IOL implantation was 6.5months (0.5months to 2.4years). Median follow-up was 12.5years (range, 3.0-20.7). Four eyes required reoperation for adverse events related to PB IOL implantation (1 each for IOL tilt, pupillary capture, pupillary block glaucoma, and pupillary membrane). All 4 of these eyes were operated for cataract before 3months of age. The sulcus-fixated PB IOL underwent a planned explantation in 33/38 eyes. Eight eyes needed intraocular pressure-lowering topical medications. Planned PB IOL explantation was uncomplicated in our series. Early complications occurred in 4 eyes, but late complications were not noted, and glaucoma developed at predictable rates for this population. Piggyback IOL placement in our cohort of young children appears to have an acceptable safety profile.

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.

Effect of a sulcus-fixated piggyback intraocular lens on negative dysphotopsia: Ray-tracing analysis

To use optical modeling to demonstrate how a sulcus-fixated piggyback intraocular lens (IOL) affects negative dysphotopsia. Mayo Clinic, Rochester, Minnesota, USA. Retrospective case series. Optical modeling was performed on 3 patients with negative dysphotopsia who were treated with a sulcus-fixated piggyback IOL. Ray-tracing software was used to simulate peripheral retina illumination preoperatively and postoperatively. Biometric data and ultrasound biomicroscopy images were used to construct eye models. Ray intensities were adjusted for surface reflections and normalized by cosine function to compensate for pupil obliquity at high incident angles. Preoperatively, retinal illumination profiles showed a region of dim or nonilluminated peripheral nasal retina at visual angles of approximately 83 to 95 degrees. A piggyback IOL shifted the iris anteriorly (mean 0.41mm; range 0.37 to 0.47mm) and the primary IOL posteriorly (mean 0.10mm; range 0.05 to 0.19mm) and increased the mean distance between the iris and primary IOL from 0.46mm preoperatively to 0.75mm postoperatively. This increased distance allowed input rays to begin missing the primary IOL at lower incident angles (≥76 degrees) compared with preoperatively (≥84 degrees), resulting in increased illumination of the peripheral retina. Illumination of the peripheral retina, including the preoperative dark area, was increased in 2 patients. The negative dysphotopsia shadow resolved in 2 eyes and was unchanged in 1 eye. In negative dysphotopsia patients, a secondary piggyback IOL allowed additional light to miss the primary IOL and illuminate larger areas of peripheral retina. Increased illumination of the peripheral retina that included the preoperative dark region was associated with improved negative dysphotopsia postoperatively.

Effect of supplementary implantation of a sulcus-fixated intraocular lens in patients with negative dysphotopsia

To evaluate whether the outcome of negative dysphotopsia treatment by implantation of a Sulcoflex intraocular lens (IOL) can be understood using individual biometry and optical modeling data. University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands. Retrospective case series. Patients with negative dysphotopsia were treated with supplementary implantation of a sulcus-fixated IOL. Preoperative and postoperative ray-tracing optical models of eyes with negative dysphotopsia were constructed in the Zemax Optic Studio program using individual biometric data. The relationship between biometric parameters, ray-tracing data, and the course of negative dysphotopsia was evaluated. The study comprised 8 patients (10 eyes). After surgery, negative dysphotopsia resolved completely in 6 eyes, partially in 2 eyes, and persisted in 2 eyes. There was no relationship between the course of negative dysphotopsia and age, IOL power, or individual biometry results other than a largerangle κ that was observed in 2 patients with persistent negative dysphotopsia after surgery. Preoperative ray-tracing models showed a decrease in light irradiance at the periphery relative to the center of visual field. After sulcus-fixated IOL implantation, this decrease partially resolved, in particular, for a small pupil aperture (P<.05), and it was more prominent in patients in whom negative dysphotopsia resolved completely than in those with partial or persistent negative dysphotopsia (P=.065 at 1.5mm aperture). Of all individual biometry results, only angle κ showed a relationship with the course of negative dysphotopsia. In patient-specific optical modeling of sulcus-fixated IOL implantation, the increase in simulated light irradiance at the periphery was related to the course of negative dysphotopsia.

