Sutureless intrascleral intraocular lens fixation supplementary video. Tips for sutureless scleral fixation a close look at two approaches to make it work for you. The rhexis runs out, the posterior capsule tears, vitreous comes forward, your heart sinks. Pdf sutureless scleral fixation of intraocular lenses.
In this modified technique, a bent 26gauge needle is used to create the scleral. To investigate the longterm outcomes and complications of scleral fixated intraocular lens sfiol implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal. Scleral fixation of iols became popular, originally with sutured scleral fixated iols and later the scharioth technique of intrascleral haptic fixation. Furthermore, iris fixation is impossible in cases of significant iris trauma.
To compare shortterm clinical outcomes between two different intraocular lens iol types in the flanged iol fixation technique. To report results of a novel technique for sutureless, glueless intrascleral fixation of threepiece posterior chamber intraocular lens iol using 26g needle for. To report the intermediate multicenter results of a technique of sutureless intrascleral fixation of a standard 3piece posterior chamber intraocular lens pc iol in the ciliary sulcus. Transscle ral fixation of posterior chamber iols can be performed using suture or sutureless techniques5. This study was a retrospective case series and included the patients who underwent flanged iol fixation between june 2017 and july 2018 at the hiroshima university hospital. Deependra singh and colleagues describe a small modification for the scleral fixation of 3piece iols. Aphakia, flanged haptics, sutureless, scleral fixation. Scleral flaps can then be closed with 100 nylon or. Pdf purpose we sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets.
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. Sutureless scleral fixation of iols in vitrectomized eyes evrs. A 72yearold male presents with a dislocated 1piece iol. The dimension of posterior chamber iols is usually not more than mm. Segment for sutureless trans scleral fixation of the capsular bag and its contents delhi j ophthalmol 20.
Pdf scleralfixated intraocular lenses researchgate. Care should be taken to hold the haptics at the very tip to avoid kinking or fracture of the haptic. Yannek leiderman, md, shares a video that demonstrates sutureless scleral fixation of an iol. Bimanual intraocular lens rescue with transconjunctival scleral. Scleral fixation of intraocular lenses with goretex suture. Iris fixation or sutureless scleral fixation of an iol, or placement of an anterior chamber iol, may also be employed effectively in the setting of poor capsular support. Sutureless, glueless, scleral fixation of singlepiece and toric.
We report a novel technique characterized by sutureless scleral fixation of threepieces foldable intraocular lens iol using 25gauge transconjunctival sutureless vitrectomy tsv trocars in. Before the onset of his complicated surgical course, the patient had a bcva of 20201 in the left eye after removal of an epiretinal membrane. Evaluation of sutureless, glueless, flapless, intrascleral. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol. Recently, iol implantation via sutureless intrascleral fixation has been performed in children with no lens dislocations after six months of. Dec 19, 2011 video of surgery for suture less scleral fixated posterior chamber intraocular lens. In case of iol flip during the process of insertion, the. This technique was adapted from a sutureless technique described by dr. Techniques involve fixation of iol haptics within partial thickness scleral flaps. Sutureless scleral fixation of a posterior chamber lens. Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss. Novel technique of sutureless glueless scleral fixated intraocular. Jan 10, 2012 sutureless intrascleral haptic fixation of a threepiece posterior chamber iol in the ciliary sulcus in eyes with no capsule support was first reported by scharioth and colleagues in the journal.
Yshaped intrascleral fixated lens versus retropupillary. To evaluate functional outcome of sutureless scleral tunnel intraocular lens sstiol in children with crystalline lens subluxation of more than 7 clock hours. Iol rescue via sutureless scleral fixation eyetube. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the iol. Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. Html and pdf versions of this article on the journals web site. It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol by using our developed simple technique.
May 10, 2017 for a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 618y having 7 clock hours of lens subluxation who underwent lensectomyvitrectomy followed by sstiol. Sutureless scleral fixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Throughout our site you will find links to external websites. Scleral fixation of a fourhaptic intraocular lens using gore. Full text sutureless intrascleral intraocular lens fixation with. Sutureless scleral fixated iol implantation with intra scleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Iol rescue using 27gauge sutureless transconjunctival. Jul 09, 2018 sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. Trocarassisted intrascleral sutureless fixation of a. However, the efficacy and safety of this technique in the pediatric age group has not been adequately studied. Modified bent catheter needles were used to penetrate the iol haptics through the sclerotomy sites. Jan 27, 2016 supplementary video of an original research paper sutureless intrascleral intraocular lens fixation with lamellar dissection of scleral tunnel published in the open access journal clinical. Recently the yamane technique has also become popular and is being widely adopted as well.
