If the capsular remnant did not offer adequate support for a pc iol, a scleral fixated iol was placed 17 eyes, 34. Several reports concerning scleral fixated posterior chamber intraocular lenses pciol have been reported with mostly favorable results. Simple new technique for scleral fixation of iol surgical technique i ntroduction scleral fixation of iol is indicated in cases of aphakia with absent or inadequate capsular bag support. The surgeries were performed at singapores national university hospital. A surgical technique for implanting a posterior chamber intraocular lens iol in eyes without capsular or zonular support is presented. In this study, 30 eyes of 30 patients were included.
For primary insertion of iols without these confounding factors, openloop ac iols are reported to yield better visual outcomes than scleralfixated pc iols, with a postoperative snellen cdva of 612 or better in 71. Abstractbackground in microspherophakia, abnormal laxity of the lenticular zonules leads to. Sutureless scleral fixation of the iol can be another solution, but this. Amodification ofthistechniqueuses ascleral pocket initiated through a peripheral clear corneal incision. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. The insertion of a scleralfixated iol requires great surgical skill and lacks an anatomical safety net to prevent an insufficiently secured implant from sinking into the vitreous space. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol. This eliminates the need to make large incisions to explant the iol for exchange with a new lens. Modified 3piece scleralfixated iol american academy of.
In the single study comparing primary and secondary scleral fixated iol implantations, glaucoma was reported to be 16. Surgical technique simple new technique for scleral. Iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Combined pars plana vitrectomy ppv and scleral fixation of rigid intraocular. Iris fixation and scleral fixation of dislocated iols had similar visual outcomes, but iris fixation was associated with more postoperative inflammation and less stable refraction, according to a. The insertion of a scleral fixated iol requires great surgical skill and lacks an anatomical safety net to prevent an insufficiently secured implant from sinking into the vitreous space. Scharioth et al23 reported good intermediate results of sutureless surgery, with no cases of recurrent dislocation or retinal detachment at a median followup of 7months. Howard fine, md, mark packer, md scleral fixation of intraocular lenses iols and adjunctive capsular devices can be performed under theprotection ofascleral flap. Complications were common, and suture rupture is an important longterm complication, particularly in young patients.
Glued iol or glued intraocular lens is a new surgical technique for implantation of a posterior chamber iol with the use of biological glue in eyes with deficient or absent posterior capsules fig 1. A 100 polypropylene suture attached to a standard needle is tied to the apex of each haptic and passed transclerally through the ciliary sulcus to secure the haptics at the 3 oclock and 9 oclock meridians. Irisclaw intraocular lens and scleralfixated posterior chamber intraocular. As the editor of the guide, i had the pleasure of working with an international team of over twenty experts in the field from all. A scleral lens, also known as a scleral contact lens and ocular surface prostheses is a large contact lens that rests on the sclera and creates a tearfilled vault over the cornea. If, however, the patient is aphakic preoperatively, we plan for a scleral fixated iol using the method described above. Outcomes and complications of scleralfixated intraocular lens. Scleral lenses are designed to treat a variety of eye conditions, many of which do not respond to other forms of treatment. For a partial dislocation of a onepiece iol in the bag, i prefer trans scleral suture fixation, he says. This postoperative inflammation with cellular proliferation of the iol is induced by. A redislocation such as in scleral fixated iols does not occur with irisclaw iols.
Combined pars plana vitrectomy and suture less scleral fixation of. Conclusion a previously scleral fixated iol with a single dislocated haptic without an islet may be successfully re fixated in a secure fashion by the technique described. Purpose implantation of a scleral fixated intraocular lens sfiol for the surgical management of aphakia in the absence of capsular support is a safe procedure with a low risk of complications in the early postoperative period. In 14 patients, iris and retinal fa were performed. Our goal was to combine some of the welldescribed ante rior segment surgical. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. Note that all scleral incisions are made with a straightentry, nontunneled approach and with the flat portion of the trocar blade parallel to the limbus. Oct 01, 2009 iol fixation techniques a european surgeon offers his views on the treatment of luxated intraocular lenses gabor b. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. The purpose of this study is to assess the longterm outcome and complication profile of. Fram said she has primarily been using scleral suture fixation and some glued iol techniques over the past 10 years.
Description a new, updated version of theguide to scleral lens fittinghas been launched recently. This was a retrospective study that included 22 eyes from 22 participants. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. A truly knotless technique for scleral fixation of.
It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. Iol exchange for scleral fixated akreos ao lens using goretex duration. Primary and secondary implantation of scleralfixated. Surgical technique simple new technique for scleral fixation. Scleral fixation is an alternate way of fixing the iol in the posterior chamber.
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. Irisclaw intraocular lens and scleralfixated posterior chamber. We also aimed to evaluate the influence of the position of the scleralfixated iols on the quality of vision of patients who had undergone scleralfixated iol implantation surgery. The indication for intraocular lens iol scleral fixation is widely variable. Mar 18, 2015 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. If you continue browsing the site, you agree to the use of cookies on this website. Reiss and adenwalla tie 60 vicryl suture to each haptic to facilitate haptic externalization.
