In cases of a dislocated iol in the vitreous, we plan for vitrectomy to retrieve the iol, followed by iris fixation. Walsh, md, phd objective to teach attendees a novel sutureless scleral intraocular lens iol fixation technique that involves melting the tips of the iol haptics to. Retrospective surgical case series using live and cadaveric human eyes. In the anterior chamber iol group, 71% of eyes achieved a snellen visual acuity of 2040 or better compared with 47. Apr 21, 2012 jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. Results sutureless intrascleral iol fixation methods are newer and have been developed to eliminate the suturerelated complications of sutured scleral fixation methods such as sutureinduced inflammation or infection and iol dislocation or subluxation due to suture. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol. Descemet membrane endothelial keratoplasty in cases with. Longterm outcome of scleralfixated intraocular lens implantation. Endoscopicassisted scleral fixated iol in the management of. To compare two different techniques for sutureless scleral fixation of posterior chamber intraocular lens iol in patients with insufficient capsule. Most of these complications can be avoided or minimized by proper selections of materials used and adopting the proper technique.
Phoebe lin, md, phd, sharon fekrat, md, facs channels. Iols can be fixated to the sclera using sutures or by tunneling the iol haptics into the sclera without sutures. Exposure of haptic of posterior chamber intraocular lens. Fortytwo eyes of 42 patients who had undergone scleral iol fixation operation with yamane technique comprised group 1. Iris fixation or scleral fixation of dislocated iols improves. In our variation, only two sulcusbased, tunnelshaped sclerotomies were created in the pars plicata during the. 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. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol.
This video demonstrates a modified method for scleral fixation of a 3piece iol. Scleral fixated iol sutureless and glueless youtube. 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. Scleral fixation of iol in the posterior chamber is the current procedure of choice for surgical rehabilitation of aphakia in the absence of adequate capsular support 18. Reiss and adenwalla tie 60 vicryl suture to each haptic to facilitate haptic externalization. Sutureless scleral fixated iol implantation with intra scleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Myriad techniques have been described for fixation of an. A technique of sutureless intrascleral fixation of an intraocular lens iol in an eye that lacks a posterior capsular support has been reported. In addition to the approaches outlined here, a conjunctivasparing cannulabased approach and many others have been reported. No onepiece iol should ever be placed in the sulcus.
Her iol power as calculated with autokeratometry and manual ascan immersion method was %plus. To evaluate the visual outcomes of the patients who had undergone sutureless scleral fixated iol implantation operation in which a new modified yamane technique called flattened flanged intrascleral intraocular lens fixation technique was applied. Posterior chamber intraocular lenses directly fixated to sclera have been used in a variety of situations such as planned secondary iol insertion and surgical. Modified technique for transscleral fixation of posterior. Inadequate capsular support is the most common cause of iol dislocation and most. Sutureless scleral fixation of intraocular lenses sciencedirect. The advantage of this technique was that the suturerelated complications did not develop. Sulcus implantation without fixation requires capsular support and an iol that is appropriate for the sulcus. Pdf sutureless intrascleral fixated intraocular lens. Scleral fixation lens are implanted inside the eyes with the help of scleral support. Secondary intraocular lens implantation in posterior chamber in the absence of posterior capsular support. Sutureless intrascleral fixation using different three.
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 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. For example, in the event of a 3piece iol dislocation into the vitreous cavity, as may be seen in cases of ocular trauma, 23 pseudoexfoliation, 24 or high myopia 25, the iol can be rescued and fixated to the sclera rather than exchanged for an aciol or ifiol. Bioptics in sutureless intrascleral multifocal posterior. Iol either to the iris or the sclera in the ciliary sulcus. Endophthalmitis following exposure of a haptic after. Crandall, mda,b, adepartment of ophthalmology, henry ford health system, 2799 west grand boulevard, detroit, mi 48202, usa. Patients were prepared and draped in the routine way for. Techniques to place intraocular lenses in the absence of adequate capsular support continue to be an important part of the vitreoretinal surgeons armamentarium. Intermediate results of sutureless intrascleral posterior. Scleral fixated intraocular lens sfiol is a safe and effective option for managing optical aphakia. A technique is presented in which pars plana fixation of a posterior chamber intraocular lens iol is achieved by the transscleral passage of the haptics. If the capsular remnant did not offer adequate support for a pc iol, a scleral fixated iol was placed 17 eyes, 34. If you continue browsing the site, you agree to the use of cookies on this website.
