Sutureless Scleral Fixation Research Articles

Outcomes of intraocular lens implantation in the absence of capsular support: a review of current literature

to classify and comparatively analyze the latest published data on the outcomes of various kinds of complicated cataract surgery. Analysis of available literature on the subject of research published in 2003-2016. The method of sutured scleral fixation of the intraocular lens (IOL) is the most fully covered in the current literature. It has been used long enough and is, therefore, well tested. Its typical complications include sutures degradation, hemorrhage, and inflammation. Sutureless fixation of the IOL, which has become more common in recent years, is free of complications associated with degradation of the sutures. However, studies on the long-term results of this technique are few and most of them were conducted in a small clinical material. Basing on the present analysis, one may conclude that at the current level of surgery, sutureless scleral and iridal fixation of the IOL is more preferable in terms of possible postoperative complications.

Extraocular needle- guided haptic insertion technique of scleral fixation intraocular lens surgeries (X-NIT).

The most challenging step in sutureless scleral fixation of intraocular lens (SFIOL) is exteriorization of haptics. The conventional handshake technique has a learning curve since it involves intraocular handing over of haptics from one forceps to another. Here, we describe “extraocular needle-guided haptic insertion technique” (X-NIT), a novel technique of exteriorizing haptics that totally eliminates intraocular manipulations. This method involves sequential introduction of two bent 26-gauge needles through the sclera (pars plicata zone) into the eye which are brought out through a sclerocorneal wound. The intraocular lens haptics are threaded through these needles and exteriorized. Nineteen consecutive patients underwent surgery by this technique. There were no intraoperative complications. The mean best-corrected visual acuity (BCVA) of these patients at 1-month follow-up was 0.5 ± 0.3 (logarithm of the minimum angle of resolution) with 18 of 19 eyes showing one or more lines of improvement in BCVA. X-NIT is a safe, easy, cost-effective, and highly reproducible technique, especially for beginners.

Sutureless Intrascleral Fixated Intraocular Lens Implantation.

To review sutureless intrascleral intraocular lens (IOL) fixation methods. Review of published literature. Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics. Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [J Cataract Refract Surg. 2016;32(9):586-597.].

Management of dislocated intraocular lenses in eyes with insufficient capsular support.

To review the different techniques for management of dislocated intraocular lenses in eyes with insufficient capsular support with a focus on recent studies and techniques reported in the literature. Visual outcomes generally improve regardless of intraocular lens selection and surgical techniques. New techniques include sutureless scleral fixation with the use of posterior segment tools and use of hybrid instrumentation for 25-/27-gauge vitrectomy. IOL selection and surgical technique should be tailored to each patient based on the preexisting disorder that led to the dislocation. The decision ultimately depends on surgeon comfort and experience with the procedure, and the presenting pathology.

Sutureless intrascleral intraocular lens fixation with lamellar dissection of scleral tunnel.

PurposeTo report the results of sutureless scleral fixation of a posterior chamber intraocular lens (IOL) by using our developed simple technique.MethodsWe retrospectively reviewed the medical records of 48 eyes of 47 patients who underwent sutureless intrascleral IOL fixation by using our modified technique. A 25-gauge microvitreoretinal knife was used to perform sclerotomies and create limbus-parallel scleral tunnels with lamellar dissection in which the haptics were fixed.ResultsThe IOLs were fixed and centered well. The mean follow-up period was 26.7 months. Postoperative complications included smooth vitreous hemorrhage in four eyes (8.3%), cystoid macular edema in two eyes (4.2%), and iris capture of the IOL in two eyes (4.2%). No other complications, such as breakage of the IOL, spontaneous IOL dislocation, or retinal detachment, were detected during the follow-up period.ConclusionThe lamellar dissection of the limbus-parallel scleral tunnel can simplify the forceps-assisted introduction of the haptics into the scleral tunnel, and this technique seemed to be safe.

One-year outcomes of eyes treated with a sutureless scleral fixation technique for intraocular lens placement or rescue.

