Transscleral Suture Research Articles

A New Technique for Treating Posttraumatic Aniridia With Aphakia

We describe a new surgical technique for treating traumatic aniridia with aphakia and its results in a small consecutive case series. We attached a 3-piece acrylic intraocular lens through the haptics to a customized silicone iris prosthesis. The combined implant was inserted through a 5-mm incision and fixated with a transscleral suture in the ciliary sulcus using a knotless technique (Z suture). In all patients, the combined implant stayed firmly fixed within the sulcus and showed a stable and centered position without any tilt or torque during follow-up. Thus, managing posttraumatic aniridia with aphakia by means of haptic fixation of a foldable intraocular lens on a custom-tailored iris prosthesis is a promising approach for visual rehabilitation and cosmetic improvement.

Corneal astigmatism correction with scleral flaps in trans-scleral suture-fixed posterior chamber lens implantation: a preliminary clinical observation.

To study the impact of scleral flap position, under which the posterior chamber intraocular lenses (PC-IOL) were sulcus-fixed by trans-scleral suture, on cornea astigmatism. Twenty-six aphakic or cataract eyes were comprised in this prospective noncomparative case series study. Eleven eyes had traumatic cataract removed without sufficient capsular support, 3 had blunt trauma with subluxated traumatic cataract, 8 had undergone vitreoretinal surgery and 4 had congenital cataract removed. The average age was 54 years (range 21-74 years), with 17 men and 7 women. The foldable PC-IOL was fixed in sulcus by trans-scleral suture. The incision for IOL implantation was made 1mm posterior to limbus along the steepest meridian of cornea, while scleral flaps to bury the knots of trans-scleral suture were made along the flattest meridian. All the surgeries were performed by a single doctor (Ma L), and the follow up was at least 13 months (range 13-28 months). The preoperative, 3 months and 1 year postoperative corneal curvature along the steepest and flattest cornea meridian and overall cornea astigmatism were compared. The curvature along the steepest meridian changed from 44.25±2.22D preoperatively to 44.08±2.16D at 3 months postoperatively, and 43.65±5.23D at 1 year postoperatively (P>0.05); the curvature along the flattest meridian changed from 41.24±2.21D preoperatively to 43.15±3.94D at 3 months postoperatively, and 42.85±5.17D at 1 year postoperatively (P<0.05); and the surgery induced astigmatism (SIA) on cornea was calculated by vector analysis, which was 2.42±2.13D at 3 months postoperatively, and 2.18±3.42D at 1 year postoperatively, the difference was statistically significant (P<0.05). The scleral flap made along the flattest meridian, under which the posterior chamber intraocular lenses (PCIOL) were sulcus-fixed by trans-scleral suture, can steepen the cornea in varying degrees, thus reducing preexisting corneal astigmatism.

In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

PurposeTo compare the degree of tilt and decentration of an intraocular lens (IOL), refractive status, and prediction error between eyes that underwent trans-scleral suturing of the IOL within the capsular bag (in-the-bag scleral suturing) and eyes that underwent scleral suturing outside of the bag (out-of-the-bag scleral suturing) because of severe zonular dehiscence.Patients and methodsThirty eyes that underwent in-the-bag scleral suturing of an IOL and 38 eyes that underwent out-of-the-bag scleral suturing were recruited sequentially. The tilt and decentration of the IOL, anterior chamber depth, manifest refractive spherical equivalent (MRSE), prediction error, and incidence of complications were examined.ResultsThe mean tilt angle and the decentration length of the IOL of the in-the-bag suturing group were significantly less than those of the out-of-the-bag suturing group (P=0.0003 in tilt and P=0.0391 in decentration), although the anterior chamber depth was similar. The mean MRSE and prediction error of the in-the-bag suturing group were less than those of the out-of-the-bag suturing group (P=0.0006 in MRSE and P=0.0034 in error). The incidence of vitreous loss was less in the in-the-bag suturing group than in the out-of-the-bag suturing group (20% vs63.2%, P=0.0009).ConclusionsThe tilt and decentration of the IOL after in-the-bag scleral suturing are significantly less than those after out-of-the-bag scleral suturing, which may lead to less MRSE and less prediction error. As the incidence of vitreous loss is less after in-the-bag scleral suturing, in-the-bag suturing is advantageous for eyes of younger patients and of less complicated cases.

Efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion.

To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion. A total of 21 patients (21 eyes) with choroidal avulsion, secondary to open eye trauma and a history of one-stage eyeball wall closure were retrospectively evaluated in the present study. Preoperative findings included 3 to 7.5 mmHg (averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception. Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days averagely 9.41±2.7 days) after the trauma. The postoperative follow-up lasted for 3 to 9 months (averagely 5.5±1.5 months). The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area. Retinal proliferation/detachment, incarceration and/or partial retinal loss were also observed. Intraoperatively, the retina was separated and released, and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area. The suture fixation on the ciliary body was also introduced in some of the patients. At one month posteoperatively, a complete choroidal reattachment was achieved in 16 eyes (16/21, 76.19%) and partial reattachment in the remaining 5 eyes. At the end of follow-up, partial choroidal redetachment was observed in 4 of 16 eyes (25%), resulting in complete reattachment in 12 eyes (12/21, 57.1％) and partial reattachment in 9 eyes (9/21, 33.34％). The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery (Chi-square test, P<0.05), while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively (Chi-square test, P>0.05). Transscleral suture fixation serves as a reliable technique, particularly improving the choroidal reattachment rate in the choroidal avulsion.

Retropupillary Fixation of Iris-claw Intraocular Lens Versus Transscleral Suturing Fixation for Aphakic Eyes Without Capsular Support

Retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse, Abbott Medical Optics) was performed for aphakic eyes without sufficient capsular support, and safety and recovery of the procedure were compared with transscleral suturing fixation. This interventional case series comprised 11 eyes of 10 aphakic patients without capsular support undergoing retropupillary fixation of the Verisyse, and 21 eyes of 20 patients undergoing transscleral suturing fixation of foldable acrylic IOLs (15 eyes of 14 patients, SuperFlex620H [Rayner Intraocular Lenses Ltd]) and polymethylmethacrylate IOLs (6 eyes of 6 patients, CP60NS [CORNEAL Laboratoire]). Surgical time was measured. Corrected distance visual acuity (CDVA) and intraocular pressure (IOP) were examined preoperatively and 1 day, 1 and 2 weeks, and 1 and 6 months postoperatively. No complications occurred in the Verisyse group, whereas complications were reported in seven eyes in the transscleral suturing fixation group throughout follow-up. Mean CDVA (logMAR) in the transscleral suturing group 1 day after surgery was significantly worse than preoperative CDVA (P<.05). In the Verisyse group, no significant changes in CDVA were noted at any time point. Mean IOP at postoperative day 1 in the transscleral suturing fixation group was significantly higher than that in the Verisyse group (P=.0126). Mean surgical time of Verisyse implantation (20.0 ± 8.9 min) was significantly shorter than transscleral suturing fixation (49.7 ± 18.9 min) (P<.0001). Retropupillary fixation of an iris-claw IOL provides early visual recovery, has a low risk of postoperative increase in IOP, and is a time-saving method compared with transscleral suturing fixation for aphakic eyes without sufficient capsular support.

