Haptics can be externalized using 25gauge forceps or hollow needle. Sutureless scleral fixation requires sclerotomy and externalization of haptics through uveal tissue, which may induce intraocular hemorrhage 6, 14. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol. Technique ab externo scleral fixation of intraocular lens d. All iols used for sutureless intrascleral fixation are existing posterior chamber iols. Trocarassisted sutureless intrascleral posterior chamber. Preoperative and postoperative bcva in 55 eyes undergoing combined ce iol and transconjunctival sutureless pars plana vitrectomy with toric iol implantation. Stability of the acrysof toric intraocular lens in. We performed this technique on patients with insufficient posterior capsule support.
Iol rescue via sutureless scleral fixation eyetube. In discussion with the panel at the retina exchange film festival, dr. In addition, this variation of sutureless intrascleral surgery seems safe and effective for patients who require secondary iols. Scleral fixation of iol simple technique dr sinumol thulaseedharan duration. Late iol dislocation or tilt is also a potential concern with scleral fixation techniques 8, 11, 15, 26, 35. Techniques involve fixation of iol haptics within partial thickness scleral flaps.
Sutureless scleral tunnel intraocular lens fixation in the pediatric population. Anterior chamber iol placement may lead to cystoid macular edema, corneal decompensation, and angle compromise. Crandall, md we describe an ab externo technique that facilitates iol scleral fixation and reduces the risk associated with previous ab externo scleral fixation techniques. This was further developed as the glued iol technique which enjoys widespread adoption all over the world. Prasad s 20 transconjunctival sutureless haptic fixation of posterior chamber iol. To report a new technique for sutureless intrascleral fixation of threepiece foldable intraocular lenses iols using 25gauge trocars. Novel technique of sutureless glueless scleral fixated. Walsh, md, phd objective to teach attendees a novel sutureless scleral intraocular lens iol fixation technique that involves melting the tips of the iol haptics to form flanges or bulbs to. A new intrascleral fixation technique for a standard 3piece posterior chamber intraocular lens pc iol using a simple guide is described. The implant and capsule were removed and replaced with an intrascleral haptic fixated iol.
A smalldiameter scleral tunnel can provide leakfree closure. Sutureless intrascleral fixation of secondary intraocular. Supplementary video of an original research paper sutureless intrascleral intraocular lens fixation with lamellar dissection of scleral tunnel published in the open access journal clinical. Eyeworld comparable results from sutureless scleral. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets. To present a technique for sutureless fixation of a threepiece, multifocal, posterior chamber intraocular lens iol in the ciliary sulcus.
Pdf scleralfixated intraocular lenses researchgate. Html and pdf versions of this article on the journals web site. Shin yamane, md, pioneered a modification of sutureless intrascleral iol fixation using needles to dock and externalize the haptics. The results of sutureless sfiol have been encouraging in adult eyes 1723.
Sutureless trocarcannula based transconjunctival flanged. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus. For scleral fixation implantation, use 6725067255 for posterior sclera fixation and 6622066225 for anterior sclera fixation accordingly. Yannek leiderman, md, shares a video that demonstrates sutureless scleral fixation of an iol.
We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. Surgical technique for sutureless intrascleral fixation of. To develop a novel, sutureless, singlepiece, nonfoldable intraocular lens iol intrascleral fixation technique based. Table of contents digital edition pdf edition archives subscription.
Sutureless, glueless, scleral fixation of singlepiece and toric intraocular lens. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Three port sutureless posterior chamber intraocular lens int. Leiderman shares advice to help perform this complex procedure.
Two years later at the ascrs 2016 annual meeting, yamane was awarded the grand prize for his video on the technique available here. Haptic flanging during 27gauge sutureless intrascleral surgery creates a more stable scleral fixated iol compared with the traditional unflanged technique based on a cadaveric human eye study. Novel technique of sutureless glueless scleral fixated intraocular. Bimanual intraocular lens rescue with transconjunctival scleral. The transconjunctival sutureless intrascleral sis fixation iol technique originally described by prasad1 uses a total of five vitrectomy trocarcannulasthree for. Results 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 or infection and iol dislocation or subluxation. Sutureless intrascleral haptichook lens implantation.
For a partial dislocation of a onepiece iol in the bag, i prefer trans scleral suture fixation, he says. Her preferred approach to secondary iols without capsular support is now glueassisted sutureless scleral tunnel fixation. Technique of using glue for scleral fixation has been described avoiding the suture related complications. Intrascleral haptic fixation as an alternative to sutures. Ab externo scleral fixation of intraocular lens pdf free. To prevent these complications, the knobs are buried under the scleral.
However, the efficacy and safety of this technique in the pediatric age group has not been adequately studied. Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss. A subluxated baglens or free implant should be fixated rather than exchanged. Sutureless intrascleral haptic fixation of a threepiece posterior chamber iol in the ciliary sulcus in eyes with no capsule support was first reported by scharioth and colleagues in the journal. Throughout our site you will find links to external websites. Sutureless intrascleral fixation using different three. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleral fixated threepiece iol. To overcome the suturerelated complications, various techniques of sutureless scleral fixation of iol have been described. Sutureless intrascleral posterior chamber iol fixation.
