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Bozho Todorich, Aris Thanos, Yoshihiro Yonekawa, Benjamin J Thomas, Lisa Jane Faia; Sutureless Intrascleral Fixation of Secondary Intraocular Lenses in Uveitic Patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5831.
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© ARVO (1962-2015); The Authors (2016-present)
Intraocular lenses (IOLs) can be implanted in eyes without adequate capsular support by anterior chamber placement (ACIOLs), iris fixation, or scleral fixation. In uveitic eyes, lens selection as well as placement can be factors in re-activation of inflammation. We describe a series of sclerally fixed lenses for secondary IOL implantation in uveitic eyes.
Retrospective review of uveitic patients who underwent secondary three-piece IOL implantation/rescue with SIS fixation. Assessments included stability of the lens, post-operative visual and anatomic outcomes, and complications.
Five consecutive patients (1 male, 4 female) with a mean age of 52.8 years were included in the series. All patients had history of uveitis, which was controlled by either topical or systemic medications for at least 3 months before the surgery. Diagnoses included HLA-B27 associated uveitis (1 patient), sarcoidosis (1 patient), rheumatoid arthritis associated uveitis (1 patient), psoriatic arthritis associated uveitis (1 patient) and idiopathic posterior uveits (1 patient). All patients underwent a standard 3-port pars plana vitrectomy with removal of the posterior capsule if necessary. If possible the dislocated lens was used. Otherwise, insertion of an MA60 was performed. In all cases, no intraoperative complications occurred. Post-operatively, all IOLs remained well centered and haptics covered by conjunctiva without dislocation, erosion, or scleral thinning. One eye developed transient post-operative IOP rise managed by topical drops, and one eye required DSAEK corneal transplantation due to pre-existing endothelial decompensation unrelated to the SIS surgery. Overall, the mean pre-operative visual acuity was improved from logMAR 2.09 pre-op to 0.59 post-op, which was statistically significant (p=0.015). All eyes were deemed quiet at 1-month post-operative visit and none required escalation of topical or systemic therapy for long-term uveitic control.
Sutureless transconjunctival intra-scleral fixation is safe and effective technique for secondary IOL implantation/rescue in well-controlled uveitic eyes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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