Surgical technique a new technique of sutureless sf iol. A new intrascleral fixation technique for a standard 3piece posterior chamber intraocular lens pc iol using a simple guide is described. Purpose the aim of this article is to describe a novel surgical technique for sutureless scleral fixation of an intraocular lens using the newly developed fil ssf carlevale iol soleko, italy. Scleral fixation lens are implanted inside the eyes with the help of scleral support. The implant and capsule were removed and replaced with an intrascleral haptic fixated iol. Novel technique of sutureless glueless scleral fixated. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol.
Jun 04, 2014 to report the clinical outcomes of sutureless scleral fixated intra ocular lens iol. Sutureless scleral fixation of iols has increased in popularity since gabor and pavlidis described fixation of a standard 3piece iol using 24gauge cannulas to create ab externo sclerotomies and adjacent scleral tunnels. Scleral fixation of intraocular lens ophthalmology. To secure the haptics, 27gauge scleral tunnels are created. Sutureless intrascleral haptic fixation of a threepiece posterior chamber iol in the ciliary sulcus in eyes with no capsule support was first reported by scharioth and colleagues in the journal. The results of sutureless sfiol have been encouraging in adult eyes 1723. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. Intermediate results of sutureless intrascleral posterior.
Patients underwent sutureless scleral fixated iol, with intrascleral tucking of haptics, into a tunnel made using 20 g microvitreoretinal blade. The hypotony occurred in cases where extensive vitrectomy was made especially in young age patients, and this was solved by anterior chamber maintainer acm in yshaped intra scleral fixated iol group while in retropupillary iol group was treated by repeated injection of ophthalmic viscosurgical devices ovd e. Crsteurope sulcus fixation of an iol using scleral tunnels. Combined pars plana vitrectomy and suture less scleral. The haptics of the iol are externalized and embedded in the scleral tunnels with a portion. Pdf sutureless intrascleral fixated intraocular lens. Various methods of sutureless scleral fixation have been described. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol by using our developed simple. Sutureless intrascleral posterior chamber iol fixation. Sutureless scleral fixation requires sclerotomy and externalization of haptics through uveal tissue, which may induce intraocular hemorrhage 6, 14. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. This video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma.
Apart from the abovementioned sutured scleral fixation, a new technique was reported in eyes without capsule support for sutureless fixation, describing fixation of the haptics in a limbusparallel scleral tunnel. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. Scleral fixation of a fourhaptic intraocular lens using goretex suture i n situations in which there is poor capsular support, such as a complicated cataract surgery or dislocated intraocular lens iol capsular bag complex, scleral fixation of a posterior chamber iol can be an effective approach for the vitreoretinal surgeon. Sutureless intrascleral fixation using different three. In the present case, a decentralized threepiece iol in the sulcus was repaired with a trocarassisted sutureless scleral fixation method, as described previously.
A technique is presented in which pars plana fixation of a posterior chamber intraocular lens iol is achieved by the transscleral passage of. The iol is removed and a 3piece iol is used for scleral fixation. 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. Sutureless intrascleral posterior chamber iol fixation offers. Abbey and wolfe describe a novel approach to scleral fixation of an iol through trocar cannulas. To overcome the suturerelated complications, various techniques of sutureless scleral fixation of iol have been described. Sutureless scleral fixation of intraocular lenses springerlink. Comparison of sutured versus sutureless scleralfixated. Technique of using glue for scleral fixation has been described avoiding the suture related complications. Techniques to place intraocular lenses in the absence of adequate capsular support continue to be an important part of the vitreoretinal surgeons armamentarium. All iols used for sutureless intrascleral fixation are existing posterior chamber iols. Iol exchange with sutureless transconjunctival cannulabased scleral fixation synopsis. International yes connect intrascleral haptic fixation. Sutureless transscleral fixation of secondary intraocular.
Supplementary video of an original research paper sutureless intrascleral intraocular lens fixation with lamellar dissection of scleral tunnel published in the open access journal clinical. Ocular surgery news apao edition implantation of an iol when capsular support is insufficient or lacking is always challenging, even for experienced cataract surgeons. Evaluation of functional outcome and stability of sutureless. A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 618y having 7 clock hours of lens subluxation who underwent lensectomy. 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. Modified technique for transscleral fixation of posterior. Sutureless transconjunctival intrascleral intraocular lens. Longterm outcome of scleralfixated intraocular lens. Haptics can be externalized using 25gauge forceps or hollow needle. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. 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.
