Transscleral Suture Research Articles

Three-point transscleral suture fixation of a foldable three-looped haptics one-piece posterior chamber intraocular lens implantation

A 73-year-old male patient was suffering from aphakia due to ocular trauma. Capsular implantation of a posterior chamber intraocular lens (PCIOL) was impossible in the absence of capsular support. Three-point transscleral suture fixation was used. The technique was performed under retrobulbar anesthesia. A three-looped haptics one-piece foldable PCIOL was suspended in the eye with one haptic at 6 o’clock and tied by a cow-hitch knot, and the haptics at 2 o’clock and 10 o’clock were threaded by another suture. The patient was followed up for 6 months postoperatively, and the postoperative logarithm of the minimum angle of resolution at the final follow-up was 0.3. The intraocular lens remained well positioned and stable. No complications, such as suture loosening, hypotony, chronic inflammation, or retinal detachment, were observed during the postsurgery follow-up period.

The Precision of Calculating the Optical Power of the IOL in Various Methods of Out-Bag IOL Fixation

The calculation of the optical power of the IOl for out-bag implantation remains one of the actual problems of cataract surgery. Purpose. Comparative study of the precision of calculating the optical power of the IOL for retropupillary fixation of an iris-claw lens, transscleral fixation of a rigid IOL with two flexible haptic elements and transscleral fixation of an soft hydrophobic IOL with two open haptic elements. Patients and methods. The study included 105 patients (108 eyes) with complicated phacoemulsification in combination with lens subluxation. First group included 39 patients (42 eyes) with complicated phacoemulsification and retropupillary implantation of an iris-claw lens. Second group included 29 patients (29 eyes) with complicated phacoemulsification and transscleral suture fixation of rigid PMMA IOL. Third group included 37 patients (37 eyes) with complicated phacoemulsification and transscleral suture fixation of an soft hydrophobic IOL with two open haptic elements. In the postoperative period we performed a comparative evaluation of visual acuity without correction and best corrected visual acuity, IOL optical power calculation precision within ±0.5 diopters, the average absolute error of IOL optical power calculation. Results. Three months after the operation the visual acuity of 0.8–1.0 without correction was obtained in 35,7 % of cases in the 1st group, 17.2 % in the 2nd group, 16.2 % in the 3rd group. The precision of postoperative refraction within ±0.5 diopters was 95.2 % in the 1st group, 86.2 % in the 2nd group 83.7 % in the 3rd group. The average absolute error of IOL optical power calculation was 0.33 ± 0.07 diopters in the 1st group, 0.57 ± 0.18 diopters in the 2nd group, 0.62 ± 0.19 diopters in the 3rd group (р < 0.05). Three months after surgery there were no significant differences in best corrected visual acuity and the degree of induced astigmatism. Conclusion. Retropupillary implantation of an iris-claw lens during complicated phacoemulsification significantly increases visual acuity without correction, frequency calculation precision within ±0.5 diopters, significantly reduces the average absolute calculation error compared to transscleral suture fixation of the IOL.

Long-term results of late “in-the-bag” IOL dislocation surgery

BACKGROUND: Intraocular lens (IOL) repositioning and IOL exchange are the main methods of surgical treatment of late in-the-bag IOL dislocation.
 AIM: To evaluate refraction, induced corneal astigmatism and IOL tilt after surgical treatment of late in-the-bag IOL dislocation by transscleral suture fixation and exchange to iris-claw IOL with retropupillary fixation.
 MATERIALS AND METHODS: 78 of patients with late in-the-bag IOL dislocation were included. Transscleral suture IOL fixation was performed in group I (38 eyes), exchange to iris-claw IOL was performed in group II (40 eyes). Refractometry, keratotopography and optical coherence tomography of anterior segment were performed before surgery, 1 week, 1, 3 and 6 months after surgery.
 RESULTS: The groups did not differ in subjective and objective refraction. But there was significant variability of data in the group I 3 and 6 months after surgery. There was no difference in corneal astigmatism in both groups during 3 months, but a significant increase was found in group II 6 months after surgery. There was no difference in IOL tilt between groups before surgery. Decrease of IOL tilt in 180 degrees plane was observed after 1 month in group II, while there was no difference in 90 degrees plane between groups.
 CONCLUSIONS: Both methods of late in-the-bag IOL dislocation treatment allow to receive good refractive result, but refraction is less predictable after trans-scleral suture IOL fixation. Surgically induced astigmatism is higher in IOL exchange group due to large sclerocorneal tunnel incision. Transscleral suture IOL fixation does not cause clinically significant IOL tilt.