Results of secondary retropupillary-fixated intraocular lens implantation

To evaluate specific morphofunctional changes in the eye after dislocated IOL exchange with retropupillary-fixated iris-claw IOL. Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus-fixated IOL dislocation (28 eyes) were analyzed. The follow-up period was 1-3 years. Increase in visual acuity and stable retropupillary fixation of the IOL was observed in all cases after reimplantation. Mean endothelial cell loss after 3 months was 6.9±1.3% in the group with preoperative density of >1200 cells/mm2 and 12.3±2.7% in the group with preoperative density of <1200 cells/mm2. There was no significant increase in intraocular pressure after IOL reimplantation. The incidence of clinical cystoid macular edema with decreased visual acuity was 4.7%, which is significantly more frequent than in patients after uncomplicated phacoemulsification with in-the-bag IOL implantation. Retropupillary implantation of iris-claw IOL provides stable fixation, good functional outcomes with low complication rates and is suitable for reimplantation in eyes without adequate capsular support.

Refractive outcomes after multifocal intraocular lens exchange

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error. The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P=.12). The mean refractive prediction error significantly decreased from 0.22±0.81 diopter (D) before the exchange to -0.09±0.53 D after the exchange (P<.05). Themedian absolute refractive prediction error significantly decreased from 0.43 D before the exchange to 0.23 D after the exchange (P<.05). Multifocal IOL exchange can be performed safely with good visual outcomes using different types of IOLs. A lower refractive prediction error and a higher likelihood of 20/40 or better vision can be achieved with the implantation of the second IOL compared with the original multifocal IOL, regardless of the final IOL position.

Capsular bag–fixated and ciliary sulcus-fixated intraocular lens centration after supplementary intraocular lens implantation in the same eye

To assess capsular bag and sulcus intraocular lens (IOL) centration in eyes that had implantation of a sulcus-fixated supplementary IOL anterior to a preexisting capsular bag IOL. Academic Teaching Hospital of St. John, Vienna, Austria. Retrospective case series. A sulcus-fixated supplementary IOL (Sulcoflex) was implanted anterior to a preexisting capsular bag IOL. The geometric center of preexisting capsular bag IOLs and newly implanted sulcus-fixated IOLs was evaluated at least 12months postoperatively and in relation to the geometric center of the pupil and limbus. The study comprised 48 eyes of 43 patients with a mean follow-up of 25months (range 12 to 84months). Themean decentration of the capsular bag-fixated IOL was 0.29mm±0.02 (SEM) when compared with the limbus and 0.29±0.03mm when compared with the dilated pupil. The mean decentration of the sulcus-fixated IOL was 0.23±0.02mm in relation to the limbus and 0.22±0.02mm when in relation to the dilated pupil. Sulcus-fixated supplementary IOLs showed significantly better centration than bag-fixated IOLs when compared with the limbus and with the pupil (both P=.03, paired t test). Implantation of a sulcus-fixated supplementary IOL resulted in good centration of capsular bag-fixated IOLs and ciliary sulcus-fixated IOLs. However, ciliary sulcus-fixated IOLs achieved significantly better centration.

The modification on the single haptic transscleral ciliary sulcus fixation of intraocular lens for congenital subluxation of lens

Objective To evaluate the clinical efficacy of modified single haptic transscleral ciliary sulcus fixation of intraocular lens for congenital subluxation of lens. Methods The data of 46 eyes of 27 patients aged 4-48 years with congenital subluxation of lens ranged from 2 to 3 quadrants were retrospectively analyzed. All cases underwent phacoemulsification and IOL implantation. The single haptic transscleral sulcus fixation of intraocular lens and the other haptic was implanted into the capsular bag. Before the fixation of the haptic, two incisions were done on the residual anterior capsule perpendicular to the equator about 40° apart after capsulorhexis at the most serious dislocation area. This flap was folded laying on the loose suspensory ligament. The follow-up time was 6-12 months. The visual acuity, intraocular pressure (IOP) location of IOL and complications were recorded. Results The operations were performed successfully in 42 eyes (91.30%). Prolapse of vitreous during the surgery occurred in 4 eyes (8.70%) and they was resolved after anterior vitrectomy. The visual acuity at 1 month after the surgery were 0.05-0.25 in 3 eyes (6.52%), 0.3-0.5 in 18 eyes (39.13%), 0.6-0.8 in 22 eyes (47.83%) and 1.0 in 3 eyes (6.52%). Postoperative visual acuity improved significantly compared with preoperative visual acuity, the difference was statistically significant (Z=5.026, P=0.000). The IOP of 5 eyes(10.87%)were high after the surgery. After used the IOP-lowering drugs, the IOP was controlled. There was not serious complication such as IOL asymmetry or tilt, decompensation of corneal endothelium, vitreous overflowing or retinal detachment after the surgery. Conclusion Modified single haptic transscleral sulcus fixation of intraocular lens for congenital lens subluxation is safe and effective. It can improve visual acuity and prevent the decentration or tilt of IOL without capsular tension ring implantation or IOL implantation with two haptics. And it also can simplify the operation procedure and shorten the operation time. Key words: Subluxation of lens, congenital; Lens, intraocular; Transscleral ciliary sulcus fixation, single haptic, modified

