Transscleral Sutured Intraocular Lens Research Articles

Clinical Outcomes of Transscleral-Sutured Intraocular Lens Combined With Descemet Membrane Endothelial Keratoplasty.

The aim of the study was to report clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) combined with transscleral-sutured intraocular lens (IOL) compared with DMEK combined with phacoemulsification and posterior chamber IOL (Phaco-DMEK). A retrospective chart review of all patients who underwent DMEK combined with transscleral-sutured intraocular lens fixation or combined with phacoemulsification for Fuchs endothelial corneal dystrophy from 2016 to 2021 at the Toronto Western Hospital or the Kensington Eye Institute (Toronto, ON, Canada) and had at least 18 months of follow-up was performed. Main outcomes were postoperative distance-corrected visual acuity, rebubbling rate, graft survival rate, and complications. Twenty-one cases of DMEK combined with transscleral-sutured IOL (DMEK-TSS-IOL) and 44 cases of Phaco-DMEK were evaluated. Twelve eyes (57.15%) had a foldable acrylic 3-piece IOL (AR40E) and 9 (42.85%) had a single-piece polymethylmethacrylate (PMMA) IOL (CZ70BD). LogMAR distance-corrected visual acuity improved significantly from 1.48 ± 0.62 (SD) to 0.86 ± 0.82 (P = 0.01) 12 months after DMEK-TSS-IOL and from 0.41 ± 0.29 logMAR to 0.11 ± 0.11 logMAR (P < 0.0001) after Phaco-DMEK. No statistically significant differences were observed in donor (P = 0.97) or 1-year postoperative endothelial cell density (P = 0.11) between the groups. Rebubbling was necessary in 33.33% of eyes in DMEK-TSS-IOL compared with 25% of Phaco-DMEK eyes (P = 0.55). Graft survival rate was 76.19% in the DMEK-TSS-IOL group compared with 90.90% in the Phaco-DMEK group (P = 0.13). Transscleral-sutured IOL combined with DMEK is an option for the management of endothelial diseases in aphakic eyes or those which require IOL exchange for the experienced surgeon. However, when compared with routine Phaco-DMEK, there are higher complication and lower survival rates at 18 months.

Microspherophakia with Novel Gene Mutations in a Young Girl

A 4-year-old girl presented with -20.00 diopters of myopia and best corrected visual acuity (BCVA) of 20/200 in each eye, was diagnosed as microspherophakia. Shallow anterior chambers and tremors of the small thickened crystalline lenses and iris were observed in both eyes with pupil dilation (Figure 1). Elevated intraocular pressure was controlled with thymoxamine. Novel compound heterozygous LTBP2 mutations were detected (c.4760G>A, c.620G>A). Bilateral lens extraction with transscleral-sutured intraocular lens implantation was performed for treatment of amblyopia and glaucoma.

Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

BackgroundThe aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes.MethodsIn this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated.ResultsThis study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively.ConclusionThe combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma 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.

Outcomes of Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes with Sutured Posterior Chamber Intraocular Lens.

Purpose To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) for vitrectomized eyes that underwent pars plana vitrectomy (PPV) and transscleral-sutured intraocular lens (IOL) implantation. Methods In this retrospective study, DMEK cases were reviewed from medical records and divided into two groups: the eyes after PPV and transscleral-sutured IOL implantation (vitrectomized group) and the eyes with in-the-bag IOL implantation (control group) prior to DMEK. The main outcome measures included time of graft unfolding during surgery and best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, and 6 months after the DMEK. Results Twenty-three eyes (vitrectomized group, n = 8; control group, n = 15) in 23 patients were included in this study. The unfolding time was significantly longer in the vitrectomized group than in the control group (P < 0.001). Postoperative BSCVA was worse in the vitrectomized group (0.16 ± 0.15) than in the control group (−0.06 ± 0.06; P = 0.017). The improvement in BSCVA was negatively correlated with the patients' age and frequency of previous surgeries. Conclusions Despite the longer graft unfolding time and limited visual recovery, DMEK should be applicable to vitrectomized eyes with transscleral-sutured IOL implantation.

Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes

To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. When a secondary IOL cannot be placed withinthe capsular bag, sulcus with optic capture is the bestalternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.

