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1.
J Cataract Refract Surg ; 43(5): 706-708, 2017 05.
Article in English | MEDLINE | ID: mdl-28602343
2.
J Cataract Refract Surg ; 41(11): 2347-52, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26703481

ABSTRACT

UNLABELLED: We present a simplified modification to a technique for early or mild in-the-bag subluxation that avoids conjunctival and scleral incisions and minimizes intraocular manipulation. While the capsulorhexis edge is grasped with an intraocular forceps to stabilize the IOL-capsular bag complex, a 10-0 polypropylene suture on a long curved needle is used to secure the fibrotic superior capsulorhexis edge to the midperipheral iris at 12 o'clock using a combination of a modified McCannel suture and a Siepser sliding knot. FINANCIAL DISCLOSURE: Dr. Condon receives speaker and consultant fees from Alcon Surgical, Inc., Allergan, Inc., and Microsurgical Technology. Although the Microsurgical Technology Condon snare instrument is named after him, Dr. Condon reports no patents, fees, or payments related to it. Dr. Siegel has no financial or proprietary interest in any material or method mentioned.


Subject(s)
Artificial Lens Implant Migration/surgery , Capsulorhexis/methods , Iris/surgery , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Suture Techniques , Aged , Aged, 80 and over , Artificial Lens Implant Migration/etiology , Exfoliation Syndrome/complications , Female , Glaucoma, Open-Angle/complications , Humans , Male , Polypropylenes , Sutures , Visual Acuity
3.
J Cataract Refract Surg ; 40(8): 1307-12, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25088628

ABSTRACT

UNLABELLED: Microinvasive invasive glaucoma surgery has become increasingly popular as a surgical alternative for glaucoma. Although the time-honored trabeculectomy remains the unrivaled contender for lowering intraocular pressure (IOP) into the single digits, newer devices are available that attempt to reach similar IOP levels with fewer complications and quicker visual recovery. The Express mini-shunt and the Innfocus microshunt are 2 devices that bring us closer to the goal of repeatable, lower risk surgery; improved patient satisfaction; stabilization of the visual field; and long-term IOP control. The mini-shunt has been approved by the U.S. Food and Drug Administration, while the microshunt is still under review. FINANCIAL DISCLOSURES: Dr. Condon is a consultant to and speaker for Alcon Laboratories. Dr. Moster has served on the advisory board of, been a consultant to, received honoraria for lectures from, and performed contracted research for Alcon, Inc.


Subject(s)
Glaucoma Drainage Implants , Glaucoma/surgery , Microsurgery/methods , Prosthesis Implantation/methods , Trabeculectomy/methods , Humans , Intraocular Pressure/physiology , Tonometry, Ocular
5.
J Cataract Refract Surg ; 40(3): 349-53, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24480563

ABSTRACT

We present modifications to the Wise fornix-based conjunctival trabeculectomy flap technique that have minimized early wound leakage in our experience. A retrospective chart review of 509 consecutive eyes revealed a 2.9% leak rate in the first postoperative month and 1.6% returned to the operating room to resuture a persistent leak. If meticulously performed, this modified closure technique may provide watertight closure as commonly as limbal-based techniques.


Subject(s)
Conjunctiva/surgery , Glaucoma/surgery , Surgical Flaps , Trabeculectomy/methods , Humans , Intraocular Pressure , Phacoemulsification/methods , Postoperative Complications , Retrospective Studies , Suture Techniques , Tonometry, Ocular
6.
J Cataract Refract Surg ; 39(8): 1276; discussion 1279, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23889873
7.
J Cataract Refract Surg ; 38(10): 1711-5, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22999598

ABSTRACT

Many surgical techniques to repair late in-the-bag intraocular lens (IOL) dislocation have been described. We present a modification to ab externo scleral fixation of in-the-bag IOL dislocation that minimizes cumbersome intraocular manipulations. Using an iris hook for intraocular suture retrieval under direct visualization eliminates the need to mate the suture needle with a hypodermic needle, and the site through which the hook is used provides an ideal place for suture knot burial, potentially minimizing late suture erosion or exposure.