Biomechanical testing of a modified knotless transscleral suture fixation technique: an ex vivo study.

To investigate the safety and effectiveness of a modified transscleral suture through ex vivo tests. Ex vivo tests were performed in full-thickness porcine scleral pieces using modified knotless transscleral zigzag-shaped suture (Z-suture) fixation technology. The minimum traction force required to loosen or rupture the suture was assessed. The effects of different polypropylene sutures (10-0, 8-0), different suture spans (2.0, 3.0, 4.0 mm), different passes (3, 4, 5 passes), and scleral grooves were investigated. The average minimum traction forces required to loosen 10-0 polypropylene sutured for 3.0 mm with a suture span of 3, 4, and 5 passes, were 0.18 (0.15-0.18), 0.22 (0.21-0.22), and 0.37 (0.37-0.37) N, respectively. The maximum traction force to prevent the suture from rupturing for the 10-0 polypropylene suture was 0.37-0.41 N in the sclera. The average of the minimum traction forces required to loosen the 8-0 polypropylene sutured with 5 passes and spanning 2.0, 3.0, and 4.0 mm were 0.37 (0.3 -0.39), 0.42 (0.42-0.45), and 0.50 (0.50-0.51) N, respectively, which were 14-28% higher than that of the 10-0 polypropylene suture under same conditions (all P values <0.01). In addition, there was no statistical difference (P=0.3258) for the 8-0 polypropylene suture used with a 3.0-mm suture span and 5 passes between conditions with or without scleral grooves. The minimum traction force required to loosen or rupture the suture in the sclera was associated with suture specification, suture span, and the number of passes, but was uncorrelated with double scleral grooves. The 8-0 polypropylene suture with double scleral grooves may be a more favorable choice for knotless transscleral fixation.

Four-Point Scleral Fixation of An Akreos Adapt AO Intraocular Lens Using Double-Strand 9-0 Polypropylene Suture.

To report the results of a novel surgical four-point transscleral suture fixation of intraocular lens (IOL) with four hollow haptics using the double-suture technique. We retrospectively reviewed the medical records of 15 eyes of 15 patients who underwent 4-point transscleral suture fixation of a foldable IOL using the double-suture technique. Preoperative data and follow-up data for at least 4 months were collected for all patients. The IOLs were fixed and centered well. The mean preoperative corrected distance visual acuity was 0.70 ± 0.54 logarithm of the minimum angle of resolution (Snellen 20/102), and it improved to 0.29 ± 0.26 logarithm of the minimum angle of resolution (Snellen 20/39) at the final follow-up ( P = 0.001). No vitreous hemorrhage, hypotony, suture breakage, retinal detachment, IOL dislocation, and iris capture was detected during the follow-up period in any of the patients. We have developed a novel technique for 4-point transscleral suture fixation of IOL using the double-suture technique with 9-0 polypropylene suture. This technique seemed to be safe and it may not require the surgeon to learn any new technique.

A Modified Knotless Transscleral Intraocular Lens Fixation Technology for Congenital Ectopia Lentis.