Management of sulcus-fixated single-piece intraocular lens-induced pigmentary glaucoma with 3-piece IOL exchange.

To describe our experience with exchanging sulcus-fixated single-piece intraocular lens (IOL) with 3-piece IOLs for management of pigmentary glaucoma. In this retrospective study, records of patients who underwent sulcus-fixated single-piece IOL exchanged with 3-piece IOLs were retrieved, and demographic and baseline data of patients, type of IOL, pre- and post-IOL exchange BCVA, IOP, number of anti-glaucoma medications, and optic nerve head examination were documented. Baseline and final examinations were analyzed and compared. Mean age of the patients was 59±10years, and 5 (41.6%) were female. Mean interval between primary cataract extraction operation and IOL exchange was 17±5months. Nine patients received in sulcus implantation of Alcon SA60AT, and three patients had SN60WF model at the end of primary surgery. BCVA changed insignificantly from 0.06±0.06 logMAR to 0.06±0.06 after IOL exchange. (P=0.22) IOP was controlled in 8 cases (66.6%), but four cases (33.3%) needed glaucoma surgery to further control glaucoma condition. IOP decreased significantly from preoperative 17±3 to 14±1mmHg postoperatively. Patients with advanced age and higher baseline IOP were more likely to undergo glaucoma surgery after IOL exchange. (P=0.07 and 0.00, respectively). single-piece IOL exchange with 3-piece IOL dramatically decreases pigment release and reduces IOP. Those with advanced age and higher IOP are less likely to respond to IOL exchange and may need glaucoma surgery to control high intraocular pressure.

Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty.

To evaluate the efficacy, refractive outcomes, and complications of supplementary intraocular lens (IOL) implantation in pseudophakic eyes after keratoplasty. This is a retrospective review of pseudophakic postkeratoplasty eyes after implantation of a custom-designed, sulcus-fixated, supplementary "piggyback" IOL to correct refractive errors. The outcome measures included preoperative and postoperative uncorrected distance visual acuity (UDVA), spectacle-corrected distance visual acuity (CDVA), refractive correction, and complications. This study evaluated 10 eyes (10 patients) with previous penetrating or deep anterior lamellar keratoplasty with a mean follow-up period of 12.2 ± 10.7 months (range, 2-33 months). All eyes showed improved UDVA postoperatively with 70% achieving ≥20/40. Median UDVA (logarithm of the minimum angle of resolution) improved from 1.2 (20/280, range 20/70-20/2000) preoperatively to 0.3 (20/40, range 20/20-20/60) postoperatively at the latest follow-up visit (P < 0.01). Five eyes (50%) had improvement in CDVA by at least 1 line of Snellen acuity with all eyes achieving ≥20/40 and 70% achieving ≥20/25. Median CDVA (logarithm of the minimum angle of resolution) was 0.2 (20/30, range 20/20-20/50) preoperatively compared with 0.1 (20/25, range 20/20-20/40) postoperatively (P = 0.03). In 8 eyes that received toric secondary IOLs, the mean refractive astigmatism decreased by 84% from 5.7 diopters (D) (range, 4-9 D) to 0.9 D (range, 0.2-3.0 D) (P = 0.01). Postoperative refractive astigmatism was ±1 D of predicted astigmatism for 7 of 8 eyes. No eyes lost any lines of UDVA or CDVA, and there were no keratoplasty rejection/failure events. Implantation of a supplementary, sulcus-based IOL is an effective approach to reduce spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty.