Surgical results of complicated ocular trauma with cyclodialysis

Objective To explore the surgical techniques, efficacy and the management of complicated ocular trauma with anterior-posterior segment complications such as cyclodialysis. Methods Fifty-five patients (55 eyes) with complicated ocular trauma were enrolled in this study. Among them, there were 35 cases with eyeball contusion and 20 cases of eyeball rupture. Preoperative visual acuity was from no light perception to 0. 15, intraocular pressure (IOP) ranged from one to 10 mm Hg (1 mm Hg=0. 133 kPa).Cyclodialysis, vitreous hemorrhage or retinal detachment were revealed by B-ultrasound and ultrasound biomicroscopy (UBM). Cyclodialysis clefts ranged from one to 12 clock-hours. All patients underwent 3-port pars plana vitrectomy with gas/silicone oil tamponade and ciliary body reattachment by cryotherapy (cyclodialysis clefts ≤ three clock-hours) or suture fixation ( cyclodialysis clefts ＞ three clock-hours).Healing after surgical trauma, visual acuity, intraocular pressure, intraocular hemorrhage, ciliary body and retinal reattachment were followed up. Results In one month after surgery, UBM showed 54 patients out of 55 patients had good ciliary body reattachment. Gonioscopy revealed cyclodialysis still existed in one patient, and this was cured by a second surgical suture fixation. In three months after surgery, ocular trauma healed in all 55 patients, the visual acuity ranged from no light perception to 0. 15, with a best corrected visual acuity of 0.8. The ciliary body and retina had good reattachment. IOP of 52 patients was normal; IOP of three patients was still lower than 10 mm Hg. Three patients had secondary glaucoma which was treated by glaucoma surgery. Conclusions Complicated ocular trauma with cyclodialysis can be treated with vitrectomy and cryotherapy or transscleral sutures. The procedure is safe and effective. Key words: Ciliary body/injuries; Ciliary body/surgery; Vitrectomy

Modified transscleral fixation using combined temporary haptic externalization and injector intraocular lens implantation

Several transscleral suturing techniques require intricate surgical maneuvers and are associated with an increased risk for surgical trauma. We describe a new scleral fixation method that combines the advantages of temporary haptic externalization and injector implantation of an intraocular lens (IOL). After IOL insertion with the injector, each haptic is externalized through 2 adjacent corneal incisions. A 10-0 polypropylene suture loop is made at each exposed haptic and transscleral IOL fixation performed. This modified technique is a safe and effective way to fixate the IOL in eyes with insufficient capsule support.

Translocation of Malpositioned Posterior Chamber Intraocular Lens From Anterior to Posterior Chamber Along With Fibrin Glue-Assisted Transscleral Fixation

A posterior chamber intraocular lens (PCIOL) wrongly placed in anterior chamber (AC) can lead to progressive endothelial loss and damage to angle structures. We describe a sutureless, closed-chamber translocation technique to maneuver a PCIOL from AC into the PC and fixate it transsclerally with fibrin glue in presence of a large posterior capsular rent. This is a prospective interventional case series. The participants were three cases of PCIOL in AC with high intraocular pressure and poor uncorrected visual acuity who underwent the translocation surgery successfully. All cases showed improvement in uncorrected visual acuity, with lowered intraocular pressure and no loss in best spectacle-corrected visual acuity till 6 months follow-up. This technique prevents a large incision, does not require a special IOL as in transscleral suture fixation, and results in a low endothelial cell loss.

Femtosecond-assisted keratoplasty with fibrin glue–assisted sutureless posterior chamber lens implantation: New triple procedure

Abstract We report a surgical technique for managing bullous keratopathy secondary to anterior chamber intraocular lens (AC IOL). The technique comprises femtosecond laser–assisted penetrating keratoplasty and AC IOL exchange with fibrin glue–assisted sutureless posterior chamber intraocular lens (PC IOL) implantation (“glued IOL”). This new triple procedure combines the unique benefits of the femtosecond laser and the glued IOL, leading to stable wound configuration, decreased open-sky time, and less pseudophacodonesis, and there is less risk for the suture-related complications of transscleral suture fixation.