This study aimed to compare modified knotless transscleral suture fixation of intraocular lens (IOL) with traditional transscleral suture fixation for adolescents and young patients with congenital ectopia lentis (CEL). This retrospective cohort study included 49 patients with CEL (60 eyes) who underwent surgery at the Zhongshan Ophthalmic Center. Improvements based on knotless Z-suture fixation technique were made to form a modified knotless method, in which thicker 8-0 polypropylene sutures were used, and double parallel scleral grooves were constructed behind the limbus instead of triangular lamellar scleral flaps to cover suture stitches. Modified knotless transscleral fixation of IOL was conducted on 30 eyes, and the other 30 eyes underwent traditional transscleral fixation surgery. Pre- and postoperative best-corrected visual acuity (BCVA), refractive error, astigmatism, other ocular parameters, and complications were statistically analyzed. For patients in the modified knotless group, the mean cylindrical refractive error and astigmatism at 1month and 3months postoperative were lower (all P < 0.05), and the mean IOL tilt degree was smaller at 3months postoperative (3.21° ± 2.13° vs. 5.65° ± 3.66°, P = 0.032). The incidence of suture exposure in the modified knotless group was also lower than in the controls (0 vs. 16.7%, P = 0.026). No group differences were observed in mean BCVA, spherical equivalent, or other ocular biometric parameters between groups. Modified knotless technique was a valid method to achieve optimal IOL position and reduce postoperative astigmatism for adolescents and young patients with CEL. It effectively reduced the incidence of knot-related complications, greatly improved the postoperative comfort, and achieved aesthetic benefits.

Клинические результаты транссклерального подшивания заднекамерных интраокулярных линз

Currently there are a large number of modifications for fixing intraocular lenses (IOL) in case of failure of the capsular-ligamentous lens apparatus (CLLA) as a result of intraoperative complications in cataract phacoemulsification, pseudoexfoliation syndrome, chronic uveitis, eye injuries of various origins, as well as a number of congenital conditions. Most ophthalmic surgeons agree that transscleral fixation of the IOL by the supporting elements is the most preferable. Among the main advantages, we can single out a more anatomically correct IOL position, the absence of contact between the lens and the iris, the least number of intra- and postoperative complications such as hyphema, hemophthalmus, pupil deformity, and macular edema. Purpose. Using clinical examples, to present the results of surgical treatment of patients with failure of the capsular-ligamentous apparatus of the lens with implantation and transscleral suturing of the IOL. Material and methods. From 2018 to 2021 we operated on 145 patients (148 eyes) with CLLA failure. All patients underwent transscleral IOL fixation. Results. In all cases, there was a stable increase in visual acuity. There were no such serious intra- and postoperative complications as hemorrhagic (hyphema, hemophthalmia, suprachoroidal hemorrhages), as well as inflammatory (anterior, posterior uveitis, endophthalmitis). Descemetitis and corneal edema were not recorded. However, in 8 eyes in the early postoperative period, IOL rotation along the axis was observed, which required repeated intervention. In 12 eyes there was an increase in intraocular pressure. After the appointment of hypotension drops, compensation of ophthalmotonus was noted. In 2 cases, microinvasive surgery was required for uncompensated glaucoma. Conclusion. One of the modifications of the transscleral technique ab interno for IOL suturing, presented by us, allows achieving high, stable functional results. Keywords: cataract phacoemulsification, intraocular lens, weakness of the capsular-ligamentous apparatus of the lens, transscleral suturing.

Evaluation of Intraocular Lens Tilt and Decentration in Congenital Ectopia Lentis by the Pentacam Scheimpflug System.

