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Kashif Baig, Paul Bastianelli, Salina Teja; Outcomes of scleral-fixation of intraocular lenses with fibrin glue. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2991. doi: https://doi.org/.
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The advantages of scleral-fixation of IOLs with fibrin glue include relative surgical ease, minimal intraoperative complications, and stability of the IOL at follow up. Our purpose is to report the anatomic, visual, and refractive outcomes of 10 patients who had scleral-fixation of an IOL with fibrin glue.
A review of our first 10 consecutive patients that had scleral-fixation of an IOL with fibrin glue was done retrospectively. The procedure involved the creation of two partial thickness scleral flaps, 3mm from the limbus at 180 degrees from each other. A 3-piece IOL was inserted, with each haptic being externalized through a sclerotomy under the flap and tucked into an intrascleral tunnel. The flaps were then closed with fibrin glue. Operative and post-operative (1-, 3-, and 6- month) outcomes were assessed including complications, centration of IOL, visual acuity, manifest refraction, and endothelial cell count.
10 eyes of 9 patients were included in the study. 5 were male and 4 were female with a mean age of 63 years. 8 edematous, pseudophakic bullous keratopathy eyes with poor visibility through the cornea had an IOL exchange procedure in which the offending primary anterior chamber IOL was replaced by a glued IOL, later followed by endothelial keratoplasty (EK). The remaining 2 eyes were treated for traumatic lens subluxation. There were no intraoperative complications, and pain symptoms resolved within one week postoperatively. At 1-month follow up, 9 of 10 eyes had a centered IOL, with the remaining patient having inferior subluxation. One eye with preexisting glaucoma had an IOP rise to 54mmHg, which was managed with topical therapy.
Scleral-fixation of IOLs with fibrin glue has been reported in a few case series in the literature. We have incorporated this technique into our practice predominantly as a secondary IOL implant procedure in aphakes and as an IOL exchange procedure patients destined for EK. Our preliminary results show positive outcomes with respect to intraoperative complications, IOL positioning, and wound healing, and we will be able to show 6-month follow up visual acuity, manifest refraction, and endothelial cell counts. Our experiences and lessons learned with patient selection, surgical technique, and follow up outcomes of these 10 eyes may encourage the adoption of this useful technique by cataract and anterior segment surgeons.
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