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. To present a technique for sutureless fixation of a threepiece, multifocal, posterior chamber intraocular lens iol in the ciliary sulcus. Pdf versions of this article on the journals web site. Presented at the ascrs symposium on cataract, iol and refractive surgery, chicago, illinois, usa. 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. Technique of using glue for scleral fixation has been described avoiding the suture related complications.
Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss. Scharioth and pavlidis1 popularized a sutureless technique. Sutureless intrascleral intraocular lens fixation with. Tips for sutureless scleral fixation a close look at two approaches to make it work for you. To overcome the suturerelated complications, various techniques of sutureless scleral fixation of iol have been described. All patients who had undergone sutureless, glueless intrascleral iol fixation using 26g needles. The surgeon begins the case by making two ciliary sulcusbased sclerotomies and 3mm intrascleral tunnels exactly 180 degrees apart. Sutureless intrascleral fixation of secondary intraocular. Intraoperative endoscopy and ultrasound biomicroscopy demonstrated a securely fixated iol and well. 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. 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. To develop a novel, sutureless, singlepiece, nonfoldable intraocular lens iol intrascleral fixation technique based.
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. We report a novel technique characterized by sutureless scleral fixation of threepieces foldable intraocular lens iol using 25gauge transconjunctival sutureless vitrectomy tsv trocars in. Pdf sutureless intrascleral fixated intraocular lens. Jonathan prenner, md, presents a sutureless scleral fixation technique in an iol rescue case.
In the last two decades, sutureless sfiols are gaining popularity. To report a new technique for sutureless intrascleral fixation of threepiece foldable intraocular lenses iols using 25gauge trocars. Practiceupdate is free to end users but we rely on advertising to fund our site. 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. Stability of the acrysof toric intraocular lens in. Sutureless scleral fixation iol haptics can be externalized and fixated within the sclera without the use of sutures. Techniques involve fixation of iol haptics within partial thickness scleral flaps. In discussion with the panel at the retina exchange film festival, dr. Scleral fixation of iols became popular, originally with sutured scleral fixated iols and later the scharioth technique of intrascleral haptic fixation. This was further developed as the glued iol technique which enjoys widespread adoption all over the world. Many techniques involve the use of scleral flaps or scleral tunnels parallel to the limbus. Novel technique of sutureless glueless scleral fixated intraocular. Novel technique of sutureless glueless scleral fixated. Yannek leiderman, md, shares a video that demonstrates sutureless scleral fixation of an iol.
Preoperative and postoperative bcva in 55 eyes undergoing combined ce iol and transconjunctival sutureless pars plana vitrectomy with toric iol implantation. Scleral fixation of intraocular lens ophthalmology. The implant and capsule were removed and replaced with an intrascleral haptic fixated iol. This retrospective case series of live and cadaveric eyes was conducted to evaluate implanted intraocular lenses using sutureless intrascleral sis fixation. Sutureless intrascleral pocket technique of transscleral fixation of intraocular lens in previous vitrectomized eyes yongwun cho1, inyoung chung 1,2. Sutureless, glueless, scleral fixation of singlepiece and. Her preferred approach to secondary iols without capsular support is now glueassisted sutureless scleral tunnel fixation. Leiderman shares advice to help perform this complex procedure. Prasad s 20 transconjunctival sutureless haptic fixation of posterior chamber iol. The results of sutureless sfiol have been encouraging in adult eyes 1723. Bimanual intraocular lens rescue with transconjunctival scleral. Shin yamane, md, pioneered a modification of sutureless intrascleral iol fixation using needles to dock and externalize the haptics. 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. Scleral fixation of iol simple technique dr sinumol thulaseedharan duration.
To prevent these complications, the knobs are buried under the scleral. 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 transconjunctival intrascleral intraocular lens. We performed this technique on patients with insufficient posterior capsule support. Get a printable copy pdf file of the complete article 5. 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. Case report sutureless intrascleral pocket technique of. Sutureless scleral fixation requires sclerotomy and externalization of haptics through uveal tissue, which may induce intraocular hemorrhage 6, 14. Sutureless, glueless, scleral fixation of an intraocular lens is a known technique of fixing a lens in the scleral pockets. Techniques to place intraocular lenses in the absence of adequate capsular support continue to be an important part of the vitreoretinal surgeons armamentarium. Surgical technique for sutureless intrascleral fixation of.