Purpose The purpose of this study was to quantify the characteristics of the tilt and decentration of the IOL after trans-scleral suture fixation surgery in congenital ectopia lentis (CEL) patients. Methods The clinical characteristics of 70 CEL patients at Zhongshan Ophthalmic Center in China were retrospectively analyzed. The tilt and decentration of intraocular lens (IOL) were measured by using a Pentacam and compared between different axial length (AL) subgroups. The correlation between IOL tilt, decentration, and ocular characteristics was investigated using Spearman's correlation analysis. Results The postoperative IOL position of CEL patients was mainly located nasally inferiorly. The average tilt of the IOL in CEL patients was less than 7° (for temporal: 2.21 ± 1.53°, for nasal: −1.84 ± 2.04°, for superior: 2.22 ± 2.18°, and for inferior: −1.70 ± 1.62°), and the average decentration of the IOL in CEL patients was larger than 0.4 mm (for temporal: 0.49 ± 0.38 mm, for nasal: −0.69 ± 0.46 mm, for superior: 0.72 ± 0.58 mm, and for inferior: −0.68 ± 0.54 mm). The decentration of CEL patients in the AL ≥ 26 subgroup was greater than those with AL < 24 mm and AL 24 to 26 mm subgroups (for superior: 0.72 ± 0.28 mm vs. 0.46 ± 0.25 mm and 0.48 ± 0.22 mm, all P < 0.05; for inferior: -0.94 ± 0.56 mm vs. −0.44 ± 0.26 mm and -0.44 ± 0.46 mm, all P < 0.05). IOL decentration was positively correlated with AL (for superior: r = 0.44, P=0.019; for inferior: r = 0.54, P=0.006). IOL tilt was positively correlated with AL on the superior side (r = 0.38, P=0.041). Conclusions The extent of IOL decentration after trans-scleral suture fixation was great in CEL patients, and the IOL decentration in CEL patients was significantly associated with AL.

Novel Suturing Methods for the Management of Traumatic Choroidal Avulsion in Globe Injuries

PurposeTo explore the long-term efficacy of novel choroidal suturing methods including trans-scleral mattress suturing (TSS) and intraocular suturing (IOS) in the treatment of choroidal avulsion.DesignProspective cohort, hospital-based study.MethodsA total of 24 patients who were diagnosed with choroidal avulsion were enrolled in this study. The demographic characteristics, baseline information of trauma, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected before surgery, and the anatomic abnormities of the globe were recorded before or during surgery. All patients were diagnosed with choroidal avulsion and underwent choroid suturing treatment during vitrectomy, postoperative functional variables including BCVA and IOP, anatomic variables including retinal and choroidal reattachment rate, and silicone oil migration rate, which were recorded at the regular follow-ups at least 1 year after surgery.ResultsAll patients with open globe injury involved zone III, 70.8% of the patients presented with two quadrants of the avulsed choroid, and 29.2% with one quadrant involved; moreover, all patients had complications with retinal detachment (RD), of which 58.3% of patients had closed funnel retinal detachment. TSS was applied in nineteen patients and IOS in five patients. Postoperatively, a significant improvement on LogMAR BCVA was observed at each follow-up from 3.57 ± 0.69 before surgery to 2.82 ± 0.98 at the last follow-up (p < 0.05), and the proportion of no light perception (NLP) was also reduced from 69.6 to 37.5%. IOP was markedly elevated from 6.4 ± 4.1 mmHg preoperatively to 11.3 ± 4.3 mmHg at the last follow-up (p < 0.05). Choroidal reattachment was achieved in 91.7% of patients; two patients were observed with silicone oil migration at 3 months after surgery and underwent drainage of suprachoroidal silicone oil and sclera buckling. Meanwhile, retinal attachment was observed in 95.8% of patients, only one patient developed partial RD due to postoperative proliferative vitreoretinopathy, and secondary vitrectomy was performed; all patients were observed with complete retinal and choroidal attachment at the last follow-up. Eventually, four patients were silicone oil-free, and 20 patients were silicone oil-dependent.ConclusionsChoroidal suturing proved to be an effective method to fix the avulsed choroid, which greatly improved the BCVA and maintained the IOP, and efficiently increased the choroidal and retinal reattachment rate and preservation of the eyeball.