Descemet-stripping automated endothelial keratoplasty in eyes with transscleral-sutured intraocular lenses

To compare the clinical outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) with a transscleral-sutured intraocular lens (IOL) and solitary DSAEK. Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. Retrospective case series. Cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and solitary DSAEK cases were studied. The logMAR acuity, astigmatism, endothelial cell density (ECD), graft survival rate, and complications (eg, IOL dislocation, cystoid macular edema [CME]) were analyzed. Thirty-seven DSAEK cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and 147 solitary DSAEK cases were evaluated. The logMAR corrected distance visual acuity (CDVA) improved significantly at 24months, from 1.34±0.49 (SD) to 0.48±0.38 after DSAEK with transscleral-sutured IOLs and from 1.17±0.69 to 0.17±0.25 after solitary DSAEK. The logMAR CDVA after DSAEK with transscleral-sutured IOLs was significantly worse than that with solitary DSAEK at 6, 12, and 24months (P<.01). The postoperative astigmatism with DSAEK with transscleral-sutured IOLs was significantly higher than with solitary DSAEK because of the larger sclerocorneal incision (P<.02). There were no significant differences in ECD or graft survival rates between DSAEK with transscleral-sutured IOLs and solitary DSAEK. The incidence of CME in DSAEK with transscleral-sutured IOLs (4/37 eyes [11%]) was higher than with solitary DSAEK (2/147 [1.4%]) (P=.02). The CME resolved with topical diclofenac and sub-Tenon injection of triamcinolone acetonide in all eyes. The graft survival rates after DSAEK with transscleral-sutured IOLs were equivalent to those after solitary DSAEK, although the incidence of CME was higher than after solitary DSAEK. None of the authors has a financial or proprietary interest in any material or method mentioned.

Visual outcomes and stability of transscleral-sutured intraocular lenses in children

Visual outcomes and stability of transscleral-sutured intraocular lenses in children

Safety of transscleral-sutured intraocular lenses in children

To evaluate the long-term efficacy, safety, and advisability of transscleral-sutured posterior chamber intraocular lenses (IOLs) in pediatric patients with no capsular support and to determine whether a 10-0 polypropylene suture should be used for this purpose. A long-term retrospective interventional case series review of 33 eyes of 26 patients who had a sutured IOL at Duke University Eye Center. Cases were evaluated for the intraoperative surgical risks and the number, type, and severity of the postoperative complications. A survey of pediatric ophthalmologists' experience with suture breakage was performed. Intraoperative and immediate postoperative complications were minimal and not sight-threatening for the patient. Four patients developed subluxation of the IOL secondary to spontaneous 10-0 polypropylene suture breakage at 3.5, 5, 6, and 8 years after surgery. A survey of pediatric ophthalmologists revealed 13 similar cases (mean, 5 years after surgery). Caution should be exercised in the use of 10-0 polypropylene suture to fixate an IOL to the sclera in children, and an alternative material or size (such as 9-0 polypropylene) should be considered.

Pediatric transscleral sutured intraocular lenses: Efficacy and safety in 43 eyes followed for an average of three years

The authors performed a retrospective analysis of the surgical outcome of 43 eyes of 32 aphakic children who received transscleral sutured intraocular lens (TSSIOL) because of contact lens failure and inadequate capsular support for sulcus fixation. The mean age at the time of implantation was 10 (range, 13 months to 19 years). One-third of the patients were ≤ age 7 at the time of TSSIOL and 50% were ≤ age 10. The major indication for surgery was primary lens subluxation (19 eyes), predominantly because of Marfan’s syndrome, followed by congenital cataract with extensive removal of the lens capsule (14 eyes).

Pediatric transscleral sutured intraocular lenses: Efficacy and safety in 43 eyes followed an average of 3 years

Purpose To report longer term results of transscleral sutured intraocular lens (TSSIOL) implantation in a sizable cohort of aphakic children, who were not suitable for contact lens wear and lacked adequate capsular support for sulcus fixation of an intraocular lens. Methods Clinical outcome data were collated by retrospective review after surgery on 43 consecutive eyes in 32 aphakic children (mean age at implantation = 10 years; 33% ≤ age 7 years). Outcome measures included visual acuity, postoperative refractive error, postoperative complications, and rate of reoperation. Follow-up averaged 37 months. Results Visual acuity improved after surgery in 70% (30) of operated eyes (in 69% or 22/32 children). Fifty-one percent (22/43 eyes) improved by two lines or more. No patient suffered a loss of acuity or exacerbation of preexisting amblyopia. Postoperative refraction was within ±2.0 D of the predicted refraction in 93% (40/43) of eyes. Complications, with the exception of one eye (2%), were minor/transient and resolved in the first week after surgery. Complications included small hyphemas (7%, 3/43 eyes), vitreous hemorrhage (5%, 2/43 eyes), and ocular hypertension or hypotony (5%). Two eyes (5%) exhibited episodes of iris capture of the IOL optic, one of which (2%, 1/43) eventually necessitated reoperation for IOL exchange. No retinal detachments or other retinal complications were encountered. Conclusion TSSIOL implantation appears to be a safe and effective method for correcting aphakia in pediatric eyes that lack adequate capsular support. Safety over a follow-up period longer than the average 3 years reported here remains to be determined. The surgery is more difficult to perform than capsular-bag or sulcus implantation and potentially carries greater risks.