Cataract Surgical Problem: May consultation #1

Figure 1. Mydriasis shows a sulcus-fixated IOL with 2-hole PMMA optic and polypropylene loops fixated in the sulcus. The iris exhibits a basal coloboma at 12 o'clock, giving visual access to the anterior capsule rim sealed to the posterior capsule. The IOL optic is decentered inferiorly and slightly tilted but definitely shows a positive distance to the pupillary margin with the pupil undilated. A 79-year-old woman had cataract surgery with intraocular lens (IOL) implantation in the left eye in 1990. A 3-piece IOL with a poly(methyl methacrylate) (PMMA) optic with positioning holes and polypropylene loops was fixated in the ciliary sulcus. In 1993, the right eye also had cataract surgery with implantation of a PMMA diffractive multifocal IOL. In 2013, 23 years after the first surgery, the patient started having repeated attacks of blurred vision and pain in the left eye, mostly after bowing her head. These symptoms subsided within several hours. When immediately consulting with the local ophthalmologist on 2 such occasions, a 3+ erythrocyte Tyndall phenomenon was found in the anterior chamber aqueous and trickle marks (traces) were found in the inferior sector of the cornea; the intraocular pressure (IOP) approached 60 mm Hg. The patient was treated with pressure-lowering eyedrops and acetazolamide tablets; by the following day, the condition of the eye had returned to normal. The attacks, however, recurred with increasing frequency. On 1 such occasion, 1 IOL loop was reported to be visible in the peripheral coloboma at 12 o’clock; however, this was not the case when the patient returned later. When these attacks persisted, the patient was finally referred to an anterior segment specialist. When the patient first presented, the pupil in the left eye was small, the IOL optic was at a distinct distance to the pupillary margin, and no IOL loop was visible in the slit-shaped peripheral coloboma. The refraction was 1.50 +1.25 175 in the right eye and 1.50 +0.50 5 in the left eye. The decimal corrected distance visual acuity (CDVA) was 0.8 and 0.9, respectively. Both central capsules where clear, the retina and macula were normal, and the optic nerve head was vital and centrally excavated with a cup-to-disc ratio of 0.4 in the right eye and 0.3 in the left eye. On full pupil dilation, a 3-piece IOL with a PMMA optic with positioning holes and polypropylene loops was exposed in the left eye (Figure 1). The loops were fixated in the ciliary sulcus, and the slightly tilted optic was decentered inferiorly. The aqueous was clear, and the IOPwas 17mmHg. No change in haptic position or IOL rotation could be induced by gently massaging the limbus with a cotton swab under topical anesthesia. The patient was asked to immediately return if the symptoms recurred. Ten days later, she presented 2 hours after another attack. The biomicroscopic findings in the left eye were as described above, and the

Double rectangular suture sulcus reconstruction in the management of aphakia with absent capsular support

Aim This study aimed to describe a new method of sulcus fixation of intraocular lenses (IOLs) with total or partial loss of capsular support. Materials and methods This was a prospective nonrandomized comparative clinical trial, where two groups were managed for IOL scleral fixation in the absence of capsular support. Group A included 12 cases with classic ab externo two-point sclera fixation and group B included 16 cases with the double rectangular suture sulcus reconstruction (DRSSR). The etiology of aphakia in group A included congenital cataract managed by lensectomy (three cases), trauma (six cases), and complicated phacoemulsification (three cases). In group B, aphakia was because of congenital cataract in two cases, trauma in five cases, hypermature cataract in three cases, and complicated phacoemulsification in two cases. A unique subset of group B included four eyes with posterior chamber IOL subluxation or dislocation managed by DRSSR. The main outcome measures included final best-corrected visual acuity (BCVA), lens stability, and complications. Results All 28 eyes had stable or improved BCVA and the mean postoperative BCVA had improved significantly from 6/30 to 6/7.5 (P = 0.004). There were no statistical differences between groups A and B in postoperative BCVA (P = 0.403), complications (P = 0.25), and astigmatism (P = 0.113). Group 2 B cases with subluxated and posterior dislocated IOLs were managed by DRSSR, with no need for exteriorizing the IOL, with excellent centration. Conclusion The DRSSR seems to be a safe method of providing an adequate bed for IOL stabilization in the absence of capsular support. This method is particularly useful in dislocated or subluxated IOLs that need repositioning under a closed globe with minimal manipulations.