Refractive outcomes of out-of-the-bag intraocular lens implantation

To study and compare the refractive outcomes of retropupillary implantation of an iris-claw lens and transscleral suture fixation of IOL in complicated phacoemulsification. The study included 70 patients (73 eyes) after complicated phacoemulsification in combination with grade 2 lens subluxation. The first group included 36 patients (39 eyes) who underwent complicated phacoemulsification using torsional ultrasound and retropupillary implantation of an iris-claw lens. The second group included 34 patients (34 eyes) after complicated phacoemulsification using torsional ultrasound and transscleral suture fixation of an elastic hydrophobic IOL. In the postoperative period we performed a comparative evaluation of uncorrected visual acuity and best corrected visual acuity, the average absolute error of IOL optical power calculation, the precision of postoperative refraction within ±0.5 diopters, the degree of induced astigmatism, and the tilt of the IOL. At three months after surgery uncorrected visual acuity of 0.8-1.0 was achieved in 33.3% of cases in the first group and 17.6% in the second group, the average absolute error of IOL optical power calculation was 0.34±0.08 diopters in the first group and 0.63±0.19 diopters in the second group, the precision of postoperative refraction within ±0.5 diopters was 94.9% in the first group and 85.3% in the second group, the tilt of the IOL was 0.69±0.21° in the first group and 3.19±0.97° in the second group (p<0.05). There were no significant differences in best corrected visual acuity and the degree of induced astigmatism 3 months after surgery. Implantation of an iris-claw lens in the course of complicated phacoemulsification in lens subluxation significantly improves refractive outcomes of the implantation in comparison with transscleral IOL fixation.

Endoscopy-guided in vivo evaluation of ciliary sulcus location in children with ectopia lentis.

ObjectiveTo assess a new method to measure the distance of the needle passage from the ciliary sulcus to the corneal limbus anterior border (CTC) in eyes with ectopia lentis directly in vivo via endoscopy and to further evaluate the correlations among the CTC, age, automated horizontal white-to-white distance (WTW), and ocular axial length (AL).MethodsThe WTW and AL were measured using an optical biometer. An intraocular endoscope was used during transscleral suture fixation of posterior chamber intraocular lenses to identify the true location of the ciliary sulcus. Linear regression analysis was used to assess the correlation between the CTC and other ocular biological parameters, including age, WTW, and AL.ResultsThirty eyes of 30 children with ectopia lentis were evaluated. A statistically significant correlation was found between age and the CTC. The CTC could be predicted by the equation CTC = 0.1313 × Age + 0.9666. No statistically significant correlations were found between CTC and WTW, CTC and AL, WTW and AL, or WTW and age.ConclusionEndoscopy is useful for precisely suturing intraocular lens haptics in the real ciliary sulcus. Age can be used as an equivalent parameter for prediction of the true ciliary sulcus location.

The influence of intraocular lens dislocation surgical correction method on corneal endothelium

BACKGROUND:Intraocular lens (IOL) dislocation is a rare but serious complication of surgical treatment of patients with cataract. Among the factors contributing to its development, the main ones are pseudoexfoliation syndrome (PEX), high axial myopia, chronic uveitis, history of eye injury and age. There is no universal IOL dislocation correction technique.&#x0D; PURPOSE:To evaluate the impact on corneal endothelium of two different methods of IOL dislocation correction: IOL repositioning with transscleral suture fixation or IOL exchange to iris-claw one.&#x0D; MATERIALS AND METHODS:Within the study, 78 patients were examined and operated. All patients were divided into two groups: in the first group, IOL was repositioned with transscleral suture fixation, and in the second group IOL was exchanged to iris-claw IOL. Groups were equal by gender and age. Key estimated indicators were endothelial cell density and coefficient of variation reflecting the degree of polymegatism.&#x0D; RESULTS:Endothelial cell density was significantly lower both before surgery and at any term after it, in the group with IOL exchange, and coefficient of variation was significantly higher in the group with IOL exchange throughout this study.&#x0D; CONCLUSION:The choice of technique for IOL dislocation correction is the basis of success in surgical treatment. Certain preoperative examination data should be definitely considered, including the degree of dislocation, IOL type, IOP level, endothelial cell density and presence of concomitant ocular conditions.