Implantation and Explantation of a Wireless Epiretinal Retina Implant Device: Observations during the EPIRET3 Prospective Clinical Trial

Visual sensations in patients with blindness and retinal degenerations may be restored by electrical stimulation of retinal neurons with implantable microelectrode arrays. A prospective trial was initiated to evaluate the safety and efficacy of a wireless intraocular retinal implant (EPIRET3) in six volunteers with blindness and RP. The implant is a remotely controlled, fully intraocular wireless device consisting of a receiver and a stimulator module. The stimulator is placed on the retinal surface. Data and energy are transmitted via an inductive link from outside the eye to the implant. Surgery included removal of the lens, vitrectomy, and implantation of the EPIRET3 device through a corneal incision. The clinical outcome after implantation and explantation of the device was determined. The implant was removed after 4 weeks, according to the study protocol. Implantation was successful in all six patients. While the anterior part was fixed with transscleral sutures, the stimulating foil was placed onto the posterior pole and fixed with retinal tacks. The implant was well tolerated, causing temporary moderate postoperative inflammation, whereas the position of the implant remained stable until surgical removal. In all cases explantation of the device was performed successfully. Adverse events were a sterile hypopyon effectively treated with steroids and antibiotics in one case and a retinal break in a second case during explantation requiring silicone oil surgery. The EPIRET3 system can be successfully implanted and explanted in patients with blindness and RP. The surgical steps are feasible, and the postoperative follow-up disclosed an acceptable range of adverse events.

Implantation of scleral‐fixated posterior chamber intraocular lenses in adults

To report the results of transscleral fixation of posterior chamber intraocular lenses in adults. We carried out a retrospective analysis of 91 eyes of 81 patients who underwent implantation of posterior chamber lenses with transscleral sutures between 1997 and 2006. The mean age of the patients was 62 years (range 19-94 years). Sixty-eight eyes (74.7%) were aphakic at the time of surgery. In 10 patients (11.0%) an intracapsular cataract extraction and in six patients (6.6%) a pars plana lensectomy was performed prior to the fixation of the posterior chamber intraocular lens. In seven eyes (7.7%) a previously implanted IOL was removed. The mean follow-up was 36 months (range 6-116 months). The mean preoperative best corrected visual acuity (BCVA) was 0.37 (range counting fingers to 1.0), which improved to 0.5 (range light perception to 1.0) postoperatively. At the end of follow-up, BCVA was unchanged or improved in 81 eyes (89.0%), reduced by 2 Snellen lines in four eyes (4.4%), and between finger counting and light perception in four eyes (4.4%). The most serious complication was suprachoroidal haemorrhage, which occurred in two eyes. Retinal detachment occurred in three eyes, all of which successfully reattached after surgery. Suture erosion or spontaneous dislocation caused by suture degradation or breakage was not seen. Secondary implantation of posterior chamber intraocular lenses with transscleral fixation is a reasonably safe procedure in adults, with relatively few serious complications. Even in patients with longterm follow-up, suture breakage was not seen.

Bilateral intraocular lens subluxation secondary to haptic angulation

An 82-year-old man had uneventful phacoemulsification with bilateral implantation of a hydrophilic acrylic, single-piece intraocular lens (IOL) (ACR6D SE, Laboratoires Cornéal). Five years later, simultaneous and bilateral IOL subluxations occurred. In both eyes, the subluxation was situated on the side of one haptic that had moved forward (temporal area in the right eye and superior area in the left eye). In the right eye, the haptic-capsular bag was entrapped by the pupil and produced endothelial damage. A transscleral suture was placed over and under the subluxated haptic through the anterior and posterior capsules to capture the haptic. The haptic was then sutured to the sclera. No postoperative complications developed. We hypothesize that 10-degree angulated and broad haptic junctions can lead to zonular damage and IOL subluxation.

Modified cow-hitch suture fixation of transscleral sutured posterior chamber intraocular lenses: Long-term safety and efficacy