In cases of a dislocated iol in the vitreous, we plan for vitrectomy to retrieve the iol, followed by iris fixation. For primary insertion of iols without these confounding factors, openloop ac iols are reported to yield better visual outcomes than scleral fixated pc iols, with a postoperative snellen cdva of 612 or better in 71. Sclerallenses arelargediameter gaspermeablelensesthatrest beyondthelimitsofthecornea andextendontothesclera. Dmek procedures were performed on a 49yearold woman with a preexisting sf iol case 1 and a 69yearold woman with a preexisting if iol case 2 in order to treat secondary corneal edema due to. Outcomes and complications of scleral fixated intraocular lens combined with ahmed tube surgery nikhel sachdev,1 maria cecilia aquino,1 seng chee loon,1 yiong huak chan,2 paul chew,1 and victor koh 1 1department of ophthalmology, national university hospital, singapore 119228 2department of biostatistics, yong loo lin school of medicine. Pdf revised technique of four point scleral fixated intraocular. Scleral fixation, intraocular lenses, aphakia, iol dislocation. Sfiol lens procedures with strabismus correction may reduce the number of surgical and anaesthetic. We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. This video demonstrates a modified method for scleral fixation of a 3piece iol.
The scleral flap was closed with vicryl suture, covering the prolene knot. Apr 29, 2016 scleral fixated iol sfiol ashish agrawal. Pc iol could be implanted into the capsular bag in 15 eyes 30. Management of intraoperative tilting of the scleral. For scleral fixation implantation, use 6725067255 for posterior sclera fixation and 6622066225 for anterior sclera fixation accordingly. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol.
Iol, an anglesupported anterior chamber iol ac iol, or an iris fixated iol. The technique allows permanent scleral fixation of the polypropylene haptics of a 3piece iol directly into the sclera to achieve a position in the ciliary sulcus, thus obviating the need for suturing. May 10, 2017 scleral fixated pciols suturing an iol to the sclera is perhaps more technically demanding than the other techniques discussed here, but it has the advantages of durability and security, thanks in part to the haptic fixation points on pciols. Among them scleral fixated pc iol implant can provide minimum magnification of image as compared to other options.
Dmek procedures were performed on a 49yearold woman with a preexisting sfiol case 1 and a 69yearold woman with a preexisting ifiol case 2 in order to treat secondary corneal edema due to. The suture was tied to itself and secured to the sclera. Scleralfixated pc iol insertion provided favorable visual outcomes in many cases. We conceived and designed a knot ball scleral fixation technique for suture burial in a retrospective sample of 108. Retinal physician goretex sutured intraocular lens. To report two cases of descemet membrane endothelial keratoplasty dmek in patients with existing scleralfixated and irisfixated intraocular lenses sfiol and ifiol, respectively.
The disadvantage is that the iol is fixated into the iris tissue, and a too traumatic implantation may lead to an inflammation. However, data on longterm functional outcome are limited. For a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. Flanged fixation secures iol haptics within the sclera. Scleral fixation of iol is an effective but surgically demanding technique. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol.
Scleral fixation lens are implanted inside the eyes with the help of scleral support. Conclusion a previously scleralfixated iol with a single dislocated haptic without an islet may be successfully refixated in. In the single study comparing primary and secondary scleralfixated iol implantations, glaucoma was reported to be 16. In pediatric aphakia, implantation of a scleral fixated posterior chamber iol is preferable to an anterior chamber iol because of longterm complications associated with the latter, namely corneal decompensation, glaucoma, and pupillary ectopia. Intrascleral haptic fixation as an alternative to sutures. Descemet membrane endothelial keratoplasty in cases with. Som prasad and gabor scharioth present a strategy to achieve secure sutureless intrascleral haptic fixation. The purpose of this study is to assess the longterm outcome and complication profile of sfiol implantation. Iols can be fixated to the sclera using sutures or by tunneling the iol haptics into the sclera without sutures. This video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma. Scleral fixated iol this video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma. Scleral sutured lenses can have good results but require complex intraocular maneuvers and run the risk of iol tilting and late suture breakage.
This has the advantages of knotless fixation of the haptics and an outin approach for passing the needle through the sclera. Purpose implantation of a scleralfixated intraocular lens sfiol for the surgical management of aphakia in the absence of capsular support is a safe procedure with a low risk of complications in the early postoperative period. Novel technique to overcome the nonavailability of a long needle. We also aimed to evaluate the influence of the position of the scleral fixated iols on the quality of vision of patients who had undergone scleral fixated iol implantation surgery.
Iris fixation or scleral fixation of dislocated iols. Two different schematics for placement of the conjunctival peritomies and sclerotomies when performing a goretex sutured intraocular lens procedure. Fixation of intraocular lenses in cases of insufficient or no capsular support is challenging and requires a large armamentarium of techniques to resolve different situations. Resultsno major complications were noted during the procedure. Abstract pdf 1155 views full text 2944 views license. Most of these complications can be avoided or minimized by proper selections of materials used and adopting the proper technique.