Recently the yamane technique has also become popular and is being widely adopted as well. Observational study of intraocular lens tilt in sutureless. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. Surgical technique simple new technique for scleral fixation. Shin yamane, md, pioneered a modification of sutureless intrascleral iol fixation using needles to dock and externalize the haptics.
Eyes tend to be very quiet postoperatively with rapid visual rehabilitation. Two techniques for sutureless intrascleral posterior. Sutureless intrascleral intraocular lens fixation supplementary video. Pdf scleralfixated intraocular lenses researchgate. 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 intrascleral posterior chamber iol fixation. To evaluate the shortterm postoperative outcomes in endoscopicassisted sclera fixation intraocular lens iol for the management of secondary aphakia in children. Sutureless trocarcannula based transconjunctival flanged. Crsteurope sulcus fixation of an iol using scleral tunnels. Eyeworld comparable results from sutureless scleral.
It is currently the fastest method of sutureless pciol intrascleral haptic fixation. However, no prospective study has compared the iol positions associated with the sutureless intrascleral technique and the standard transscleral suturing technique. A knot ball scleral fixation technique is reported. This is a prospective study, whereas 40 aphakic eyes with absence of a good capsular support were implanted by endoscopyassisted sclera fixation technique. After discussing various treatment options available with the patient, written informed consent was obtained, and righteye cataract extraction with a scleral fixated singlepiece iol, in view of poor capsular support, followed later by the left eye, was planned. Intrascleral haptic fixation as an alternative to sutures. Sutureless intrascleral intraocular lens fixation with. Sutureless, glueless, scleral fixation of singlepiece and. Scleralfixated iol using 25gauge needle scleral tunnel. This was further developed as the glued iol technique which enjoys widespread adoption all over the world. Anterior chamber intraocular lens iol, irisfixed iol, and transscleral posterior chamber iol suture fixation have been used to treat eyes without sufficient capsular support. In addition, the incidence of exposed suture knots through the conjunctiva was 3.
Despite these advantages, suturerelated complications, such as suture rupture or erosion, may occur9. Flattened flanged intrascleral intraocular lens fixation. I believe a backup lens should be available for every cataract procedure. Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss. Sutureless scleral iol fixation american academy of. This includes aphakia following a large pc rent, following penetrating injury, in cases of subluxation or dislocation of lens, hypermature. 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. In cases of spontaneous iol dislocation and traumatic subluxation, the iol was recentered in a subsequent surgery in which the haptics were adjusted in the existing scleral tunnel. The scleral tunnel incision used for an iol exchange can be used as one of the scleral flaps to cover a 90 prolene suture. However, the conventional method of suturing the iol is associated with a number of side effects related to the suture and extensive iol manipulation in the anterior.
The cases of smooth vitreous hemorrhage resolved within 1 week without surgical intervention. Modified technique of scleral fixation intraocular lens. The position of the intraocular lens iol is a major factor that affects the final visual acuity after cataract surgery. Modified 3piece scleralfixated iol american academy of. Scleral fixation of iol is an effective but surgically demanding technique. Summary scleral fixated iols have evolved in the last 2 decades with technical modifications, extended indications and improvised instrumentation. Hovanesian described sutureless intrascleral iol fixation as safer and easier than suturing a lens into the scleral flap. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79.