To evaluate the long-term safety and efficacy of a new technique using a modified cow-hitch knot for transscleral suture fixation of posterior chamber intraocular lenses (PC IOLs). Public hospital in Brisbane, Australia. A retrospective chart review was conducted of consecutive patients who had transscleral sutured PC IOL implantation from March 2000 to June 2006 using the new technique, which was modified to eliminate free suture ends and minimize the risk for knot slippage. Data collected included demographic data, ocular history, preoperative and final best corrected visual acuities (BCVAs), preoperative and postoperative intraocular pressure (IOP), and postoperative complications. Eighty-two eyes of 79 patients (51 men, 28 women) with a mean age of 62.5 years+/-18.9 (SD) were included in the study. The mean follow-up was 22.9+/-21.2 months (range 5 to 76 months). The BCVA was 20/40 or better in 45 eyes (54.9%) and 20/200 or worse in 10 eyes (12.2%). The final BCVA was largely determined by the preoperative underlying ocular pathology. Postoperative complications included temporary increased IOP in 14 eyes (17.1%), escalated glaucoma in 7 eyes (8.5%), temporary hypotony in 7 eyes (8.5%), and retinal detachment, hyphema, and irregular astigmatism in 1 eye (1.2%) each. The PC IOLs remained well centered and without tilt in all eyes. The technique provided excellent PC IOL centration in the presence of no adequate capsule support. It was effective and safe for transscleral suturing of PC IOLs.

Transsclerally sutured intraocular lens placement in pediatric Marfan syndrome

Introduction: Surgical correction of subluxated lens in Marfan syndrome requires leaving the patient aphakic or implanting a lens in the absence of capsular support. In the absence of capsular support the options include placement of an ACIOL or transscleral fixation of a PCIOL. We report our experience with PCIOL fixation in six patients with Marfan syndrome. Methods: This is a retrospective case review. Results: Eleven eyes of six patients were treated with lensectomy, vitrectomy, and primary transscleral fixation of PCIOL. All children had dislocated lenses or aphakia related to Marfan syndrome. Average age at surgery was 8.8 years (39 to 179 months). Average follow-up was 21 months (9-50 months). Best-corrected distance acuity ranged from 20/30 to 20/100 preoperatively (average, 20/60). Best-corrected postoperative vision ranged from 20/15 to 20/30 (average, 20/20). All patients’ BCVA improved a minimum of three lines, and no patient lost vision. Complications included suture erosion (1), vitreous wick (1), postoperative hyphema (1), and temporary IOL capture (3). Five reoperations were performed for complications secondary to IOL placement. No patient experienced lens tilt or decentration, suture failure, CME, or retinal detachment. Conclusions: Transscleral suture fixation of posterior chamber IOL in Marfan syndrome is successful in restoration of visual acuity. There is a trend toward improved binocular function. All patients included in this study had failed standard optical rehabilitation and required intraocular surgery at the time of the implant surgery. Complications required a reoperation rate of 45%.

Solutions chirurgicales à la luxation du complexe ICP — sac capsulaire — anneau de tension capsulaire

The spontaneous luxation of the intraocular lens-capsular bag-capsular tension ring complex is a serious but fortunately rare complication. The authors report a combined surgical procedure to reposition the complex in a patient who was operated on for bilateral lens subluxation 4 years before and whose enophthalmia made surgery difficult. Two surgical techniques can be considered to reposition the complex and avoid explantation. The McCannel modified stitch can capture the complex with the help of a transcorneal point and then a transscleral suture on the 12 o'clock meridian, despite the enophthalmia of the patient; the Moreno transscleral stitch. Both techniques suture the complex to the ciliary sulcus. Moreno's technique is easy and safe for the endothelium and must therefore be attempted first. In case of failure, the McCannel modified stitch remains a useful and satisfying procedure allowing transscleral fixation of the complex to the sulcus at the cost of a minimal corneal trauma.

Ab Externo Technique for Accurate Haptic Placement of Transscleral Sutured Posterior Chamber Intraocular Lenses

A modified technique is presented for transscleral suture fixation of posterior chamber intraocular lenses for aphakic correction in cases with inadequate capsular support. An ab externo approach for suture externalization is described that minimizes intraocular manipulation and facilitates accurate placement of haptics in the ciliary sulcus, thereby reducing the risk of lens tilt and decentration. This technique eliminates intraocular suture knots and reduces the amount of time the globe is open during surgery by creating two intraocular suture loops in preparation for posterior chamber intraocular lens placement before creating a limbal incision.