Subject(s)
Artificial Lens Implant Migration/surgery , Lens Implantation, Intraocular/methods , Sclera/surgery , Suture Techniques , Aged , Aged, 80 and over , Female , Humans , Intraocular Pressure/physiology
8.
Am J Ophthalmol ; 149(2): 245-252.e2, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19896636

ABSTRACT

PURPOSE: To report ultrasound biomicroscopic (UBM) findings of iris-sutured foldable posterior chamber intraocular lenses (PCIOLs). DESIGN: Prospective, noninterventional consecutive case series. METHODS: Fifteen eyes with foldable acrylic IOL implantation using peripheral iris suture fixation in the absence of capsular support were included. UBM was used to determinate the haptic position in relation to the ciliary sulcus and ciliary body in these eyes. Additionally, anterior chamber depth, lens tilt, site of suture fixation, focal iris or angle abnormalities, and relationship of iris to lens were determined. Main outcome measures were haptic position, anterior chamber depth, and iris anatomic changes. RESULTS: Of the 30 haptics imaged, 16 (53.3%) were positioned in the ciliary sulcus. Nine (30%) haptics were found over the ciliary processes, and 5 (16.7%) were over pars plana. No patients were found to have peripheral anterior synechiae present at the haptic position. The mean (+/- standard deviation) depth of the anterior chamber was 3.84 +/- 0.36 mm. The iris profile was altered in all patients at the iris-haptic suture fixation site. No angle abnormalities or tilted lenses were found. CONCLUSIONS: Iris-sutured PCIOL haptics were found to be in the ciliary sulcus or over the ciliary body with no significant tilt on UBM analysis. The procedure respects the angle anatomy, and no evidence of angle closure was found. The anterior chamber was deeper than has been reported previously for scleral sutured PCIOLs and was similar to that of pseudophakic eyes. This may have implications for surgical technique, IOL power calculations, and postoperative complications.


Subject(s)
Anterior Eye Segment/diagnostic imaging , Iris/surgery , Lens Implantation, Intraocular/methods , Pseudophakia/diagnostic imaging , Suture Techniques , Acrylic Resins , Adult , Aged , Aged, 80 and over , Aphakia, Postcataract/surgery , Female , Humans , Lenses, Intraocular , Male , Microscopy, Acoustic , Middle Aged , Prospective Studies , Visual Acuity , Young Adult
9.
Ophthalmology ; 114(7): 1311-8, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17613327

ABSTRACT

PURPOSE: To report visual outcomes and complications of modified McCannel iris suture fixation of small-incision foldable acrylic intraocular lenses (IOLs) for aphakia in the absence of capsule support. DESIGN: Retrospective interventional case series. PARTICIPANTS: Forty-six patients who underwent foldable acrylic IOL implantation using peripheral iris suture fixation for aphakia in the absence of capsule support. METHODS: Data from 46 patients who underwent iris fixation of a foldable acrylic IOL were retrospectively evaluated for underlying diagnoses, surgical history, clinical results, and complications. MAIN OUTCOME MEASURES: Postoperative best-corrected visual acuity (BCVA), spherical equivalent, and surgical complications. RESULTS: Best-corrected visual acuity improved from 20/100 to 20/50 (P = 0.01), with 97% of eyes maintaining or improving BCVA after a mean (+/- standard deviation) follow-up of 24.1+/-12.4 months. Complications included transient low-grade uveitis (3 [6.5%]), transient pigment dispersion (3 [6.5%]), IOL dislocation (2 [4.3%]), elevated intraocular pressure (1 [2.2%]), and retinal detachment (1 [2.2%]). No new cases of cystoid macular edema or worsening of glaucoma occurred. CONCLUSION: Small-incision peripheral iris fixation of 3-piece acrylic foldable IOLs in the absence of capsule support appears to be an effective technique with few severe adverse events.


