For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. An alternative technique using 23gauge surgery for refixation of a scleral sutured lens megan e. Yannek leiderman demonstrates his technique for a sutureless scleral fixation of a 3piece iol, a challenging procedure simplified by modifying haptic fixation within the scleral tunnel. The implant and capsule were removed and replaced with an intrascleral haptic fixated iol. Because iciols are classified into anterior chamber iciols and retropupillary iciols, this study merged the 2 types of iols. Apr 21, 2012 the iol haptics are the jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. The sutureless irisclaw iols are inserted through a 5mm incision. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets. Oct 01, 2009 in 2006, we performed the first intrascleral haptic fixation of a standard threepiece intraocular lens and reported the surgical technique in 2007. These include using an anterior chamber intraocular lens, an irisfixated posterior chamber iol or a scleralfixated pciol. Pdf sutureless scleral fixation of intraocular lenses.
Sutureless scleral fixated iol implantation with intra scleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Iol rescue via sutureless scleral fixation eyetube. Novel technique of sutureless glueless scleral fixated intraocular. Transscle ral fixation of posterior chamber iols can be performed using suture or sutureless techniques5. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. Jun 04, 2014 to report the clinical outcomes of sutureless scleral fixated intra ocular lens iol. Irisclaw intraocular lens and scleralfixated posterior chamber intraocular lens implantations in. Scleralsutured lenses can have good results but require complex intraocular maneuvers.
Iol exchange for scleral fixated akreos ao lens using goretex. Among them scleral fixated pc iol implant can provide minimum magnification of image as compared to other options. The insertion of a scleral fixated iol requires great surgical skill and lacks an anatomical safety net to prevent an insufficiently secured implant from sinking into the vitreous space. We describe a flanged sutureless scleral fixation fssf technique for dislocated sulcus intraocular. Sutureless scleral fixation of iols in vitrectomized eyes evrs. Surgical technique a new technique of sutureless sf iol. Descemet membrane endothelial keratoplasty in cases with. Scleral sutured lenses can have good results but require complex intraocular maneuvers and run the risk of iol tilting and late suture breakage. In sutureless scleral fixation3,4 and glued iol techniques5, intraocular bimanual handshake technique6 is used. The iol haptics provide an adequate fixation point for securing the lens to the peripheral iris.
Evaluation of suturless scleral fixation with posterior chamber. In 2006, we performed the first intrascleral haptic fixation of a standard threepiece intraocular lens and reported the surgical technique in 2007. Scleralfixated intraocular lenses madanagopalan v g, sen p. A new minimally invasive technique for fixation of an intraocular lens iol was presented at two recent retina conferences. In order to reduce suturerelated complications, some studies embedded the haptics of threepiece iol into the scleral tunnel, but there are still some risks of postoperative hypotony, iol. Sutureless scleralfixated iol in children american academy. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart.
At the 5th annual vitbuckle society meeting in april, mark walsh, md, of tucson, az, presented his method. Yannek leiderman, md, shares a video that demonstrates sutureless scleral fixation of an iol. Novel technique to overcome the nonavailability of a long needle. It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. A scleralfixated iol, despite being technically challenging, has long been regarded as a good primary or secondary technique for iol implantation in cases without enough capsular support.
Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79. He has observed no complications so far, with a maximum followup of 4 years. Sutureless intrascleral intraocular lens implantation after ocular trauma. A 63yearold male with ho sbppv presents with a dislocated 3piece iol after initial sulcus placement. Intraocular lens iol implantation in an eye without sufficient capsular support has been accomplished by using an anterior chamber iol, an irisfixed iol, and a transscleralfixed posterior chamber pc iol through the ciliary sulcus or pars plana. We have developed this new technique for intrascleral iol fixation which is quite. Recently, iol implantation via sutureless intrascleral fixation has been performed in children with no lens dislocations after six months of follow. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol. Sep 08, 2016 sutureless intrascleral iol fixation methods are newer and have been developed to eliminate the suturerelated complications of sutured scleral fixation methods such as sutureinduced inflammation. Surgical technique simple new technique for scleral fixation. An sfk joining the two sutures was passed through the sclera without. Retina surgery retina earls scleral fixation of a fourhaptic. Journal of ophthalmology hindawi publishing corporation. In this study, 30 eyes of 30 patients were included.
