Endoscopic-Assisted Scleral Fixated IOL in the Management of Secondary Aphakia in Children (original) (raw)
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Open Journal of Ophthalmology, 2019
Background: Many reasons can lead to an aphakia without adequate capsular support for implantation of a posterior chamber intraocular lens (IOL), such as intraoperative unintentional rupture of posterior capsule during phacoemulsification, planned intracapsular cataract extraction, ocular trauma and lens dislocation due to congenital and acquired causes. Purpose: To compare Y-shaped intra-scleral fixation of a posterior chamber IOL with retro pupillary fixation of an iris-claw intraocular lens (IOL) for Aphakic eyes without sufficient capsular support as respects safety, visual recovery and complications of both methods. Patients and Methods: One hundred Aphakic eyes were arbitrarily distributed between two groups. Group A included 50 eyes treated with retropupillary fixation of iris claw lens and group B included 50 eyes treated with Y-shaped intra-scleral fixation technique. Preoperative, intraoperative and postoperative data were analysed including best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical time, intraoperative problems, IOL malposition and postoperative complications. Following up on patients was carried out for at least six months. Results: The mean duration of surgery was 21 ± 5.3 min in group A and was 53.4 ± 6.9 min in group B (p-value < 0.001). After 6 months, the mean BCVA was 0.34 ± 0.15 in group A and was 0.31 ± 0.16 in group B (p > 0.05). IOL tilt was found in 0 (0%) eyes in group A and in 5 (10%) eyes in group B (p < 0.05). IOL decentration was observed in 1 (2%) eye in group A and 7 (14%) eyes in group B, with statistically significant difference (p value = 0.03). Cystoid macular edema was found in 2 (4%) eyes in group A and in 5 (10%) eyes in group B (p > 0.05). Conclusion: The results of our study indicated that both methods are satisfactory in correcting aphakia without sufficient capsular support as regards postoperative best corrected visual acuity (BCVA)
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015
To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. METHODS In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients .2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth \3 mm, central endothelial cell density (CECD) \2500 cells/mm 2 , uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively. RESULTS A total of 25 aphakic eyes of 18 patients (mean age, 7.86 AE 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 AE 0.36; for patients with subluxation, 0.7 AE 0.26. Values improved at 1 year to 0.38 AE 0.15 (P \ 0.002) and 0.3 AE 0.2 (P \ 0.0001), respectively. One year after surgery the CECD (2892.64 AE 441.79 cells/mm 2) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 AE 468.9 cells/mm 2 , 3081 AE 495 cells/mm 2 ; P \ 0.0001, P \ 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%). CONCLUSIONS Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.
International Ophthalmology, 2020
Purpose To evaluate the long-term refractive outcomes and complications of posterior chamber intraocular lens placement by scleral fixation surgery (SF-IOL) with the knotless Z-suture method. Methods The authors retrospectively reviewed the medical records of patients who underwent SF-IOL placement with the Z-suture method between January 2010 and December 2018 and who attended a followup after at least 1 year. Preoperative and postoperative best-corrected visual acuity (BCVA), anterior segment biomicroscopy, fundus examinations, and postoperative complications were evaluated. Lenticular astigmatism was calculated through the vector analysis method. Results One hundred thirty-six eyes of 136 patients (mean age 57.78 ± 22 years, 98 male/38 female) were included in the study. Of the 136 patients, 67 (49.3%) had a complicated cataract, 50 (36.8%) had pseudoexfoliation syndrome, and 19 (14%) had a trauma history. The mean follow-up period was 50.83 ± 27 months. The mean preoperative BCVA was 0.65 ± 0.24 LogMAR, and the postoperative BCVAs were: 0.40 ± 0.30 (p \ 0.001) at 1 year; 0.40 ± 0.30 (p \ 0.001) at 2 years; 0.41 ± 0.31 (p \ 0.001) at 3 years; 0.43 ± 0.32 (p \ 0.001) at 5 years; and 0.47 ± 0.24 (p = 0.03) at 8 years. Complications included retinal detachment in 2 patients (1.5%), cystoid macular edema in 4 patients (2.9%), increase in intraocular pressure in 5 patients (3.6%), suture loosening in 3 patients (2.2%), and IOL dislocation in 3 patients (2.2%). Conclusion Scleral fixation of IOL with knotless Z-suture technique is an effective method to correct aphakia, with reliable long-term results.
