Transscleral Fixation of Intraocular Lenses Using Modified Injector

PURPOSE: To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector. METHODS: We have modified and used the Sapphire unfolder injector system (Allergan(R), USA). This involved, cutting a slit longitudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o'clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o'clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o'clock) is tied to the haptic on the opposite side and inserted. RESULTS: The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly. CONCLUSIONS: This technique is an effective procedure for minimizing entangled thread and corneal astigmatism.

Two Cases of WIOL-CF(R) IOL Dislocation after Nd:YAG Laser Capsulotomy

PURPOSE: To report 2 cases of WIOL-CF(R) intraocular lens (IOL) (Gelmed International, Kamenne Zehrovice, Czech Republic) dislocation after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. CASE SUMMARY: A 78-year-old female was referred for IOL dislocation. She was implanted with WIOL-CF(R) IOL 18 months prior. Two months after WIOL-CF(R) implantation, she received Nd:YAG laser capsulotomy at a local clinic. Pars plana vitrectomy and transscleral fixation of IOL were performed. CONCLUSIONS: This is the first report of WIOL-CF(R) IOL dislocation after Nd:YAG laser capsulotomy in unvitrectomized eyes. When Nd:YAG laser capsulotomy is performed after WIOL-CF(R) IOL implantation, IOL dislocation should be considered even in unvitrectomized eyes.

Comparison of Clinical Outcomes after Various Techniques of Intraocular Lens Dislocation Correction

PURPOSE: To compare clinical outcomes of various surgical methods of intraocular lens dislocation correction surgery. METHODS: We retrospectively analyzed the medical records of patients who underwent intraocular lens dislocation correction surgery with and without vitrectomy by two seasoned surgeons, and compared postoperative best corrected visual acuity and spherical equivalent. Clinical outcomes of secondary intraocular lens insertion after primary intraocular lens removal and primary intraocular lens reposition were compared among the cases without vitrectomy. RESULTS: Dislocated intraocular lens correction without vitrectomy showed better postoperative visual acuity compared to procedures with vitrectomy (0.35 +/- 0.37 vs. 0.54 +/- 0.18; t-test, p = 0.001), but there were no significant differences in spherical equivalent (1.30 +/- 1.10 vs. 1.80 +/- 1.57; p = 0.24) between cases with and without vitrectomy. In comparing primary intraocular lens reposition and secondary intraocular lens insertion among the cases without vitrectomy, the outcomes did not show significant differences in best corrected visual acuity (0.28 +/- 0.40 vs. 0.40 +/- 0.37; p = 0.38) or spherical equivalent (1.66 +/- 1.43 vs. 1.07 +/- 0.79; p = 0.19). In comparing secondary intraocular lens insertion into the capsular bag and fixation to the sclera, iris and iris sulcus, the outcomes did not show significant differences in best corrected visual acuity (p = 0.49) or spherical equivalent (p = 0.33). CONCLUSIONS: The various intraocular lens correction methods examined did not show clinically significant differences in best corrected visual acuity and spherical equivalent when performed by experienced surgeons, except for better postoperative best corrected visual acuity in cases without vitrectomy compared to cases with vitrectomy.

A Reverse Ab Externo Scleral Fixation for Posterior Chamber Intraocular Lens Dislocation

PURPOSE: To report the clinical effects of reverse ab externo scleral fixation with scleral penetration using a 10-0 prolene needle in patients with dislocation of a posterior chamber intraocular lens (PCIOL). METHODS: The ab externo scleral fixation technique uses a corneal tunnel and a loop of 10-0 propylene made by 2 consecutive scleral sutures to fix the haptic to the sclera. The reverse technique penetrates the sclera with a 10-0 prolene needle instead of a 26-gauge needle and introduces the 26-gauge needle into the corneal tunnel to pull the 10-0 prolene needle through, thus creating a loop around the haptic and fixing it to the sclera. Scleral fixation was performed on one haptic in 2 eyes and on both haptics in 3 eyes. RESULTS: The dislocated IOLs were successfully repositioned, and the corrected visual acuity was improved postoperatively in all 5 eyes. There was no specific complication except mild hyphema in 1 eye. CONCLUSIONS: Reversed ab externo scleral fixation is an easy and effective way to reposition dislocated PCIOLs and decrease the complication of hemorrhage and hypotony frequently associated with the standard ab externo technique.