Yamane scleral iol fixation technique vladimir pfeifer duration. 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. 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 this study, 30 eyes of 30 patients were included. However, sutureless scleral fixation of the iol requires posterior segment instruments and a machine for pars plana vitrectomy. 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. 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.
Placement of iol in the posterior chamber rather than anterior or. An sfk joining the two sutures was passed through the sclera without. Cover story sulcus fixation of an iol using scleral tunnels. 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. 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. Full text sutureless intrascleral intraocular lens fixation. Scleral fixation is an alternate way of fixing the iol in the posterior chamber. 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. Pdf sutureless scleral fixation of intraocular lenses. Videos by topic the american society of retina specialists. 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. Sutureless intrascleral fixation of a customtailored iris.
I need a code for a pars plana vitrectomy and removal of iol, and implantation of sclera fixation. An alternative technique using 23gauge surgery for refixation of a scleral sutured lens megan e. A total of 122 consecutive patients who underwent iol placement using sis technique were included in the study with mean followup of 1. Abbey am, hussain rm, shah ar, faia lj, wolfe jd, williams ga 2014 sutureless scleral fixation of 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. 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. In a case with a dislocated posterior chamber pmma iol, the same iol can be repositioned, thereby reducing the need for further manipulation. Novel technique of sutureless glueless scleral fixated intraocular. He has observed no complications so far, with a maximum followup of 4 years.
Sutureless scleral iol fixation american academy of. Scleral fixation lens are implanted inside the eyes with the help of scleral support. Sutureless scleral fixation of intraocular lenses springerlink. Comparison of sutured versus sutureless scleralfixated intraocular lenses article in journal of cataract and refractive surgery 421. Suture exposure remains to be a potential problem of transscleral fixated posterior chamber intraocular lens pciol. It is indicated in case of weak zonules, posterior capsular tear and improper capsular bag support. Sutureless intrascleral iol fixation methods are newer and have been developed to eliminate the suturerelated complications of sutured scleral fixation methods such as. Scleralfixated intraocular lenses madanagopalan v g, sen p. Retina surgery retina earls scleral fixation of a fourhaptic. 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.
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. Intrascleral fixation of an intraocular lens through the pars plana. Sutureless, glueless, scleral fixation of singlepiece and. 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 intrascleral posterior chamber iol fixation has. A new minimally invasive technique for fixation of an intraocular lens iol was presented at two recent retina conferences. Among them scleral fixated pc iol implant can provide minimum magnification of image as compared to other options. Sutureless intrascleral intraocular lens implantation after ocular trauma. In sutureless scleral fixation3,4 and glued iol techniques5, intraocular bimanual handshake technique6 is used. The haptics of the 3piece lens were passed through pars plana and then the tips were melted in order to hold them in place. A 63yearold male with ho sbppv presents with a dislocated 3piece iol after initial sulcus placement. Sutureless scleral fixation involves externalizing iol haptics for fixation within the sclera. Yannek leiderman, md, shares a video that demonstrates sutureless scleral fixation of an iol. An alternative technique using 23gauge surgery for refixation of a scleralsutured lens megan e.
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. Iol power calculation special situations slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. Because iciols are classified into anterior chamber iciols and retropupillary iciols, this study merged the 2 types of iols. The majority 75% of patients received a new 3piece iol for primary aphakia or after iol exchange. All patients underwent abexterno scleral fixation of iol by the same surgeon. Sutureless techniques have also been developed to avoid potential complications. Retina surgery retina earls scleral fixation of a four.
Sutureless scleral tunnel intraocular lens fixation in the p. Sutureless intrascleral fixation of secondary intraocular lenses. At the 5th annual vitbuckle society meeting in april, mark walsh, md, of tucson, az, presented his method. On the other hand, if the haptics is being externalized, sutureless fixation of a threepiece iol is usually done. 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. Surgical technique simple new technique for scleral fixation. 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. Eyeworld comparable results from sutureless scleralfixated. Scleralsutured lenses can have good results but require complex intraocular maneuvers. 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. Aug 15, 2012 the iol haptics provide an adequate fixation point for securing the lens to the peripheral iris.
Sutureless scleral fixation of iols in vitrectomized eyes evrs. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. Iol rescue via sutureless scleral fixation eyetube. Scleral fixated iol sutureless and glueless youtube. These include using an anterior chamber intraocular lens, an irisfixated posterior chamber iol or a scleralfixated pciol.
