Purchase this article with an account.
Christianne A. Wa, Mark K. Walsh, Maxwell Stem, Bozho Todorich, Jeremy D. Wolfe; The Efficacy and Safety of Flanged Needleless Sutureless Intrascleral Intraocular Lens Fixation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4431.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The placement or repositioning of intraocular lenses (IOL) in the absence of capsular support can be difficult. The aim of this study was to evaluate the efficacy and safety of a novel surgical technique using flanged needleless sutureless intrascleral (SIS) fixation of a sulcus IOL.
A retrospective chart review was performed for 52 patients who underwent pars plana vitrectomy with IOL repositioning, exchange, or secondary placement with flanged needleless SIS fixation. Trocar cannulas were used to make scleral tunnels instead of needles. Average follow-up was 6 months. Main outcome measures were best corrected visual acuity (BCVA), stable anatomic placement of IOL, and any intra- or post-operative complications.
The indications for SIS were dislocated crystalline lens (2 patients, 3.7%), aphakia (7, 13%), and pseudophakia with dislocated IOL (45, 83.3%). A total of 9 eyes (16.7%) underwent secondary IOL placement, 19 eyes (35.2%) underwent IOL exchange, and 26 (48.1%) underwent IOL repositioning. BCVA improved from pre-operative 0.93±0.74 logMAR (Snellen equivalent 20/170) to post-operative 0.34±0.35 logMAR (Snellen equivalent 20/44) (P < 0.001). Intra-operatively, one case of retinal tear, one case of serous choroidal effusion with a retinal tear, and one case of limited suprachoroidal hemorrhage were noted. The most common post-operative issues were transient IOP elevation (22.2%), CME (20.4%), reverse pupillary block (11.1%), and IOL tilt or decentration (11.1%). All patients with IOP elevation and CME responded to topical medications. Reverse pupillary block resolved after laser peripheral iridotomy. IOL tilt was mild and did not require reoperation. One eye with mild iris capture developed increased IOP at postoperative month 4, so the IOL was repositioned at the slit lamp with complete resolution of symptoms. There were no cases of endophthalmitis or retinal detachments. Of the 52 patients, 2 patients (3.8%) underwent reoperation for recurrent dislocation for a total of 54 surgeries.
Our study demonstrated that a flanged needleless SIS fixation technique was effective with improved BCVA and minimal transient complications. Additionally, an intra-operative peripheral iridectomy may prevent the occurrence of reverse pupillary block. This combination offers a new approach in the surgical repair of dislocated lenses, especially in the absence of capsular support.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only