"Double Prosthesis Implantation": Biometry and Refractive Outcomes in Combined Intraocular Lens and Artificial Iris Surgery.

PurposeTo assess the biometry and postoperative refraction in iris repair using ArtificialIris in combination with an intraocular lens (IOL).SettingDepartment of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Germany.DesignRetrospective observational study.MethodsWe included 44 aniridic and aphakic eyes for IOL implantation in combination with iris prosthesis reconstruction. The iris prostheses were either sutured into the ciliary sulcus and fixed by transscleral suturing or were implanted together with a capsular tension ring and the IOL in the capsular bag. The primary outcomes measured were pre- and postoperative best corrected visual acuity (CDVA), objective and subjective refraction, anterior chamber depth and optical biometry comparing common IOL formulae.ResultsReasons for surgery were trauma (39 eyes), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly (p<0.0001) from median 0.55 logMAR (0.0 to 1.98) to 0.16 logMAR (−0.08 to 2.0). There were no significant differences between the postoperative target refraction calculated by the formulae “Haigis”, “Hoffer-Q”, “SRK/T” and “Holladay 1” (p=0.68). The absolute deviation from target refraction did not differ significantly between the formulae (p=0.87). Median target refraction was −0.42 D (−4.0 to 1.68). Postoperatively median spherical equivalent was 0.00 D (−5.38 to 2.38). Median absolute deviation from target refraction after 5 months of follow-up was 0.98 D (0.06 to 5.17).ConclusionPostoperative refraction using common techniques and using preoperative biometry revealed a well predictable postoperative refraction. There is no correction factor needed.

Surgical Outcome of Refixation versus Exchange of Dislocated Intraocular Lens: A Retrospective Cohort Study.

We compared the surgical outcomes and complications of refixation vs. exchange of dislocated intraocular lenses (IOLs) in patients who underwent transscleral suture fixation combined with pars plana vitrectomy for the treatment of IOL dislocation. A total of 83 eyes (n = 83 patients) with postoperative follow-up of ≥6 months were evaluated: 40 received refixation of dislocated IOL (refixation group) while 43 received IOL exchange (exchange group) treatment. Treatment outcomes, including best-corrected visual acuity (BCVA), spherical equivalent, corneal cylinder, intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial cell density (ECD), and postoperative complications were retrospectively reviewed. BCVA improvement at 6 months after surgery was comparable between the groups. Postoperative decrease in corneal ECD was significantly greater in the exchange group than in the refixation group, but no significant differences were found in spherical equivalent, corneal cylinder, IOP, or CMT changes. The exchange group experienced significantly more frequent postoperative vitreoretinal complications, such as retinal detachment, choroidal effusion, cystoid macular edema, and secondary epiretinal membrane, than the refixation group. Without any reason to extract the dislocated IOL, reuse of the dislocated IOL would be a better surgical option for transscleral suture fixation to protect corneal endothelial cells and prevent postoperative vitreoretinal complications.

Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects

BackgroundTo assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients.MethodsRetrospective observational study in 59 aniridic and aphakic eyes for ArtificialIris (AI) and IOL reconstruction. The iris prostheses were placed together with the IOL in the capsular bag using an injection system or were fixed by transscleral suturing of the IOL and AI. The primary outcomes measured were visual acuity, contrast and glare sensitivity (Pelli-Robson chart for photopic and dark adaptometer for mesopic conditions), intraocular pressure, endothelial cell density (ECD) and patient impairment.ResultsBlunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly (p < 0.0001) from median 0.7 logMAR (0.0–1.98) to 0.3 logMAR (− 0.08–2.0). Median pupillary area could significantly (p < 0.0001) be reduced by 79.3% from 51.27 mm2 (17.91 to 98.23) to 8.81 mm2 (4.16 to 8.84). Median ECD decreased from 2646.0 mm2 to 2497.5 mm2 (p = 0.007). Contrast and glare sensitivity improved significantly (p = 0.008) in photopic light conditions from 0.9 (0.0–1.95) to 1.35 (0.0–1.8). Patients reported to be highly satisfied with the functional improvement.ConclusionThe flexible ArtificialIris seems to be a safe and effective iris prosthesis in combination with an IOL having functionally and cosmetically exceptional reconstruction options.