To report the 1 year results of a novel surgical technique for sutureless scleral fixation of a 3-piece intraocular lens. Retrospective consecutive series of patients who underwent sutureless scleral fixation of a three-piece intraocular lens. All patients were required to have at least 1 year of follow-up to be included in the series. Outcomes data were obtained and treated with simple statistical analyses. A total of 24 patients were included in the study population. The average age was 75 years (range, 44-87). Short-term complications were few and included vitreous hemorrhage (n = 2), elevated intraocular pressure (n = 1), and hypotony (n = 1). Long-term complications included intraocular lens dislocation (n = 3) and cystoid macular edema (n = 1). Mean visual acuity improved from logMAR 1.30 (Snellen 20/399) to 0.52 (Snellen 20/66) at 1 year. This novel technique for sutureless scleral fixation of a three-piece intraocular lens was well-tolerated 1 year after surgery.

Intravenous catheter-assisted scleral fixation of an intraocular lens in eyes without adequate capsular support.

Sutureless scleral fixation is an effective technique for placement of a secondary intraocular lens. The authors propose a modification that may simplify intraoperative technical challenges. Description of surgical technique. Successful placement of stable secondary intraocular lens. This modified technique has the potential to reduce intraoperative complications. Studies including more patients with longer follow-up are needed to test the viability.

Scleral-Fixated Intraocular Lenses: An Update on the Current Surgical Approaches

In the past, the available surgical options for patients with a lack of capsulozonular support or aphakia were limited to placing an intraocular lens (IOL) in the anterior chamber, suturing an IOL to the iris, or suturing it to the sclera. The first two options involve leaving the IOLs in close proximity to the iris and the cornea and are not ideal for patients with compromised corneas, peripheral anterior synechiae, shallow anterior chambers, or glaucoma. Scleral-sutured IOL fixation allows the IOL to sit away from the cornea and closer to the nodal point of the eye, but the suture-related complications and the technically challenging nature of the surgery are unappealing. In recent years, with the advent of novel sutureless scleral fixation techniques, an increasing number of surgeons are adopting the sutureless techniques, such as the fibrin glue and the intrascleral tunnel IOL fixation techniques. We discuss the pros and cons as well as the preliminary results of these techniques as reported in the recent literature.

Late in-the-bag intraocular lens dislocation in patients with uveitis.

Late in-the-bag intraocular lens (IOL) dislocation is an unusual complication of cataract surgery, being strongly associated with pseudoexfoliation, less so with previous vitreoretinal surgery, myopia and uveitis. We present the clinical features, management and outcomes of late spontaneous IOL dislocation in a series of patients with uveitis. A retrospective case series of IOL dislocation affecting patients in the Manchester Uveitis Clinic, UK. The uveitis diagnosis, IOL type, presentation and management are discussed. Six patients from out of 1056 undergoing cataract surgery (0.57%) were affected. Uveitis was the only identified risk factor for IOL dislocation, which occurred a mean 10.3 years following uncomplicated cataract surgery by phakoemulsification with endocapsular IOL implantation. The dislocation was in-the-bag in all six cases. Two patients presented with the IOL in the anterior chamber, and required removal of the IOL-bag complex, and are using aphakic refractive correction. Two patients with inferior IOL subluxation have been managed conservatively. Two patients underwent pars plana vitrectomy with sutureless scleral fixation of the existing IOL in one case, and IOL exchange with a scleral sutured IOL in the other. IOL dislocation is an uncommon late complication in patients with uveitis. Conservative management is appropriate in patients with tolerable symptoms, or in those with difficult uveitis. Otherwise, fixation of the existing IOL, or removal and implantation of a secondary IOL, may be necessary. Angle-supported, or iris-enclaved IOLs, are not of proven safety in this patient group; scleral-fixated posterior chamber IOLs are the favoured approach in our service.

Sutureless scleral fixation of intraocular lenses: outcomes of two approaches. The 2014 Yasuo Tano Memorial Lecture.

