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G. Migliorati, P. Brusini; A Brand New 360° Foldable Scleral-fixation Intraocular Lens . Invest. Ophthalmol. Vis. Sci. 2003;44(13):264.
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Purpose: The aim of this study is to present a new type of foldable, acrylic scleral-fixation IOL. Methods: The new IOL (Corneal-GM 65 S) that we are presenting has the following characteristics: round shaped with an external ring diameter of 13 mm; 6.5 mm optic diameter; foldable acrylic hydrophilic material; 4 holes for sutures (at 3-6-9-12 o’clock). The shape and dimension allow for a stable positioning and no tilting after insertion through a 4 mm corneal incision. We used this new IOL in 10 cases in which traditional implants could not be used: aphakic patients after previous intracapsular cataract extraction (2 cases), traumas with crystalline loss or displacement in the vitreous (2 cases), removal of IOLs previously positioned in the anterior chamber in association with corneal transplantation (2 cases), substitution of vitreous dislocated IOL (1 case), during or after vitreoretinal surgery (2 cases), in cases of wide capsular ruptures during cataract facoemulsification (1 case) In all cases the lens was folded and positioned in the ciliary sulcus using a foldable IOL forceps. At times suturing was not necessary, while in some cases, two to four sutures were given. The patients have been checked on a monthly basis for a follow up period of 8 months. Results: In all cases the IOL has remained perfectly centred and no tilting has been observed till present. The intraocular inflammation after surgery was mild. The IOP was not altered. The treated eyes without retinal disorders were able to recuperate a good visual acuity. Cystoid macular edema was observed in one eye two months after surgery, which spontaneously healed three months later. No retinal detachment or other post-surgical complications have been observed till now. Discussion: We consider this lens an innovation in ophthalmic surgery. It is the first 360° foldable scleral-fixation IOL (that does not necessarily require sutures). It provides some advantages that traditional scleral fixation IOLs have not shown till now: the possibility to insert a scleral fixation lens through a 4 mm anastigmogen corneal incision (without the need of corneal sutures); a great intraocular stability without any tilting; furthermore it is useful in vitreoretinal surgery when silicone oil is necessary, preventing its passage in the anterior chamber which could cause corneal damage. One to four sutures can be applied to fix the lens. In some cases sutures are not required, thanks to its unique geometry. Additional IOLs or artificial iris can be placed on top of the lens in piggyback way. The flexibility of the material prevents surgical pupillary damages in cases of myosis or pupil sclerosis during its insertion.
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