Combined pars plana vitrectomy ppv and scleral fixation of rigid intraocular. Positioning of scleralsutured posterior chamber iols. 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. Irisclaw intraocular lens and scleralfixated posterior chamber intraocular. In the single study comparing primary and secondary scleralfixated iol implantations, glaucoma was reported to be 16. 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. Modified 3piece scleralfixated iol american academy of. Two different schematics for placement of the conjunctival peritomies and sclerotomies when performing a goretex sutured intraocular lens procedure. This postoperative inflammation with cellular proliferation of the iol is induced by.
In 14 patients, iris and retinal fa were performed. 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. This includes aphakia following a large pc rent, following penetrating injury, in cases of subluxation or dislocation of lens, hypermature. Iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Novel technique to overcome the nonavailability of a long needle. A truly knotless technique for scleral fixation of. The surgeries were performed at singapores national university hospital. Reiss and adenwalla tie 60 vicryl suture to each haptic to facilitate haptic externalization. In recent studies,5 iol exchange with vitrectomy and a scleral suture fixated iol is the most frequently. If, however, the patient is aphakic preoperatively, we plan for a scleral fixated iol using the method described above. 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. Hence, combining the two surgeries as a single step procedure. This article is from indian journal of ophthalmology, volume 62.
We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. 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. This video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma. 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. If, however, the patient is aphakic preoperatively, we plan for a scleralfixated iol using the method described above. Surgical technique simple new technique for scleral fixation. Amodification ofthistechniqueuses ascleral pocket initiated through a peripheral clear corneal incision. Howard fine, md, mark packer, md scleral fixation of intraocular lenses iols and adjunctive capsular devices can be performed under theprotection ofascleral flap. 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. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. Materials and methods in total, 26 eyes of 26 patients 14 women, 12 men who. This includes aphakia following a large pc rent, following penetrating injury, in cases of.
The indication for intraocular lens iol scleral fixation is widely variable. Sutureless scleral fixated iol implantation with intra scleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Pdf scleralfixated posterior chamber intraocular lenses in. Primary and secondary implantation of scleralfixated. Original article visual outcome and complications in ab. Among them scleral fixated pc iol implant can provide minimum magnification of image as compared to other options. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. This eliminates the need to make large incisions to explant the iol for exchange with a new lens. 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. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. In cases of a dislocated iol in the vitreous, we plan for vitrectomy to retrieve the iol, followed by iris fixation.
Management of intraoperative tilting of the scleral. Outcomes and complications of scleralfixated intraocular lens combined with ahmed. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years.
Flanged fixation secures iol haptics within the sclera. Mar 08, 2016 iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Intrascleral haptic fixation as an alternative to sutures. 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. A redislocation such as in scleral fixated iols does not occur with irisclaw iols. In this study, 30 eyes of 30 patients were included. 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. 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. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Description a new, updated version of theguide to scleral lens fittinghas been launched recently. A quickacting surgical fibrin sealant derived from human blood plasma, with both hemostatic and adhesive properties is used. Positioning of scleralsutured posterior chamber iols affects. Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case.
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. Iol rescue via sutureless scleral fixation eyetube. Sfiol lens procedures with strabismus correction may reduce the number of surgical and anaesthetic. Sutureless scleral fixation of the iol can be another solution, but this. Fram said she has primarily been using scleral suture fixation and some glued iol techniques over the past 10 years. 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.
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. Sutureless scleral iol fixation american academy of. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79. 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.
Resultsno major complications were noted during the procedure. Modified technique for transscleral fixation of posterior. Retinal physician goretex sutured intraocular lens. Sclerallenses arelargediameter gaspermeablelensesthatrest beyondthelimitsofthecornea andextendontothesclera. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleral fixated threepiece iol. If you continue browsing the site, you agree to the use of cookies on this website. We conceived and designed a knot ball scleral fixation technique for suture burial in a retrospective sample of 108. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. 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. Most of these complications can be avoided or minimized by proper selections of materials used and adopting the proper technique.
Pdf revised technique of four point scleral fixated intraocular. 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. Oct 01, 2009 iol fixation techniques a european surgeon offers his views on the treatment of luxated intraocular lenses gabor b. 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.
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. An sfk joining the two sutures was passed through the sclera without. For scleral fixation implantation, use 6725067255 for posterior sclera fixation and 6622066225 for anterior sclera fixation accordingly. Pc iol could be implanted into the capsular bag in 15 eyes 30. Followup examinations measured visual acuity, intraocular pressure, and iol decentration and tilting. Scleralsutured lenses can have good results but require complex intraocular maneuvers. Visual outcomes and complications of scleralfixated. 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.