Indications for intraoperative anterior segment optical coherence tomography in corneal surgery

PurposeRecently, intraoperative optical coherence tomography (iOCT) has evolved in the field of ophthalmic surgery. So far, the use of iOCT was mainly focused to lamellar keratoplasty, especially deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). The aim of this study was to report our experiences with iOCT to introduce new possibilities of this application.MethodsWe used iOCT in 18 patients who underwent the following surgeries: DALK, DMEK, penetrating keratoplasty, autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens, pannus removal on corneal surface and newborn investigation in Peters’ anomaly. We obtained qualitative video data for all procedures.ResultsWith the iOCT, the cannula placement during DALK preparation of the recipient cornea and bubble formation could be visualized to improve the success rate of the big bubble injection. In DMEK, the iOCT enables the visualization of Descemet’s membrane removal in the recipient and graft orientation as well as better control of graft attachment. The iOCT enables intraoperative visualization of the graft–host interface during penetrating keratoplasty. During autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens and removal of corneal surface pannus the iOCT is capable of showing the thickness of lamellar preparations to avoid penetrations and to save healthy recipient’s tissue.ConclusionThe iOCT is a helpful device for intraoperative anterior segment imaging not only for DALK and DMEK. It is also beneficial in penetrating keratoplasty and every other form of lamellar preparation during corneoscleral surgery.

Partial-thickness scleral tethering suture for optimum fixation and centration of transscleral-sutured intraocular lens–capsule complex

We describe a surgical technique for fine-tuning the centration of a transscleral-sutured modified capsular tension ring (CTR)-intraocular lens-capsular bag complex using a partial-thickness scleral tethering suture placed posterior to the external episcleral portion of a transscleral suture loop. The technique can be used for adjusting the centration of any intraocular supporting or prosthetic device that is transsclerally sutured in a "hanging" technique, such as capsular tension segments, modified CTRs, capsular anchoring devices, or iris prostheses.

Observational study of intraocular lens tilt in sutureless intrascleral fixation versus standard transscleral suture fixation determined by ultrasound biomicroscopy

BackgroundThe position of the intraocular lens (IOL) is a major factor that affects the final visual acuity after cataract surgery. However, no prospective study has compared the IOL positions associated with the sutureless intrascleral technique and the standard transscleral suturing technique. The current study compared the IOL positions in the two techniques using ultrasound biomicroscopy (UBM) in vivo.MethodsTwenty-one eyes of 21 patients were included in this observational study conducted between February and May 2015. Eleven patients underwent the sutureless intrascleral technique, and 10 patients underwent transscleral fixation with suturing. Ophthalmologic examination and UBM were performed in all patients. Optic tilt was measured in relation to the iris plane. The haptic location was defined. Mann–Whitney test and multiple linear regression were used to analyze the vertical and horizontal gradients. Significant differences were considered when p ≤ 0.05.ResultsThe most common indication for scleral fixation was a complication during phacoemulsification (81.81% in the sutureless group and 60% in the suture group). The mean vertical and horizontal tilts were, respectively, 0.24 ± 0.21 and 0.25 ± 0.19 mm in the sutureless group and 0.14 ± 0.17 and 0.23 ± 0.16 mm in the suture group. No significant differences were seen in the vertical tilt and horizontal tilt (p = 0.888 and p = 0.148, respectively) between the groups. Gender (p = 0.835), age (p = 0.888), follow-up time (p = 0.915), and surgical duration (p = 0.094) were not associated with optic tilt. Of the 22 haptics in the sutureless group, 21 (95.45%) were in the intrascleral tunnel; of the 20 haptics in the suture group, 13 (65%) were posterior to the ciliary body, four (20%) anterior to the ciliary body, and three (15%) in the ciliary sulcus.ConclusionThis study showed that there are no significant differences in the IOL positions between the two techniques.