Patients underwent sutureless scleral fixated iol, with intrascleral tucking of haptics, into a tunnel made using 20 g microvitreoretinal blade. Apr 21, 2012 the iol haptics are the jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Nakhwa, ms, frcs, sabyasachi sengupta, do, dnb, frcs j cataract refract surg jan 2015. A conjunctival peritomy is performed, and light scleral cautery is used to achieve adequate hemostasis. Journal of ophthalmology hindawi publishing corporation. The implant and capsule were removed and replaced with an intrascleral haptic fixated iol. Sutureless scleralfixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. The iol haptics are the jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case.
After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon. Surgical technique a new technique of sutureless sf iol. Descemet membrane endothelial keratoplasty in cases with. Suture techniques need to cover, bury, or rotate suture. 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. We describe a flanged sutureless scleral fixation fssf technique for dislocated sulcus intraocular. The iol haptics provide an adequate fixation point for securing the lens to the peripheral iris. Mar 03, 2017 these include using an anterior chamber intraocular lens, an irisfixated posterior chamber iol or a scleralfixated pciol. To report two cases of descemet membrane endothelial keratoplasty dmek in patients with existing scleralfixated and irisfixated intraocular lenses sfiol and ifiol, respectively. Sutureless intrascleral intraocular lens fixation with. We report a modified technique to minimize the risk of suture exposure for the transscleral fixation of pciol.
To report the results of sutureless scleral fixation of a posterior chamber intraocular. 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. Intrascleral intraocular lens iol fixation is a standard technique for secondary implantation. Sutureless scleral fixation of intraocular lenses sciencedirect. May 10, 2017 for a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. Transscle ral fixation of posterior chamber iols can be performed using suture or sutureless techniques5. 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. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets. To report the clinical outcomes of sutureless scleral fixated intra ocular lens iol. In discussion with the panel at the retina exchange film festival, dr. Original article visual outcome and complications in ab.
Irisclaw intraocular lens and scleralfixated posterior chamber. We have developed this new technique for intrascleral iol fixation which is quite. Novel technique to overcome the nonavailability of a long needle. This is a pdf file of an unedited manuscript that has been accepted for. 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.
Here the haptics of the 3 piece iol are grabbed through the respective sclerotomies using microvitreous forceps and exteriorised. Sutureless scleralfixated iol in children american academy. If you continue browsing the site, you agree to the use of cookies on this website. Fixation of iol may also be considered safe while managing subluxated or dislocated crystalline lens or in iol exchange procedure2,79.
For a partial dislocation of a onepiece iol in the bag, i prefer transscleral suture fixation, he says. Jun 04, 2014 to report the clinical outcomes of sutureless scleral fixated intra ocular lens iol. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol. 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. In 2006, we performed the first intrascleral haptic fixation of a standard threepiece intraocular lens and reported the surgical technique in 2007. 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. The sutureless irisclaw iols are inserted through a 5mm incision. Scleral sutured lenses can have good results but require complex intraocular maneuvers and run the risk of iol tilting and late suture breakage. Aimto assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens pciol.
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. 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. Sutureless scleral fixated iol implantation with intrascleral haptic fixation and gluing of the iol has been gaining recognition in recent years. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleralfixated threepiece iol. Modified technique for transscleral fixation of posterior. Irisclaw intraocular lens and scleralfixated posterior chamber intraocular lens implantations in. 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. Crsteurope sulcus fixation of an iol using scleral tunnels. Care should be taken to hold the haptics at the very tip to avoid kinking or fracture of the haptic.
Leiderman shares advice to help perform this complex procedure. Iol exchange for scleral fixated akreos ao lens using goretex. Sutureless intrascleral fixated intraocular lens implantation. Sutureless scleral fixated iol implantation with intra scleral haptic fixation and gluing of the iol has been gaining recognition in recent years. Mark walsh has performed sutureless scleral tunnel iol fixation in 11 pediatric patients with a variety of lenticular disorders. At the retina world congress in february, shin yamane, md, of japan, presented his technique of flanged fixation. Comparison of sutured versus sutureless scleralfixated. In case of iol flip during the process of insertion, the. Sutureless intrascleral posterior chamber intraocular lens fixation. About europe pmc funders joining europe pmc governance roadmap outreach. In the latter case, sutureless intrascleral haptic fixation may be per.