We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses (IOLs): transconjunctival fixation through trocar cannulas and fixation using scleral tunnels created with a microvitreoretinal (MVR) blade. This retrospective chart review was comprised of 23 eyes that received scleral fixation of a three-piece IOL with concurrent pars plana vitrectomy between June 2012 and June 2014. Scleral fixation was performed either by transconjunctival fixation through trocar cannulas (cannula fixation) or by the creation of scleral tunnels using an MVR blade (tunnel fixation). The preoperative and postoperative corrected distance visual acuities (CDVA), spherical equivalents (SE), and complications were evaluated. 15 cannula fixations and 8 tunnel fixations were performed. Mean follow-up was 353 days (Range: 94 - 790 days). Fifteen IOLs were fixated 2 mm posterior to the limbus. Seven IOLs were fixated 1.5 mm posterior to the limbus, and one IOL was fixated 0.75 mm posterior to the limbus. Mean preoperative CDVA was logMAR 1.17 (Snellen 20/297), and mean postoperative CDVA was logMAR 0.37 (Snellen 20/47) (p <0.0001). At last follow-up, none of the IOLs have dislocated or subluxed and there has been no erosion of the subconjunctival haptics. Scleral fixation of IOLs using trocar cannulas or scleral tunnels is an effective surgical option for the treatment of aphakia or IOL dislocation. Both techniques result in significant visual improvement with minimal postoperative complications.

Two Techniques for Sutureless Intrascleral Posterior Chamber IOL Fixation

To compare two different techniques for sutureless scleral fixation of posterior chamber intraocular lens (IOL) in patients with insufficient capsule support. Of 29 patients, 17 received the needle technique using a 24-gauge needle for the scleral tunnel opening and 12 received the novel trocar technique, in which the scleral tunnel was prepared with a 25-gauge transconjunctival sutureless vitrectomy trocar and a three-piece foldable IOL was placed through clear corneal incision. Visual acuity, intraocular pressure, related complications, and IOL stability were assessed postoperatively. Postoperative visual acuities significantly improved with both techniques (P = .028 and .012, respectively). Postoperative intraocular pressure did not significantly change with either technique. Sufficient IOL stabilities were provided in all patients. Complications were similar in both techniques and none of the complications affected the patients' vision. Postoperative visual acuity improvement, intraocular pressure changes, and complications were similar in both techniques.

Trocar-assisted sutureless intrascleral posterior chamber foldable intra-ocular lens fixation

We report a novel technique characterized by sutureless scleral fixation of three-pieces foldable intraocular lens (IOL) using 25-gauge transconjunctival sutureless vitrectomy (TSV) trocars in patients with insufficient posterior capsule support. We performed this technique on the eight eyes of the seven patients. The scleral tunnels (STs) are prepared by insertion of the 25-gauge TSV microcannulas using the trocars, and anterior vitrectomy is performed through the clear corneal paracentesis with the aid of anterior chamber maintainer (ACM). Finally, the three-piece foldable IOL haptics are incarcerated into the prepared STs. The patients were followed up 5-8 months. None of the patients had complications such as postoperative endophthalmitis, glaucoma, IOL tilt or decentralization, and retinal detachment. Injection of a foldable IOL through a clear corneal small incision also contributes the less surgical-induced astigmatism. The presented novel sutureless scleral IOL fixation technique may provide minimal trauma to the surrounding tissues, good IOL stabilization decreasing the incidence of IOL tilt along with shorter operation time, and postoperative quiet eye.

Anterior chamber intraocular lens, sutured posterior chamber intraocular lens, or glued intraocular lens

To review the recent literature addressing the surgical approaches to intraocular lens (IOL) fixation in the setting of inadequate capsular support. Lack of capsular support is a commonly encountered problem facing the anterior segment surgeon. Recent reports suggest that visual outcomes are generally good with modern IOLs and surgical approaches. More recently described techniques include sutureless scleral fixation and intraocular endoscopy-guided suture placement. Many clinical circumstances require extracapsular IOL fixation and multiple options exist in the setting of inadequate capsular support. Ultimately, there are many factors that must be considered in selecting an appropriate surgical approach. These include ocular history as well as the skill, experience, and comfort level of the individual surgeon. The myriad of options that now exist for IOL fixation increases the likelihood that patients with a wide variety of pathologic states will attain their best possible visual outcome.

Sutureless scleral fixation of intraocular lenses

A technique is presented in which pars plana fixation of a posterior chamber intraocular lens (IOL) is achieved by the transscleral passage of the haptics. The 101 - used has three equidistant supple loops, each attached to an armed suture, which serve as haptics. A specially designed needle driver is used to pass the sutures into and out of the eye through the pars plana and along the surface of the sclera, where they are severed by cautery. Stable fixation is achieved without contact with the inner tissues of the eye, and no additional sutures are necessary. Lens stability is maintained even in the presence of asymmetrical fibrosis of the capsular remnants.