This eliminates the need to make large incisions to explant the iol for exchange with a new lens. We conceived and designed a knot ball scleral fixation technique for suture burial in a retrospective sample of 108. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus. Visual outcomes and complications of scleral fixated posterior chamber intraocular lenses. In discussion with the panel at the retina exchange film festival, dr. Comparison of sutured versus sutureless scleralfixated. A 75yearsold man had a sutureless intrascleral fixation y. However, the longterm complications of a sutureless iol implantation have not been reported.
Irisclaw intraocular lens and scleralfixated posterior chamber intraocular. Scleral sutured lenses can have good results but require complex intraocular maneuvers and run the risk of iol tilting and late suture breakage. Despite its conceptual simplicity, it is surgically challenging even for a surgeon who is experienced in methods of scleral fixation. Aug 15, 2012 the iol haptics provide an adequate fixation point for securing the lens to the peripheral iris. I would combine this procedure with a pars plana vitrectomy, and i would take advantage of the pars plana infusion to give myself better control throughout the procedure. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols.
Intraocular lens iol implantation in an eye without sufficient capsular support has been accomplished by using an anterior chamber iol, an irisfixed iol, and a transscleralfixed posterior chamber pc iol through the ciliary sulcus or pars plana. In sutureless scleral fixated pc iol technique, small clear corneal incision is enough for injection of foldable iol thus reducing surgical induced corneal astigmatism. A redislocation such as in scleral fixated iols does not occur with irisclaw iols. 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. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol. Comparison of sutured versus sutureless scleralfixated intraocular lenses article in journal of cataract and refractive surgery 421. Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. 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 1ry indication is iol dislocation as a principal complication of cataract surgery, with early reports of % rate of iol dislocation 1. Our goal was to combine some of the welldescribed ante rior segment surgical. Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. The suture was tied to itself and secured to the sclera. The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications.
Scleral fixation is an alternate way of fixing the iol in the posterior chamber. Scleral fixated posterior chamber intraocular lens sfiol, anterior chamber intraocular lenses aciol, irisfixed iol, are alternative options to intraocular lens. Bioptics in sutureless intrascleral multifocal posterior chamber intraocular lens fixation article in journal of refractive surgery thorofare, n. In a case with a dislocated posterior chamber pmma iol, the same iol can be repositioned, thereby reducing the need for further manipulation. Jan 10, 2012 visual outcomes and complications of scleral fixated posterior chamber intraocular lenses. Sutureless trocarcannula based transconjunctival flanged intrascleral intraocular lens fixation mark k. A new technique of sutureless sf iol haptic is then held with the mvr forceps introduced through the upper right sclerotomy using a handshake technique and externalized fig. Surgical technique a new technique of sutureless sf iol. Scleral fixation of intraocular lens pakistan journal of. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. Scleral tunnels for haptic fixation were created with 28 eyes, 27. The disadvantage is that the iol is fixated into the iris tissue, and a too traumatic implantation may lead to an inflammation. Pc iol could be implanted into the capsular bag in 15 eyes 30. 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.
A new intrascleral fixation technique for a standard 3piece posterior chamber intraocular lens pc iol using a simple guide is described. The 101 used has three equidistant supple loops, each attached to an armed suture, which serve as haptics. Recently, intrascleral iol fixation, in which iol haptics are pulled out transsclerally and fixed to the sclera, has been widely performed due to good visual outcomes or as a convenient means of sutureless haptics. We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. In case of iol flip during the process of insertion, the. Scleral fixation of an intraocular lens in the absence of capsular support. This postoperative inflammation with cellular proliferation of the iol is induced by. Eyeworld comparable results from sutureless scleralfixated.
Sutureless scleral fixation of intraocular lenses springerlink. The inflammation resolved gradually, and at the 1year followup her bcva had recovered to 0. In 2012, ohta introduced the y fixation technique that fixed an iol without large lamellar scleral. Sutureless transconjunctival intrascleral intraocular lens.