The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. Several reports concerning scleral fixated posterior chamber intraocular lenses pciol have been reported with mostly favorable results. Crsteurope sulcus fixation of an iol using scleral tunnels. Abstractbackground in microspherophakia, abnormal laxity of the lenticular zonules leads to. Iris fixation or scleral fixation of dislocated iols. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. Outcomes and complications of scleralfixated 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. Iol exchange for scleral fixated akreos ao lens using goretex duration. Scleral sutured lenses can have good results but require complex intraocular maneuvers and run the risk of iol tilting and late suture breakage. For a partial dislocation of a onepiece iol in the bag, i prefer trans scleral suture fixation, he says. 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.
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. Surgical technique simple new technique for scleral. Scleral fixated intraocular lens sfiol is a safe and effective option for managing optical aphakia. 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. This has the advantages of knotless fixation of the haptics and an outin approach for passing the needle through the sclera. Descemet membrane endothelial keratoplasty in cases with. Three patients were aphakic, 14 had an intraoperative posterior capsule rupture during cataract surgery, and one. Our goal was to combine some of the welldescribed ante rior segment surgical.
Scleralfixated posterior chamber intraocular lenses in. 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. I need a code for a pars plana vitrectomy and removal of iol, and implantation of sclera fixation. Irisclaw intraocular lens and scleralfixated posterior chamber. Scleral fixation lens are implanted inside the eyes with the help of scleral support. To report two cases of descemet membrane endothelial keratoplasty dmek in patients with existing scleralfixated and irisfixated intraocular lenses sfiol and ifiol, respectively. Evaluation of scleralfixated intraocular lens position. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. The suture was tied to itself and secured to the sclera. In addition, the incidence of exposed suture knots through the conjunctiva was 3. Eyeworld comparable results from sutureless scleral. 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. The purpose of this study is to assess the longterm outcome and complication profile of sfiol implantation. 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.
Ppv in a major way, scleral fixation of iol sfiol surgery has also had its share. Apr 29, 2016 scleral fixated iol sfiol ashish agrawal. To evaluate the outcome and complications of transscleral suturefixated posterior chamber intraocular lens. This was a retrospective study that included 22 eyes from 22 participants. The disadvantage is that the iol is fixated into the iris tissue, and a too traumatic implantation may lead to an inflammation. Eyeworld comparable results from sutureless scleralfixated. The 1ry indication is iol dislocation as a principal complication of cataract surgery, with early reports of % rate of iol dislocation 1. Outcomes and complications of scleralfixated intraocular lens. 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. Placement of iol in the posterior chamber rather than anterior or. Iols can be fixated to the sclera using sutures or by tunneling the iol haptics into the sclera without sutures. If the capsular remnant did not offer adequate support for a pc iol, a scleral fixated iol was placed 17 eyes, 34. Som prasad and gabor scharioth present a strategy to achieve secure sutureless intrascleral haptic fixation.
Scleral fixation without conjunctival dissection richard s. A surgical technique for implanting a posterior chamber intraocular lens iol in eyes without capsular or zonular support is presented. 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. 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. 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. 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. 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 lenses are designed to treat a variety of eye conditions, many of which do not respond to other forms of treatment. Conclusion a previously scleralfixated iol with a single dislocated haptic without an islet may be successfully refixated in. Longterm outcome of scleralfixated intraocular lens. Implantation of scleralfixated posterior chamber intraocular. Combined pars plana vitrectomy and suture less scleral fixation of. Abstract pdf 1155 views full text 2944 views license. To assess the longterm outcome of scleralfixated sutured posterior chamber intraocular lens spciol implantation in non pars plana.
Apr 21, 2012 the iol haptics are the jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. However, data on longterm functional outcome are limited. 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. 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. Iol, an anglesupported anterior chamber iol ac iol, or an iris fixated iol. Knotless scleral fixation describes the technique for implanting an iol by scleral fixation sutures. For a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. Scleral fixation, intraocular lenses, aphakia, iol dislocation.
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. The purpose of this study is to assess the longterm outcome and complication profile of. 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. 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. The scleral flap was closed with vicryl suture, covering the prolene knot. Complications were common, and suture rupture is an important longterm complication, particularly in young patients.
The implant and capsule were removed and replaced with an intrascleral haptic fixated iol. Scleral fixation of iol is an effective but surgically demanding technique. Modified technique of scleral fixation intraocular lens. Pdf scleralfixated posterior chamber intraocular lenses. In the single study comparing primary and secondary scleral fixated iol implantations, glaucoma was reported to be 16.
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