Seventeen eyes from 15 patients with aphakia, dislocated iol, or subluxated crystalline lens undergoing posterior chamber sutureless implantation of an iol. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol by using our developed simple technique. Recently, iol implantation via sutureless intrascleral fixation has been performed in children with no lens dislocations after six months of. A new intrascleral fixation technique for a standard 3piece posterior chamber intraocular lens pc iol using a simple guide is described. In the present case, a decentralized threepiece iol in the sulcus was repaired with a trocarassisted sutureless scleral fixation method, as described previously. Three port sutureless posterior chamber intraocular lens int. Sutureless intrascleral fixation using different three. Table of contents digital edition pdf edition archives subscription. Scleralfixated intraocular lenses sfiols are important tools for an ophthalmologist when dealing with the eyes that have inadequate. Sutureless scleral tunnel intraocular lens fixation in the pediatric. Intrascleral haptic fixation as an alternative to sutures. To report the results of sutureless scleral fixation of a posterior chamber intraocular lens iol. Sutureless intrascleral haptichook lens implantation.
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. Recently the yamane technique has also become popular and is being widely adopted as well. Trocarassisted intrascleral sutureless fixation of a. A 72yearold white man was referred with uveitisglaucomahyphema ugh syndrome in an eye with a scleral fixated threepiece iol. Bioptics in sutureless intrascleral multifocal posterior. 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. Sutureless scleral iol fixation american academy of. Technique ab externo scleral fixation of intraocular lens d. 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, glueless, scleral fixation of singlepiece and toric intraocular lens. Html and pdf versions of this article on the journals web site. In addition, this variation of sutureless intrascleral surgery seems safe and effective for patients who require secondary iols. For complete dislocation of a onepiece lens including the capsular bag, however, he prefers replacing it with a scleral fixated threepiece iol.
The dimension of posterior chamber iols is usually not more than mm. 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. There is no reason to become somewhat over conscious about the slightly higher risk of complications with scleral sutured pc iol. However, the efficacy and safety of this technique in the pediatric age group has not been adequately studied. In this prospective series, 30 eyes of 20 patients with aphakia, subluxated iol, or crystalline lens were included. Iol either to the iris or the sclera in the ciliary sulcus. Evaluation of sutureless, glueless, flapless, intrascleral.
Mohamed elnoamany sutureless scleral fixation iol national eye center rodelfarag. Trocarassisted sutureless intrascleral posterior chamber. Scleral fixation of intraocular lens zia ul mazhri, wasif m qadri. For a partial dislocation of a onepiece iol in the bag, i prefer trans scleral suture fixation, he says.
All iols used for sutureless intrascleral fixation are existing posterior chamber iols. Anterior chamber iol placement may lead to cystoid macular edema, corneal decompensation, and angle compromise. To compare the superiority of sutureless scleral fixation of a threepiece foldable acrylic posterior chamber intraocular lens pciol in the absence of capsular. Sutureless intrascleral posterior chamber iol fixation. 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. Intermediate results of sutureless intrascleral posterior. Eyeworld comparable results from sutureless scleral. Sutureless scleral iol fixation is an important technique to maintain in a 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 rescue via sutureless scleral fixation eyetube.
Surgical outcome of simultaneous intraocular lens rescue and sutureless intrascleral tunnel fixation of dislocated intraocular lenses. Late iol dislocation or tilt is also a potential concern with scleral fixation techniques 8, 11, 15, 26, 35. Recurrent ugh syndrome in an eye with a scleralfixated iol. Exceptions to this rule are when the implant is damaged. 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 scleral fixation implantation, use 6725067255 for posterior sclera fixation and 6622066225 for anterior sclera fixation accordingly. Mandelscleral fixation of dislocated posterior chamber intraocular lenses. We sought to assess the clinical outcomes and complications of two approaches to scleral fixation of intraocular lenses iols. Sutureless intrascleral posterior chamber iol fixation has. Haptics can be externalized using 25gauge forceps or hollow needle. After removal of the existing iol, he creates 2 sclerotomies, 180 degrees apart, and inserts a 3piece alcon ma60 iol. 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. The transconjunctival sutureless intrascleral sis fixation iol technique originally described by prasad1 uses a total of five vitrectomy trocarcannulasthree for.
Before the iol is rescued, it should be free of the. Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dis. 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. A subluxated baglens or free implant should be fixated rather than exchanged. Scleral fixation of iol is an effective but surgically demanding technique. Ab externo scleral fixation of intraocular lens pdf free. A smalldiameter scleral tunnel can provide leakfree closure. In sutureless microincisional vitrectomy surgery, one. Pdf scleralfixated intraocular lenses researchgate. Sutureless scleral tunnel intraocular lens fixation in the pediatric population.
Throughout our site you will find links to external websites. A simple modified way of glueless sutureless scleral. To secure the haptics, 27gauge scleral tunnels are created. Pdf fourflanged intrascleral intraocular lens fixation technique. 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. Two years later at the ascrs 2016 annual meeting, yamane was awarded the grand prize for his video on the technique available here. Sutureless sfiol avoids suture related complications such as suture exposure and suture breakage.
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