Subject(s)
Aphakia/pathology , Aphakia/surgery , Iris/surgery , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Suture Techniques , Adolescent , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Foreign-Body Migration/etiology , Humans , Lens Capsule, Crystalline/pathology , Lens Implantation, Intraocular/adverse effects , Male , Middle Aged , Ocular Hypertension/etiology , Retinal Detachment/etiology , Retrospective Studies , Uveitis/etiology , Visual Acuity
11.
J Cataract Refract Surg ; 31(11): 2193-204, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16412938

ABSTRACT

Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.


Subject(s)
Foreign-Body Migration , Lens Capsule, Crystalline , Lenses, Intraocular , Postoperative Complications , Foreign-Body Migration/epidemiology , Foreign-Body Migration/prevention & control , Foreign-Body Migration/surgery , Humans , Incidence , Lens Implantation, Intraocular , Ophthalmologic Surgical Procedures , Phacoemulsification , Risk Factors
12.
J Cataract Refract Surg ; 29(9): 1663-7, 2003 Sep.
Article in English | MEDLINE | ID: mdl-14522283

ABSTRACT

In the absence of capsule and zonule support, a modified insertion technique allows simple peripheral iris fixation of a posterior chamber 3-piece acrylic intraocular lens (IOL) via a small incision for secondary implantation. A bimanual unfolding maneuver creates pupillary capture of the optic to temporarily stabilize the IOL. Peripheral modified McCannel sutures fixate the flexible monofilament poly(methyl methacrylate) haptics to the posterior peripheral iris surface, after which the optic is safely prolapsed into the posterior chamber.


Subject(s)
Iris/surgery , Lens Implantation, Intraocular/methods , Suture Techniques , Aged , Humans , Male
13.
Ophthalmology ; 109(7): 1336-41; discussion 1341-2, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12093659

ABSTRACT

PURPOSE: To examine the 5-year complications and results of primary trabeculectomy with mitomycin-C (MMC). DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: One hundred twenty-three eyes that underwent primary trabeculectomy with MMC between December 1991 and March 1995. METHODS: All patients received standard trabeculectomy performed by one of two surgeons, using a Weck cell-soaked pledget of MMC, 0.25, 0.33, or 0.5 mg/ml, for 0.5 to 5 minutes. Laser suture lysis was performed postoperatively for intraocular pressure control. MAIN OUTCOME MEASURES: The incidence of complications, including hypotony with or without maculopathy, bleb leak or blebitis, pressure control, and medication reduction at yearly intervals. RESULTS: Mean preoperative and year 5 postoperative intraocular pressures (IOP) were 25.79 and 9.91 mmHg (P < 0.05, paired t test). Hypotony (IOP < 6) occurred in 42.2% of eyes after a mean follow-up of 26.1 months. Hypotony maculopathy occurred in 8.9% of eyes at mean follow-up of 33.7 months. Bleb leak occurred in 14.6% of eyes at a mean follow-up of 27.9 months. Blebitis occurred in 5.7% of eyes at a mean follow-up of 35.4 months, and endophthalmitis occurred in 0.8% of eyes at 15 months; 14.9% of eyes lost 4 lines of visual acuity. The single predictor for the development of late-term hypotony was IOP 1 month after operation (P < 0.05). CONCLUSIONS: Primary mitomycin trabeculectomy significantly lowers IOP at 5 years but is associated with a high incidence of delayed hypotony.


Subject(s)
Antibiotics, Antineoplastic/therapeutic use , Glaucoma, Angle-Closure/surgery , Glaucoma, Open-Angle/surgery , Mitomycin/therapeutic use , Sclera/drug effects , Trabeculectomy/methods , Combined Modality Therapy , Female , Follow-Up Studies , Glaucoma, Angle-Closure/drug therapy , Glaucoma, Open-Angle/drug therapy , Humans , Intraocular Pressure , Male , Postoperative Complications , Retrospective Studies , Safety , Time Factors , Treatment Outcome
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