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A. Teixeira, J. L. Ferreira, F. K. Jose, C. H. R. Salaroli, P. P. O. Bonomo; Evaluation of Different Surgical Techniques to Management Foldable 3-piece IOL Lens for Transscleral Fixation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6077.
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© ARVO (1962-2015); The Authors (2016-present)
Compare the two different knots techniques for transscleral fixation in cases without capsule support.
Prospective study conducted on 12 eyes with IOL luxated (6) or aphakic (6) without capsule support. All patients underwent a complete 23-gauge pars plana vitrectomy with consisted vitreous base shave near the scleral flaps. All IOL (5.5mm) were fixed 0.8-1.0mm from the limbus. The patients were divided in: Group 1 -10.0 prolene to tie the haptic using a slipknot suture with expose a single wire out of the scleral incision; and Group 2 - using the Clove Hitch knot suture to tie the haptic to make two wires expose out of the scleral incision.Fixed luxated IOL lens the surgeon performed temporary haptic externalization concept (Chen CK, 1992) to tie it with 10.0 prolene. Perfluorocarbon liquid was used to protect the macula.For aphakic eyes a 1.75 clear-corneal was performed to implant the 3-piece foldable IOL and externalize the wire. Group 1 was performed the standard technique based in a 10.0 prolene with needle without curve was inside into the posterior chamber and exteriorized from the other scleral tunnel assisted by a 27-gauge needle, the wire was grasped and externalized using a iris hook and tied to the haptics. Group 2 used the previous author technique (Ferreira JL, ARVO 2006) based a 10-0 prolene was inserted into the posterior chamber assisted by a 27 gauge needle. The mid part of the suture was grasped with a Kelman-McPherson forceps from a clear cornea incision and then the wire was tied onto a silicone tube using clove hitch knot suture. The haptic tip was inserted into the silicone tube and the knot was transferred. Uncorrected and best corrected visual acuity, IOL astigmatism induced, manifest refraction, UBM lens position, pos-operative complication and specular corneal microscopy were evaluated during the three months.
Mean age was 72.40 ys (SD 11.01) for group 1 and 78.57 ys (SD 5.77) for group 2. All patients improvement at least 2 lines of vision. Mean astigmatism induced by IOL was less than 1.50D (1.34D group 1 and 0.83D group 2, P = 0.093). No IOL descentration was observe.UBM shows no iris touch and no posterior IOL location for all fixations. The loss endothelium cell was 10% for the group 1 and 22% for the group 2 (P = 0.183). One patient developed a regmatogenic retinal detachment (group 1) treated without complications and two patients developed macular cystic edema (group 2) treat with steroids eye drops
The two techniques to transscleral fixation using 5.5mm 3-piece foldable IOL are a safe procedure and an effective option. But these results should be confirmed in larger and long-term prospective randomized trials.
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