Double rectangular suture sulcus reconstruction in the management of aphakia with absent capsular support

AimThis study aimed to describe a new method of sulcus fixation of intraocular lenses (IOLs) with total or partial loss of capsular support.Materials and methodsThis was a prospective nonrandomized comparative clinical trial, where two groups were managed for IOL scleral fixation in the absence of capsular support. Group A included 12 cases with classic ab externo two-point sclera fixation and group B included 16 cases with the double rectangular suture sulcus reconstruction (DRSSR). The etiology of aphakia in group A included congenital cataract managed by lensectomy (three cases), trauma (six cases), and complicated phacoemulsification (three cases). In group B, aphakia was because of congenital cataract in two cases, trauma in five cases, hypermature cataract in three cases, and complicated phacoemulsification in two cases. A unique subset of group B included four eyes with posterior chamber IOL subluxation or dislocation managed by DRSSR. The main outcome measures included final best-corrected visual acuity (BCVA), lens stability, and complications.ResultsAll 28 eyes had stable or improved BCVA and the mean postoperative BCVA had improved significantly from 6/30 to 6/7.5 (P = 0.004). There were no statistical differences between groups A and B in postoperative BCVA (P = 0.403), complications (P = 0.25), and astigmatism (P = 0.113). Group 2 B cases with subluxated and posterior dislocated IOLs were managed by DRSSR, with no need for exteriorizing the IOL, with excellent centration.ConclusionThe DRSSR seems to be a safe method of providing an adequate bed for IOL stabilization in the absence of capsular support. This method is particularly useful in dislocated or subluxated IOLs that need repositioning under a closed globe with minimal manipulations.

Scheimpflug photography for the examination of phakic intraocular lenses

High myopia phakic intraocular lenses (IOL) have become an established means of surgical correction for high ametropia. Scheimpflug photography is one of the methods which are frequently applied for postoperative examination of the implants. Results from published studies employing Scheimpflug photography for examination of anterior chamber angle-fixated, iris-fixated and sulcus-fixated phakic IOLs were evaluated. In several published studies Scheimpflug photography was used to examine the position of the implant and opacification of the crystalline lens. The results provided valuable evidence for the improvement of phakic IOL design. Scheimpflug photography offers an easy to use, rapid non-contact examination of phakic IOLs.

Sulcus-fixated intraocular lens implantation for the management of negative dysphotopsia

To determine whether intraocular lens (IOL) exchange with insertion of a sulcus-fixated IOL is an effective treatment for the management of pseudophakic negative dysphotopsia. Department of Ophthalmology, Stoke Mandeville Hospital, Buckinghamshire, United Kingdom. Case series. Participants in the study were recruited prospectively from the clinic at the time of diagnosis or retrospectively from the operating room logs by identifying all patients who had IOL exchanges over a 4-year period (2009 to 2012). Five eyes of 5 women with negative dysphotopsia were treated with IOL exchange and replacement with a 3-piece IOL (Acrysof MA60AC) inserted in the ciliary sulcus. All patients had a resolution of the negative dysphotopsia symptoms. One patient had primary insertion of a sulcus IOL in the fellow eye and did not develop negative dysphotopsia symptoms. Intraocular lens exchange with insertion of a 3-piece IOL in the ciliary sulcus appears to be a safe and effective treatment for the management of pseudophakic negative dysphotopsia. Neither author has a financial or proprietary interest in any material or method mentioned.

Comparison of additional pseudophakic multifocal lenses and multifocal intraocular lens in the capsular bag

AimsTo compare the clinical results and the intraoperative and postoperative performance of an additional sulcus-fixated multifocal intraocular lens (IOL) with a conventional multifocal IOL implanted in the capsular bag.MethodsIn this...