Sutureless scleral iol fixation is an important technique to maintain in a vitreoretinal surgeons armamentarium. In the last two decades, sutureless sfiols are gaining popularity. All patients who had undergone sutureless, glueless intrascleral iol fixation using 26g needles. Sutureless scleral iol fixation american academy of. A simple modified way of glueless sutureless scleral. Seventeen eyes from 15 patients with aphakia, dislocated iol, or subluxated crystalline lens undergoing posterior chamber sutureless implantation of an iol. Intraoperative endoscopy and ultrasound biomicroscopy demonstrated a securely fixated iol and well. Sutureless intrascleral pocket technique of transscleral fixation of intraocular lens in previous vitrectomized eyes yongwun cho1, inyoung chung 1,2. Exceptions to this rule are when the implant is damaged. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol. Scleral fixation of iol is an effective but surgically demanding technique. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol by using our developed simple technique. Sutureless sfiol avoids suture related complications such as suture exposure and suture breakage. Get a printable copy pdf file of the complete article 5.
Sutureless scleral tunnel intraocular lens fixation in the pediatric. Sutureless intrascleral haptic fixation of a threepiece posterior chamber iol in the ciliary sulcus in eyes with no capsule support was first reported by scharioth and colleagues in. Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. Scharioth and pavlidis1 popularized a sutureless technique. In sutureless microincisional vitrectomy surgery, one. 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. Surgical outcome of simultaneous intraocular lens rescue and sutureless intrascleral tunnel fixation of dislocated intraocular lenses. In the present case, a decentralized threepiece iol in the sulcus was repaired with a trocarassisted sutureless scleral fixation method, as described previously. This retrospective case series of live and cadaveric eyes was conducted to evaluate implanted intraocular lenses using sutureless intrascleral sis fixation. Trocarassisted intrascleral sutureless fixation of a. Pdf fourflanged intrascleral intraocular lens fixation technique.
After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol. Case report sutureless intrascleral pocket technique of. Sutureless, glueless, scleral fixation of singlepiece and. We report a novel technique characterized by sutureless scleral fixation of threepieces foldable intraocular lens iol using 25gauge transconjunctival sutureless vitrectomy tsv trocars in. To compare the superiority of sutureless scleral fixation of a threepiece foldable acrylic posterior chamber intraocular lens pciol in the absence of capsular. The dimension of posterior chamber iols is usually not more than mm.
Tips for sutureless scleral fixation a close look at two approaches to make it work for you. Recently the yamane technique has also become popular and is being widely adopted as well. To report results of a novel technique for sutureless, glueless intrascleral fixation of threepiece posterior chamber intraocular lens iol using 26g needle for management of aphakia. Scleral fixation of intraocular lens ophthalmology. Scleral fixation of intraocular lens zia ul mazhri, wasif m qadri. Mohamed elnoamany sutureless scleral fixation iol national eye center rodelfarag. Before the iol is rescued, it should be free of the. Bioptics in sutureless intrascleral multifocal posterior.
Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case. Apart from the abovementioned sutured scleral fixation, a new technique was reported in eyes without capsule support for sutureless fixation, describing fixation of the haptics in a limbusparallel scleral tunnel. Although we make every effort to ensure that these links are accurate, up to date and relevant, alyko cannot take responsibility for pages maintained by external providers. The technique of scleral fixation of the iol requires a conjunctival dissection to make a scleral bed for the passage of fixation sutures and to prevent knot exposure 79. Practiceupdate is free to end users but we rely on advertising to fund our site. Mandelscleral fixation of dislocated posterior chamber intraocular lenses.
Presented at the ascrs symposium on cataract, iol and refractive surgery, chicago, illinois, usa. Evaluation of sutureless, glueless, flapless, intrascleral. The yamane technique sutureless needleguided intrasceral iol implantation with lamellar scleral dissection was first published in 2014 by shin yamane of yokohama university hospital, yokohama, japan 1. For pars plana vitrectomy, if done with 65920, bill 67036, but if done with 67121, you cannot bill the pars plana vitrectomy separately, as it is considered integral component of the procedure. Sutureless intrascleral intraocular lens fixation with. 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. Sutureless intrascleral posterior chamber iol fixation has. In this prospective series, 30 eyes of 20 patients with aphakia, subluxated iol, or crystalline lens were included. A 72yearold white man was referred with uveitisglaucomahyphema ugh syndrome in an eye with a scleral fixated threepiece iol. Retina surgery retina earls scleral fixation of a four. Iol in the posterior chamber, some surgeons turn to sutureless intrascleral fixation of a 3piece, posterior chamber iol pciol as the solution. Scleralfixated intraocular lenses sfiols are important tools for an ophthalmologist when dealing with the eyes that have inadequate.
Techniques to place intraocular lenses in the absence of adequate capsular support continue to be an important part of the vitreoretinal surgeons armamentarium. Before the onset of his complicated surgical course, the patient had a bcva of 20201 in the left eye after removal of an epiretinal membrane. Iol either to the iris or the sclera in the ciliary sulcus. Scleral fixation of iols became popular, originally with sutured scleral fixated iols and later the scharioth technique of intrascleral haptic fixation.
Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dis. Recently, iol implantation via sutureless intrascleral fixation has been performed in children with no lens dislocations after six months of. 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. To secure the haptics, 27gauge scleral tunnels are created. Sutureless transconjunctival intrascleral intraocular lens. Pdf versions of this article on the journals web site. Pdf sutureless intrascleral fixated intraocular lens. Intermediate results of sutureless intrascleral posterior. To report the intermediate multicenter results of a technique of sutureless intrascleral fixation of a standard 3piece posterior chamber intraocular lens pc iol in the ciliary sulcus.
1080 741 1044 1370 1603 636 496 1211 863 1224 931 941 1212 455 1239 139 769 994 373 1669 1490 711 305 273 848 854 1105 452 1545 1001 953 614 1064 503 50 93 966 1425 486 1170 485 28 348 780 153 935 98 158