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 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. The iol haptics were inserted into 30guage g scleral tunnels guided by double 30g needles piercing the sclera. Nakhwa, ms, frcs, sabyasachi sengupta, do, dnb, frcs j cataract refract surg jan 2015. Anterior chamber iol placement may lead to cystoid macular edema, corneal decompensation, and angle compromise. Cataract surgery is a safe procedure with excellent outcomes, but every so often, things go wrong. Iol exchange with sutureless transconjunctival cannula. Sutureless scleral fixation of intraocular lenses sciencedirect. Sutureless intrascleral intraocular lens fixation with. Sutureless scleral iol fixation american academy of. Get a printable copy pdf file of the complete article 5.
Sutureless intrascleral posterior chamber iol fixation has. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Sutureless trocarcannula based transconjunctival flanged. Shin yamane, md, pioneered a modification of sutureless intrascleral iol fixation using needles to dock and externalize the haptics. They demonstrate it here in a 63yearold patient with a dislocated 3piece iol, initially placed in the sulcus, and a history of scleral buckle and vitrectomy for retinal detachment. For scleral fixation implantation, use 6725067255 for posterior sclera fixation and 6622066225 for anterior sclera fixation accordingly. Scleral flaps can then be closed with 100 nylon or fibrin glue. Trocarassisted sutureless intrascleral posterior chamber. Sutureless scleral iol fixation is an important technique to maintain in a vitreoretinal surgeons armamentarium. Leiderman shares advice to help perform this complex procedure. We invented a new method for fixing an intraocular lens iol in the scleral tunnel without using a wide conjunctival incision. Suture techniques need to cover, bury, or rotate suture. Sutureless scleral fixation of intraocular lenses request pdf.
Hence, we performed a retrospective study to compare the intermediateterm visual outcomes of sutured versus sutureless scleral fixated iol implantation in the setting of post cataract as well as post trauma aphakia. Sutureless intrascleral fixation of iols has emerged as an alternative. The choice of intraocular lens iol implantation includes anterior chamber ac iol, irisfixated iol, iris claw iol, sutured sclerafixated iol, and. 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. Late iol dislocation or tilt is also a potential concern with scleral fixation techniques 8, 11, 15, 26, 35. Longterm safety and functional outcome of combined pars plana vitrectomy and scleral fixated sutured posterior chamber lens implantation.
Yannek leiderman, and inspired by the needle haptic externalization technique described by dr. This was further developed as the glued iol technique which enjoys widespread adoption all over the world. A 72yearold white man was referred with uveitisglaucomahyphema ugh syndrome in an eye with a scleral fixated threepiece iol. Goretex suture can be used in smallincision scleral. Recurrent ugh syndrome in an eye with a scleralfixated iol. Ebscohost serves thousands of libraries with premium essays, articles and other content including goretex suture can be used in smallincision scleral fixation of hydrophilic acrylic iol. Aug 15, 2012 the iol haptics provide an adequate fixation point for securing the lens to the peripheral iris. A simple modified way of glueless sutureless scleral.
Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. Modified sutureless technique for scleralfixated iols. Eyeworld comparable results from sutureless scleralfixated. Scleral sutured lenses can have good results but require complex intraocular maneuvers and run the risk of iol tilting and late suture breakage. Glued endocapsular hemiring segment for sutureless trans. Transconjunctival sutureless intrascleral intraocular lens. Eyeworld comparable results from sutureless scleral. The major disadvantages of this technique are wide sclerotomies and the risk of ocular hypotony due to sclerotomy closure using fibrin glue without suture augmentation. In discussion with the panel at the retina exchange film festival, dr. Iol haptics can be externalized and fixated within the sclera without the use of sutures. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. 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.
Comparison of different iol types in the flanged iol. Evaluation of flanged haptics intrascleral sutureless. Sutureless intrascleral haptic fixation of a threepiece posterior chamber iol in the ciliary sulcus in eyes with no capsule support was first reported by scharioth and colleagues in. Scleral fixation of iol is an effective but surgically demanding technique. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus. Retina surgery retina earls scleral fixation of a four. Most of these complications can be avoided or minimized by proper selections of materials used and adopting the proper technique. Scharioth and pavlidis1 popularized a sutureless technique for intrascleral fixation of an intraocular lens iol. Principles of scleralfixated intraocular lenses surgery.
For a partial dislocation of a onepiece iol in the bag, i prefer trans scleral suture fixation, he says. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Presented at the ascrs symposium on cataract, iol and refractive surgery, chicago, illinois, usa. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol. Visual outcomes and complications of scleral fixated posterior chamber intraocular lenses. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleral fixated threepiece iol. The transconjunctival sutureless intrascleral sis fixation iol technique originally described by prasad1 uses a total of five vitrectomy trocarcannulasthree for. Table of contents digital edition pdf edition archives subscription. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols.
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