“To Fulfill two needs with one deed”: Iris fixation of intraocular lens using four-throw pupilloplasty

Background: Pupil distortion and aphakia are common complications that follow blunt injury of the eye globe, surgical complications, and iris coloboma. Patients with these two complications complain of severe glare and photophobia even after successful intraocular lens (IOL) implantation like scleral fixation of intraocular lens (SFIOL) due to irregular pupil. To overcome this, we prefer to do pupilloplasty along with IOL implantation. Purpose: In this video, we demonstrate iris fixation of IOL using four?throw pupilloplasty; thus with one surgical technique, both pupilloplasty and iris fixation are done. Synopsis: The technique of an IOL implantation without capsular support can be challenging. There are different techniques, such as iris claw, iris fixation, and scleral fixation. Permanent mydriasis or distorted pupil can be a disabling condition, even after successful vision gain, due to photophobia. So pupilloplasty is nowadays preferred along with IOL implantation. Usually after IOL implantation, iris cerclage or pupilloplasty is done. We combined both steps with one technique: iris fixation with four?throw pupilloplasty. This technique can be used for iris coloboma with weak zonules and surgical iridectomy with aphakia cases where the pupil is irregular. Highlights: The video highlights the steps of four?throw pupilloplasty technique which is also used for fixating the IOL to the iris (iris fixation). This can give an excellent outcome in aphakia with distorted pupil using a single technique approach.

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.

Anterior chamber fixation of a posterior chamber intraocular lens: A novel technique.

We aimed to evaluate the implantation of a posterior chamber intraocular lens (IOL) in the anterior chamber (AC) with the haptics passing through two iridectomies to the posterior chamber. A total of 33 eyes of 33 patients with inadequate posterior capsular support due to either previous aphakia or posterior capsular rupture during cataract extraction were included in the study. A double iridectomy was performed on all patients using a vitrectomy probe on the midperiphery of the iris. IOLs were implanted in the AC, and the haptics were passed through the iridectomies to the posterior chamber. The mean follow‑up time was 25.3 months. AC hemorrhage occurred in five patients during the iridectomy procedure. Corneal edema was detected in eight of 14 patients with primary IOL insertions. Haptic dislocation was detected in only one patient. This technique may be a good alternative to scleral‑fixated IOL implantation in eyes with aphakia.