Clinical observation of a novel technique: transscleral suture fixation of a foldable 3-looped haptics one-piece posterior chamber intraocular lens implantation through scleral pockets with intact conjunctiva

BackgroundTo present the follow-up outcomes of a modified technique of transscleral suture fixation of posterior chamber intraocular lens (PCIOL) in eyes with inadequate capsule support.MethodsA retrospective chart review of 21 patients underwent transscleral suture fixation of a foldable 3-looped haptics one-piece PCIOL implantation through scleral pockets was conducted. Preoperative data and follow-up data for at least 3 months were collected for all patients.ResultsThe mean operative duration was 36.62 ± 10.70 min. The mean pre- and post-operative LogMAR uncorrected distance visual acuity was (1.25 ± 0.50 vs. 0.41 ± 0.22, P < 0.01). The mean pre- and post-operative LogMAR best corrected visual acuity was (0.48 ± 0.25 vs. 0.33 ± 0.24, P < 0.01). The mean proportion of postoperative endothelial cell loss was 11.46 ± 4.78%. The mean postoperative anterior chamber depth was 3.05 ± 0.44 mm. The mean postoperative IOL tilt degree was 2.81 ± 1.41°, and the mean postoperative IOL decentration degree was 0.31 ± 0.13 mm. Four patients with transient corneal edema (19.0%) and three patients with transiently elevated IOP (14.3%) were observed after operation, and such complications were resolved within 1 week. No severe complications were observed.ConclusionsThe modified technique was a feasible method of PCIOL implantation.

Telemetric Intraocular Pressure Monitoring after Boston Keratoprosthesis Surgery Using the Eyemate-IO Sensor: Dynamics in the First Year

To analyze the dynamics of telemetrically measured intraocular pressure (IOP) during the first year after implantation of a Boston keratoprosthesis type I (BI-KPro) cornea and to compare agreement of telemetric IOP measurements with finger palpations. Prospective, open-label, multicenter, single-arm clinical trial. In the ARGOS (NCT02945176) study, 12 individuals underwent implantation of an Eyemate-IO intraocular system. Follow-up after surgery took place 12months later with 13 visits planned per patient. During BI-KPro surgery, an electromagnetic induction sensor ring enabling telemetric IOP data transfer to a hand-held reading device outside the eye was implanted into the ciliary sulcus with or without trans-scleral suture fixation. Comprehensive ophthalmic examinations and IOP assessments through the telemetric system were compared to IOP assessed by finger palpation by 2 experts. Preoperative IOP measured by Goldmann tonometry was 13.4 ± 6.2mm Hg. Telemetric IOP peaked at 23.1 ± 16.5mm Hg at the first postoperative day. On day 5, mean IOP was 16.0 ± 5.2mm Hg and 20.95 ± 6.5mm Hg after 6-12months. IOP estimation by finger palpation was grouped in 4 categories: normal, A; soft/hypotonic, B; borderline, C; and hypertonic, D. Mean telemetric IOP was 18.2 ± 6.1mm Hg in category A, 8.9 ± 2.8mm Hg in B, 22.4 ± 4.9mm Hg in C, and 34.3 ± 11.0mm Hg in D. Differences in mean telemetric IOPs per category were statistically significant (P < .001). Daily IOP fluctuations and peaks could be identified. Telemetric IOP assessment seems to be able to identify postoperative IOP peaks and a longitudinal increase of IOP after BI-KPro surgery. IOP measurements using the telemetric Eyemate-IO sensor showed a satisfactory agreement with those of finger palpations by 2 experts.