Third, in eyes in which cataract surgery is complicated with loss of the capsular bag or massive zonular loss, this is a good method of securing an iol in the posterior chamber. Scleral fixation lens are implanted inside the eyes with the help of scleral support. Eyeworld comparable results from sutureless scleralfixated. Aug 15, 2012 the iol haptics provide an adequate fixation point for securing the lens to the peripheral iris. Sutureless scleral tunnel intraocular lens fixation in the p. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. Care should be taken to hold the haptics at the very tip to avoid kinking or fracture of the haptic.
Sutureless, glueless, scleral fixation of singlepiece and. May 10, 2017 for a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. Retina surgery retina earls scleral fixation of a four. A step by step guide for doing a sutureless and glueless scleral fixation of the intraocular lens in cases of aphakia without capsular support, traumatic subluxation, pseudoexfoliation. Comparison of sutured versus sutureless scleralfixated intraocular lenses article in journal of cataract and refractive surgery 421. However, the posterior chamber iol pciolnamely, the capsularsupported pciol and, in the absence of capsular support, the irissutured or transsclerally sutured pcioloffers numerous advantages for certain patients.
This is a pdf file of an unedited manuscript that has been accepted for. On the other hand, if the haptics is being externalized, sutureless fixation of a threepiece iol is usually done. At the retina world congress in february, shin yamane, md, of japan, presented his technique of flanged fixation. The iol haptics are the jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. Dmek procedures were performed on a 49yearold woman with a preexisting sfiol case 1 and a 69yearold woman with a preexisting ifiol case 2 in order to treat secondary corneal edema due to. However, sutureless scleral fixation of the iol requires posterior segment instruments and a machine for pars plana vitrectomy. Scleral fixated intra ocular lens implantation is a procedure of recent origin which is more advancing such that even sutureless technique with foldable iol has achieved. Mar 03, 2017 these include using an anterior chamber intraocular lens, an irisfixated posterior chamber iol or a scleralfixated pciol. Modified technique for transscleral fixation of posterior. We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol. Sutureless intrascleral iol fixation methods are newer and have been developed to eliminate the suturerelated complications of sutured scleral fixation methods such as.
A total of 122 consecutive patients who underwent iol placement using sis technique were included in the study with mean followup of 1. Sutureless intrascleral fixation of a customtailored iris. Sutureless scleral fixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. To report the clinical outcomes of sutureless scleral fixated intra ocular lens iol. Abbey am, hussain rm, shah ar, faia lj, wolfe jd, williams ga 2014 sutureless scleral fixation of intraocular lenses. Scharioth et al23 reported good intermediate results of sutureless surgery, with no cases of recurrent dislocation or retinal detachment at a median followup of 7months. Sutureless intrascleral intraocular lens fixation with. Patients underwent sutureless scleral fixated iol, with intrascleral tucking of haptics, into a tunnel made using 20 g microvitreoretinal blade. Because specially made lenses for iris suturing do not fold, many retina surgeons prefer to use traditional threepiece iols that can be folded and inserted through a small scleral incision. This glued iol technique would be useful in many clinical situations in which scleral fixated iols are indicated, such as luxated iol, dislocated iol, zonulopathy or secondary iol implantation. A new technique of sutureless sf iol haptic is then held with the mvr forceps introduced through the upper right sclerotomy using a handshake technique and externalized fig.
Cover story sulcus fixation of an iol using scleral tunnels. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. Sutureless intrascleral fixated intraocular lens implantation. Full text sutureless intrascleral intraocular lens fixation.
