Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

PURPOSE: To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens. METHODS: Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit. RESULTS: There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation. CONCLUSIONS: In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

PURPOSE: To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens. METHODS: Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit. RESULTS: There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation. CONCLUSIONS: In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

Astigmatic Changes and Clinical Outcomes after Scleral Fixation of IOL

PURPOSE: To evaluate the clinical outcomes, complications and surgically induced astigmatism (SIA) after scleral fixation in patients with intraocular lens (IOL) or crystalline lens dislocation. METHODS: The present study retrospectively investigated the postoperative best corrected visual acuity (BCVA), refractory change, corneal astigmatism, clinical outcomes, and influencing factors of SIA in 57 eyes of 55 patients with a follow-up of 6 months after the IOL scleral fixation. RESULTS: In comparison of preoperative and postoperative 6 months, BCVA, spherical equivalent and astigmatism were significantly improved but corneal astigmatism was not and SIA (diopter, D) improved from 2.10 +/- 1.88 D to 0.86 +/- 0.73 D (p = 0.002). 4 eyes having redislocation were repositioned and 4 eyes having tilted IOL, 6 eyes having elevated intraocular pressure, 3 eyes having exposure scleral knots, 1 eye having endophthalmitis, and 1 eye showing macular edema were observed. At postoperative 3 months, the SIA of a large incision size (>3 mm) and small incision size (< or =3 mm) was significantly differented (p = 0.041). According to the location of scleral fixation, SIA at postoperative 1 month was significantly different but, was not different at postoperative 6 months. CONCLUSIONS: Surgical management of dislocated IOLs or crystalline lens resulted in significant improvement of visual acuity and absence of influencing SIA factors. However, location of scleral fixation and small incision size influenced corneal astigmatism.

Four ports pars plana vitrectomy in retrieving dislocated posterior chamber intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the use of modified four ports pars plana vitrectomy in managing a dislocated posterior chamber intraocular lens.METHODS: A young man with bilateral pseudophakia and dislocated PC-IOLs had undergone modified four ports pars plana vitrectomy in relocating a dislocated posterior chamber intraocular lens. This procedure was surgically less tedious and demanding compared with previous methods of IOL retrieval.RESULTS: No significant intra- or post-operative complication was noted. The visual recovery of the operated eye was rapid with the best corrected visual acuity at 14 months post-operation being 0.5. In contrast, the right eye without operation due to patient refusal developed total retinal detachment with hand movement visual acuity.CONCLUSION: Modified four ports pars plana vitrectomy may be a more ophthalmic surgeon friendly alternative in the retrieval of dislocated IOL.

Clinical Analysis of the Operation of Dislocated Intraocular Lens / 医学研究杂志

Objective To analysis of the causes, operative methods and the clinical results in patients with dislocated intraocular lens(IOL). Methods 11 cases (11 eyes) underwent surgical management of dislocated IOL were analyzed retrospectively. Results In the all cases trauma was the main cause; Surgical techniques included IOL exchange in 3 eyes and IOL removal in 1eye,removal combined with re-implantation in 5 eyes, simple cut the after cataract in 2 eyes, the final best-corrected visual acuity was 0.6~0.8 in 3 patients (27.27%), 0.4～0.5 in 4 patients (45.45%) ,0.2~0.3 in 2 patients (18.18%) and

A Case of the Sclera-fixated Intraocular Lens with Haptic Fracture Developed After Rubbing the Eye

PURPOSE: We report one case of the sclera-fixated posterior chamber intraocular lens in which haptic fracture developed after rubbing the eye. METHODS: A 72-year-old man visited our clinic because of diminished vision in his right eye after rubbing the eye. Four years previously, the posterior capsule was ruptured and the nucleus dropped into the vitreous cavity during phacoemusification at another hospital. The patient was transferred to our hospital where vitrectomy, lens nucleus removal and scleral fixation using a PMMA intraocular lens were performed. RESULTS: The uncorrected visual acuity was finger count 30cm in the right eye and 0.8 in the left eye, and best-corrected visual acuity was 0.6 in the right eye. A dislocated intraocular lens was found at the inferonasal peripheral area in the vitreous cavity. The dislocated intraocular lens was removed through the corneal wound using injection of perfluorocarbon into the vitreous cavity, and then a PMMA intraocular lens with a haptic ring was inserted by scleral fixation. The haptic of the dislocated intraocular lens fixed at the superotemporal region had broken and a rough plane revealed in the electromicroscopic finding. We considered that impact rather than friction caused the haptic to break.

A New Technique to Reposition the Posteriorly Dislocated Intraocular Lens

The previously reported repositioning methods have been known to be very difficult to be performed. A new external knotting technique was performed to reposition the dislocated intraocular lenses (IOLs). After 3-port vitrectomy, a 30 gauge injecting needle tip into which the thread end of a 10-0 polypropylene was put, was introduced into the vitreous cavity through the ciliary sulcus to make a loop having an external knot. After one haptic of the IOL was engaged into the loop, the thread was pulled back and tied to make a knot. After holding and pulling the haptic of the IOL with the intraocular forceps for proper position of the knot. Then it was sutured and fixed in sclera. The IOLs were kept in central position without complications. The final visual outcome was 0.8 and 0.3 respectively. This method might be safe and easy to correct the dislocated IOL.