A New Small-Incision Technique for Injector Implantation of Transsclerally Sutured Foldable Lenses

A new, minimally invasive technique for clear cornea implantation of one-piece acrylic posterior chamber lenses for transscleral suture fixation in aphakic eyes without capsular support is described. Based on the techniques of modern small-incision cataract surgery, implantation was performed through a self-sealing, 2.75-mm temporal clear cornea incision using the injector technique. This was possible by modifying the insertion of the lens into the cartridge and introducing a new suturing technique of the lens. Suturing of the leading haptic end was performed while the lens was still securely stored inside the cartridge. The trailing haptic was tied after implantation. By using a self-sealing tunnel incision and injector technique, significant fluid egress and consecutive transient hypotony may be minimized throughout the procedure and early visual rehabilitation achieved.

A study in the capsular bag intraocular lens implantation for cases of subluxation of lens

目的 探讨晶状体超声乳化人工晶状体囊袋内植入术治疗晶状体不全脱位的可行性.方法 对32例(51眼)年龄为20～58岁的晶状体不全脱位行晶状体超声乳化囊袋内缝线固定人工晶状体植入术.观察术中术后情况,随访时间10～24月.结果 手术顺利完成,术后人工晶状体固定良好,无移位,视轴区透明,视力提高迅速且较稳定,术后无严重并发症发生..结论 晶状体超声乳化囊袋内缝线固定法人工晶状体植入术治疗晶状体半脱位,可有效保持视轴清晰,恢复眼部正常解剖结构,显著减少并发症的发生。

Iris fixation of foldable intraocular lenses for ectopia lentis in children

To describe a technique for iris fixation of acrylic intraocular lenses (IOLs) in ectopia lentis and evaluate the medium-term anatomical and functional results in children. Pediatric Ophthalmology Department, Fondation Rothschild, Paris, France. This retrospective study included 17 eyes of 9 children. The technique consisted of lens ablation, leaving in place the capsule in the zone of nonruptured zonule, and an IOL placement in the remaining sulcus with 2 iris sutures. The age of patients, postoperative complications, follow-up, anatomical results, final refraction, and visual acuity were noted. Median age was 4.8 years. One case of postoperative hyphema and 1 case of aseptic endophthalmitis occurred and resolved after treatment. The anatomical outcome was favorable in all cases, with centered IOLs and round pupils. Mean follow-up was 16.3 months. Mean final refraction was +0.18 diopter, and mean final best corrected visual acuity was 20/32 (range 20/50 to 20/20). The results suggest that iris fixation of foldable IOLs for ectopia lentis in children can lead to good anatomical and functional results. The use of the remaining part of the sulcus is helpful in reaching correct positioning of the IOL. The complication rate is similar to that with other techniques described in the literature, whereas the small incision and the absence of transscleral sutures could simplify the short-term and long-term evolution.

Long-Term Outcome of Combined Pars Plana Vitrectomy and Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation

To investigate the long-term visual outcome and the complication rate following transscleral suture fixation of posterior chamber intraocular lenses (sutured PC-IOLs). A retrospective case-series descriptive study. Records of patients who underwent combined pars plana vitrectomy and sutured PC-IOLs at Moorfields Eye Hospital and who had at least 12 months of follow-up were examined for recorded complications. Sixty-one eyes of 48 patients (33 males and 15 females) were identified and included in the analysis, with mean follow-up of 6 years. The mean final best-corrected visual acuity remained at preoperative levels (P=.211) and was largely determined by the underlying ocular pathology before sutured PC-IOL. Overall 30 of 61 (49%) eyes, two or more procedures were performed to reverse a significant peri- or postoperative complication. Breakage of polypropylene sutures was the main indication accounting for 17 of 30 (57%) of those reoperations. Subgroup analysis showed that younger patients were more likely to suffer the above complication (P=.009). The multivariate analysis also showed that longer follow-up was significantly associated with suture breakage (P=.014), with the mean time to breakage approximately 4 years after surgery. Long-term follow-up of patients undergoing sutured PC-IOLs appears to be associated with a high rate of postoperative complications and significant need for further surgery, which should be discussed during their informed consent process.