Irisclaw intraocular lens and scleralfixated posterior chamber. Furthermore, standard threepiece iol can be used without any change in its design 5, 6. Scharioth et al 23 reported good intermediate results of sutureless surgery, with no cases of recurrent dislocation or retinal detachment at a median followup of 7 months. Abbey am, hussain rm, shah ar, faia lj, wolfe jd, williams ga 2014 sutureless scleral fixation of intraocular lenses. 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. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. That same day, we performed vitrectomy and iol removal, immediately followed by intravitreal injection of antibiotic. A novel approach for posterior chamber intraocular lens placement or rescue via a sutureless scleral fixation technique. Sutureless intrascleral intraocular lens fixation using a. Presented at the ascrs symposium on cataract, iol and refractive surgery, chicago, illinois, usa. There are several advantages to this technique, dr. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol by. Evaluation of sutureless, glueless, flapless, intrascleral.
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. Sutureless scleral iol fixation is an important technique to maintain in a vitreoretinal surgeons armamentarium. 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. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Care should be taken to hold the haptics at the very tip to avoid kinking or fracture of the haptic. The indication for intraocular lens iol scleral fixation is widely variable. Oct 01, 2009 iol fixation techniques a european surgeon offers his views on the treatment of luxated intraocular lenses gabor b. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. Yannek leiderman, md, shares a video that demonstrates sutureless scleral fixation of an iol. May 10, 2017 for a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. The scleral flap was closed with vicryl suture, covering the prolene knot. In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes 49%, iol dislocation in 38 eyes 37% and natural lens dislocation in 15 eyes 14%. The flanged intrascleral intraocular lens fixation with doubleneedle technique the yamane technique madeleine hasbrook, mda, david a. To determine whether haptic flanging during 27gauge sutureless intrascleral fixation of intraocular lenses iols increases iol stability and to report the shortterm clinical outcomes of sutureless intrascleral surgery using 27gauge trocar cannulas with haptic flanging.
It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. This glued iol technique would be useful in many clinical situations in which scleral fixated iols are indicated, such as luxated iol, dislocated iol, zonulopathy or secondary iol implantation. A truly knotless technique for scleral fixation of. Iol power calculation special situations linkedin slideshare. Sutureless scleral fixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Original article visual outcome and complications of anterior. Mar 12, 2012 this video illustrates a modification of the scleral fixated iol technique described by j. To secure the haptics, 27gauge scleral tunnels are created. Because specially made lenses for iris suturing do not fold, many retina surgeons prefer to use traditional threepiece iols that can be folded and inserted through a small scleral incision. 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. The implant and capsule were removed and replaced with an intrascleral haptic fixated iol. If, however, the patient is aphakic preoperatively, we plan for a scleral fixated iol using the method described above. Table 3 shows the postoperative complications, all of which occurred within the first 4 weeks after surgery. We report a novel technique characterized by sutureless scleral fixation of threepieces foldable intraocular lens iol using 25gauge transconjunctival sutureless vitrectomy tsv trocars in.
Simultaneous rescue and intrascleral tunnel fixation of a dislocated threepiece iol can be combined in one surgical session. Patients should receive careful, longterm followup after sutureless intrascleral iol fixation. A step by step guide for doing a sutureless and glueless scleral fixation of the intraocular lens in cases of aphakia without capsular support, traumatic subluxation, pseudoexfoliation. Trocarassisted sutureless intrascleral posterior chamber. Iol rescue via sutureless scleral fixation eyetube. 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. Nov 30, 2017 a step by step guide for doing a sutureless and glueless scleral fixation of the intraocular lens in cases of aphakia without capsular support, traumatic subluxation, pseudoexfoliation. Sutureless intrascleral posterior chamber iol fixation offers. 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.
The current study compared the iol positions in the two techniques using ultrasound biomicroscopy ubm in vivo. The flanged intrascleral intraocular lens fixation with. Pdf scleralfixated posterior chamber intraocular lenses in. A new surgical technique for scleral fixation using a.
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