Visual Outcome and Complications in Ab-Externo Scleral Fixation IOL in Aphakia
2011
Acceptance for publication May’ 2011 .................................. Purpose: To assess the visual outcome and complications in patients after Ab-externo scleral fixation of intraocular lens. Materials and Methods. This quasi experimental study was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Malir, Karachi; from May 2006 to April 2007. Study included total 30 eyes of 30 patients fulfilling criteria. All cases were worked up according to the protocol. All patients underwent Ab-externo scleral fixation of IOL. Patients were followed up at 1st day, 1st week, 1st month, 2nd month and 3rd month. Complete eye examination including best-corrected visual acuity and complications were noted on each visit. Results: Best corrected visual acuity improved in 29 (96.7%) patients while 26 (86.7%) patients showed BCVA 6/12 or better. The most common intraoperative and postoperative complications observed were vitreous hemorrhage and astigmatism respectivel...
Purpose to compare between intrascleral (Yamane Technique) and trans-scleral (ab externo technique) posterior chamber intraocular lens (PCIOL)implantation in cases of pediatric aphakia. Patients and methods: a prospective interventional study included 20 aphakic eyes < 18 years old with insufficient capsular support. Patients were randomly assigned into two groups; group (1) underwent sutureless intrascleral IOL implantation using Yamane technique and group (2) underwent trans-scleral IOL implantation (ab externo technique). Outcome measures included visual acuity (uncorrected UCVA& best corrected BCVA), astigmatism (corneal and IOL-induced), Keratometric readings, IOL state and any developed surgical complications. Patients were followed for at least 6 months. Results There was a statistically significant improvement in UCVA and BCVA at 6th month compared to preoperative values, without significant difference between the 2 groups. Corneal astigmatism was higher in group (2) wher...
Results of intraocular lens implantation in paediatric aphakia
Eye, 1992
Intraocular lenses were implanted in 16 eyes of 13 patients with congenital cataract, and visual progress was plotted using a preferential-looking technique. Initial surgery was by lens aspiration with preservation of the posterior capsule, and subsequent posterior capsulotomy without anterior vitrectomy. Poly-HEMA posterior chamber lenses were used, usually as a primary pro cedure but in four cases as a secondary procedure after contact lens failure. No serious complications were encountered. Most ey es achieved a very significant visual improvement, and none were worse than preoperatively. Residual refractive error was highly unpredictable, but did not exceed 6 dioptres. The importance of rigorous occlusion therapy is stressed. With close follow-up, this procedure offers an effective and safe method for the cor rection of unilateral paediatric aphakia, and, in selected cases only, for bilateral aphakia.
Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support
Journal of Ophthalmology
There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficien...
Secondary IOLs: ACIOL vs Iris Sutured vs Scleral Fixated vs Phakic IOL in Aphakic Settings
Current Ophthalmology Reports, 2018
Purpose of Review The aim of this review is to present ophthalmologists with up-to-date literature and treatment practices in the correction of vision with secondary intraocular lenses (IOLs) in the aphakic setting. Recent Findings Advances in the surgical techniques for the implantation of secondary intraocular lenses have allowed for improved postoperative outcomes. Studies published continue to evaluate the different surgical approaches and provide guidance to surgeons when choosing the optimal treatment plan for their patients. Summary In the absence of adequate capsular support, surgical implantation of intraocular lenses in different positions within the eye can be performed. Anterior chamber, iris-sutured, scleral-fixated, and iris-claw intraocular lenses have been found to be safe and effective treatment modalities in the correction of aphakia in eyes lacking adequate capsular support. Recent studies show that the development of new surgical techniques continue to provide safer and more effective treatment options for these patients.
European journal of medical and health sciences, 2020
The article evaluates the functional stability in the eye and the method of intrascleral fixation of spherical or toric, monofocal, intraocular Carlevale lens by Soleko. The procedure was performed in patients requiring correction of aphakia. Haptics of the one-piece lens, due to the T-shape structure are fixed intrasclerally and thus do not require additional fixation sutures. Intrascleral fixation was performed in 14 eyes, in 13 patients, between 2017 and 2019. In one case, a corneal astigmatism correction model (Carlevale toric) was used. Good visual quality and full intraocular stabilization were obtained. Except for transient vitreous haemorrhage, corneal oedema, and elevated intraocular pressure, no other adverse effects were observed, including intraocular displacement, subluxation or rotation of the lens relative to the axis. The normal and stable position of the lens was also obtained in the eyes with accompanying nystagmus.