The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. Pdf scleralfixated posterior chamber intraocular lenses. If, however, the patient is aphakic preoperatively, we plan for a scleralfixated iol using the method described above. Visual outcomes and complications of scleralfixated. Pdf scleralfixated posterior chamber intraocular lenses in. This article is from indian journal of ophthalmology, volume 62. Yannek leiderman demonstrates his technique for a sutureless scleral fixation of a 3piece iol, a challenging procedure simplified by modifying haptic fixation within the scleral tunnel. To evaluate the outcome and complications of transscleral suturefixated posterior chamber intraocular lens pciol implantation combined with ahmed glaucoma valve agv surgery in asian eyes. Eyeworld comparable results from sutureless scleral. Modified technique for transscleral fixation of posterior. Evaluation of scleralfixated intraocular lens position. Placement of iol in the posterior chamber rather than anterior or. Positioning of scleralsutured posterior chamber iols. This includes aphakia following a large pc rent, following penetrating injury, in cases of.
Scleralfixated posterior chamber intraocular lenses in. In recent studies,5 iol exchange with vitrectomy and a scleral suture fixated iol is the most frequently. Original article visual outcome and complications in ab. In pediatric aphakia, implantation of a scleralfixated posterior chamber iol is preferable to an anterior chamber iol because of longterm complications associated with the latter, namely corneal decompensation, glaucoma, and pupillary ectopia.
Therefore, reducing iol power by up to 1 d, as is commonly employed with sulcus fixation, should not be routinely practiced in scleralsutured posterior chamber iol cases to avoid postoperative. Pdf on feb 28, 2018, sikander lodhi and others published revised technique of four point scleral fixated intraocular lens. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleral fixated threepiece iol. Scleralsutured lenses can have good results but require complex intraocular maneuvers. In addition, the incidence of exposed suture knots through the conjunctiva was 3.
Ppv in a major way, scleral fixation of iol sfiol surgery has also had its share. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. Followup examinations measured visual acuity, intraocular pressure, and iol decentration and tilting. Eyeworld comparable results from sutureless scleralfixated. A quickacting surgical fibrin sealant derived from human blood plasma, with both hemostatic and adhesive properties is used. Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. Sutureless scleral iol fixation american academy of. Iol rescue via sutureless scleral fixation eyetube. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. Crsteurope sulcus fixation of an iol using scleral tunnels. Three patients were aphakic, 14 had an intraoperative posterior capsule rupture during cataract surgery, and one. Materials and methods in total, 26 eyes of 26 patients 14 women, 12 men who.
Scleral fixation without conjunctival dissection richard s. An sfk joining the two sutures was passed through the sclera without. To assess the longterm outcome of scleralfixated sutured posterior chamber intraocular lens spciol implantation in non pars plana. Knotless scleral fixation describes the technique for implanting an iol by scleral fixation sutures.
Apr 21, 2012 the iol haptics are the jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. This includes aphakia following a large pc rent, following penetrating injury, in cases of subluxation or dislocation of lens, hypermature. Implantation of scleralfixated posterior chamber intraocular. Jan 20, 2014 to report two cases of descemet membrane endothelial keratoplasty dmek in patients with existing scleral fixated and iris fixated intraocular lenses sf iol and if iol, respectively. I need a code for a pars plana vitrectomy and removal of iol, and implantation of sclera fixation. In the last year, she said she has been evaluating the yamane technique, because she views it as a clever smallincision technique with much promise. Mar 08, 2016 iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Outcomes and complications of scleralfixated intraocular lens combined with ahmed. Modified technique of scleral fixation intraocular lens. Hence, combining the two surgeries as a single step procedure. The 1ry indication is iol dislocation as a principal complication of cataract surgery, with early reports of % rate of iol dislocation 1. To evaluate the outcome and complications of transscleral suturefixated posterior chamber intraocular lens. Posterior chamber intraocular lenses directly fixated to sclera have been used in a variety of situations such as planned secondary iol insertion and surgical complications at the time of primary cataract surgery. Positioning of scleralsutured posterior chamber iols affects.
Scleral fixated intra ocular lens implantation is a procedure of recent origin which is more advancing such that even sutureless technique with foldable iol has achieved. Longterm outcome of scleralfixated intraocular lens. Clinical study outcomes and complications of scleralfixated intraocular lens combined with ahmed tube surgery nikhel sachdev,1 maria cecilia aquino,1 seng chee loon,1 yiong huak chan,2 paul chew,1 and victor koh 1 1department of ophthalmology, national university hospital, singapore 119228 2department of biostatistics, yong loo lin school of medicine, singapore 119228. Therefore, reducing iol power by up to 1 d, as is commonly employed with sulcus fixation, should not be routinely practiced in scleral sutured posterior chamber iol cases to avoid postoperative. Outcomes and complications of scleralfixated intraocular. Because externalization of the haptic can be difficult at times using forceps alone, this method allows for easier externalization of the haptics even though it. 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. Sutureless scleral fixated iol implantation with intra scleral haptic fixation and gluing of the iol has been gaining recognition in recent years.