Sutureless scleral fixation of the iol is a new technique for overcoming the common weaknesses of sutured scleral fixation, which include spontaneous breakage, knot exposure, and iol position problems 6, 8. An alternative technique using 23gauge surgery for refixation of a scleralsutured lens megan e. Comparison of sutured versus sutureless scleralfixated. In case of iol flip during the process of insertion, the. Nov 30, 2017 a step by step guide for doing a sutureless and glueless scleral fixation of the intraocular lens in cases of aphakia without capsular support, traumatic subluxation, pseudoexfoliation. Sutureless intrascleral posterior chamber iol fixation has. Intrascleral intraocular lens iol fixation is a standard technique for secondary implantation. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon. Sutureless scleral fixation involves externalizing iol haptics for fixation within the sclera. Aimto assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens pciol.
Posterior chamber intraocular lenses directly fixated to sclera have been used in a variety of situations such as planned secondary iol insertion and surgical complications at the time of primary cataract surgery. In a case with a dislocated posterior chamber pmma iol, the same iol can be repositioned, thereby reducing the need for further manipulation. Sutureless intrascleral posterior chamber intraocular lens fixation. The technique allows permanent scleral fixation of the polypropylene haptics of a 3piece iol directly into the sclera to achieve a position in the ciliary sulcus, thus obviating the need for suturing. Iris fixation or sutureless scleral fixation of an iol, or placement of an anterior chamber iol, may also be employed effectively in the setting of poor capsular support. The majority 75% of patients received a new 3piece iol for primary aphakia or after iol exchange. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. All patients underwent abexterno scleral fixation of iol by the same surgeon. Mark walsh has performed sutureless scleral tunnel iol fixation in 11 pediatric patients with a variety of lenticular disorders. A scleral fixated iol, despite being technically challenging, has long been regarded as a good primary or secondary technique for iol implantation in cases without enough capsular support. Leiderman shares advice to help perform this complex procedure. Videos by topic the american society of retina specialists.
Sutureless scleral fixation of intraocular lenses springerlink. Intrascleral fixation of an intraocular lens through the pars plana. The insertion of a scleralfixated iol requires great surgical skill and lacks an anatomical safety net to prevent an insufficiently secured implant from sinking into the vitreous space. To report two cases of descemet membrane endothelial keratoplasty dmek in patients with existing scleralfixated and irisfixated intraocular lenses sfiol and ifiol, respectively. Sutureless scleral iol fixation american academy of.
Sutureless scleral fixation of intraocular lenses sciencedirect. Sutureless techniques have also been developed to avoid potential complications. About europe pmc funders joining europe pmc governance roadmap outreach. Original article visual outcome and complications in ab. This glued iol technique would be useful in many clinical situations in which scleralfixated iols are indicated, such as luxated iol, dislocated iol, zonulopathy or secondary iol implantation.
We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. Sutureless intrascleral fixation of secondary intraocular lenses. Jan 22, 2018 a total of 122 consecutive patients who underwent iol placement using sis technique were included in the study with mean followup of 1. However, this technique is applied to singlepiece and toric lenses instead of 3piece lenses, allowing the advantage of the use of premium lenses in patients with poor capsular support. I need a code for a pars plana vitrectomy and removal of iol, and implantation of sclera fixation. Scleral fixated iol sutureless and glueless youtube. If you continue browsing the site, you agree to the use of cookies on this website. Irisclaw intraocular lens and scleralfixated posterior chamber. To report the results of sutureless scleral fixation of a posterior chamber intraocular. In the latter case, sutureless intrascleral haptic fixation may be per.
Sutureless scleral fixation of the iol can be another solution, but this. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. Scleral fixated iol this video demonstrates the implantation of a scleral fixated iol in an aphakic eye of a patient who had a previous eye trauma. Scharioth et al 23 reported good intermediate results of sutureless surgery, with no cases of recurrent dislocation or retinal detachment at a median followup of 7 months. Placement of iol in the posterior chamber rather than anterior or. Suture techniques need to cover, bury, or rotate suture. In discussion with the panel at the retina exchange film festival, dr. Here the haptics of the 3 piece iol are grabbed through the respective sclerotomies using microvitreous forceps and exteriorised. For a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. Nakhwa, ms, frcs, sabyasachi sengupta, do, dnb, frcs j cataract refract surg jan 2015. Yamane scleral iol fixation technique vladimir pfeifer duration.
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