Combined Pars Plana Vitrectomy and Scleral Fixation of an Intraocular Lens Using Gore-Tex Suture

Khan, Mohammed; Samara, Wasim A.; Gerstenblith, Adam T.; Chiang, Allen; Mehta, Sonia; Garg, Sunir J.; Hsu, Jason; Gupta, Omesh P.

doi:10.1097/iae.0000000000001692

Cited by 53 publications

(74 citation statements)

References 25 publications

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“…It is possible that the scleral fixation of the lens, as well as the vitrectomy, can be performed with 27-gauge instrumentation. 5 This could theoretically decrease the incidence of sclerotomy leakage. Further studies would need to be performed to determine if this could decrease the rate of hypotony postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture

Patel

Shah

Yannuzzi

et al. 2018

OPTH

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PurposeTo report the visual outcomes and complications of scleral fixated intraocular lenses (IOLs) using Gore-Tex suture.MethodsThe current study is a retrospective noncomparative case series including patients who underwent scleral fixation of IOL (Akreos AO60) using Gore-Tex suture from August 2015 to March 2017 at a university teaching center. Primary outcome measures were visual acuity and complications at last follow-up.ResultsThe current study included 49 eyes of 48 patients. Mean follow-up duration postsurgery was 6.9 months (range: 0.9–29.4 months). The indications for secondary IOL surgery were dislocated IOL in 16/49 (33%), subluxed IOL in 9/49 (18%), dislocated or subluxed crystalline lens in 9/49 (18%), traumatic cataract in 8/49 (16%), and complicated cataract surgery in 7/49 (14%). Mean best-corrected logMAR visual acuity improved from 1±0.7 (20/200 Snellen equivalent) preoperatively to 0.5±0.5 (20/63 Snellen equivalent) at last follow-up. There were no intraoperative complications noted. Early postoperative complications included significant persistent corneal edema (longer than 1 week) in 4/49 (8.2%), ocular hypertension (intraocular pressure ≥25 mmHg) in 8/49 (16.3%), hypotony (intraocular pressure ≤5 mmHg) in 6/49 (12.2%), cystoid macular edema 3/21 (6.1%), IOL tilt 2/49 (4.1%), hyphema in 2/49 (4.1%), and vitreous hemorrhage in 5/49 (4.8%). There was one case of recurrent retinal detachment. One patient presented with an erosion of the Gore-Tex suture through the conjunctiva resulting in a purulent scleritis 6 months after the initial surgery, and was managed with removal of the IOL, debridement, and cryotherapy. Forty-one of 49 patients completed 3-month follow-up, among which visual acuity improved, deteriorated, or remained same compared to baseline in 27/49 (55.1%), 8/49 (16.3%), and 6/49 (12.2%) eyes, respectively.ConclusionIn the current study, visual acuity outcomes were generally favorable. The complications were largely transient. Significant complications included a suture-related infection, which required removal of the IOL, and a recurrence of a retinal detachment.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture

Patel

Shah

Yannuzzi

et al. 2018

OPTH

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“…Although the patient records do not retrospectively reveal the reason for the transient early hypotony, we speculate that this was most likely due to leakage of a sclerotomy. Our results on visual acuity, retinal detachment and reoperation rates are compared with reports on other scleral fixation techniques in Table 4 (Vote et al 2006;McAllister & Hirst 2011;Luk et al 2013;Khan et al 2018;Kokame et al 2018).…”

Section: Discussionmentioning

confidence: 93%

“…Four-point fixation of the Akreos AO60 IOL (Bausch and Lomb, Bridgewater, NJ, USA) is different in this aspect. As reported recently (Khan et al 2018), many surgeons utilizing that technique currently aim for placement of the fixation at 3 mm from the limbus, that is just behind the ciliary body to the anterior portion of pars plana. Additionally, scleral fixation of a previously existing dislocated IOL at the pars plana level would cause an often-undesired hyperopic shift in the patient's refraction as compared to sulcus fixation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of intraocular lens scleral fixation with the friction knot technique

Aaltonen

Oskala

Immonen

2018

Acta Ophthalmologica

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Purpose To examine the clinical outcomes of intraocular lens (IOL) scleral fixation with the friction knot technique. Methods Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot IOL scleral fixation technique by a single surgeon. The fixated IOLs were one‐piece or three‐piece models all with open loop haptics. Main outcome measures were change in corrected distance visual acuity (CDVA) and postoperative complications. Results The mean follow‐up time was 11.7 months (median 4.9, range 0.7–64.8). The mean logarithm of the minimum angle of resolution CDVA improved from preoperative 0.77 ± 0.73 (Snellen 20/118 ± 7.3 lines) to 0.44 ± 0.56 (Snellen 20/55 ± 5.6 lines) at the final visit (p < 0.001). The main postoperative complications were ocular hypertension (30.3%), uveitis–glaucoma–hyphaema syndrome (12.5%; UGHS), vitreous haemorrhage (11.2%) and retinal detachment (8.6%). Two (1.3%) cases of suture breakage were seen. In multivariate Cox regression analysis, age under 60 years [hazard ratio (HR) = 5.41; 95% confidence interval (CI) 1.95–15.01] and scleral fixated one‐piece IOL (HR = 4.23; 95% CI 1.44–12.44) were found as significant independent risk factors for developing new UGHS. Conclusion The friction knot technique provides a firm scleral fixation. Scleral fixation may successfully be utilized in dislocated three‐piece IOLs with loop haptics. We recommend avoiding scleral fixation of one‐piece IOLs in young patients due to a high risk of UGHS.

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“…) or 7‐0 polytetrafluoroethylene sutures (PTFE, Gore‐Tex ® ; W. L. Gore & Associates, Newark, DE, USA) can be utilized (Khan et al. , , ); however, safety issues in relation to the latter are still unknown because of short follow‐up. Additionally, the 7‐0 PTFE suture technique usually requires vitrectomy and 4‐point fixation with 25G trocars (Khan et al.…”

Section: Scleral‐fixated Iolmentioning

confidence: 99%

“…2017a,b; Khan et al. , ). No single technique, however, has gained an advantage over the others (Stem et al.…”

Section: Introductionmentioning

confidence: 99%

Sutureless intrascleral fixation using different three‐piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study

Czajka

Frajdenberg

Stopa

et al. 2019

Acta Ophthalmologica

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We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral (SIS) fixation of a standard three-piece PCIOL. Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL: transient/permanent corneal oedema (9-66.6%), uveitis (1.1-39.3%); iris-fixated IOL: pupil ovalization (16-47.7%); and sutured scleral-fixated IOL: suture breakage/exposure (6.1-11%), vitreous haemorrhage: (5.5-16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony (n = 20; 19.4%), corneal decompensation (n = 7; 6.7%), IOL dislocation (n = 6; 5.8%), cystoid macular oedema (n = 5; 4.8%), vitreous haemorrhage (n = 4; 3.8%) and retinal detachment (n = 4; 3.8%). Mean best corrected visual acuity improved from logMAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.

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Combined Pars Plana Vitrectomy and Scleral Fixation of an Intraocular Lens Using Gore-Tex Suture

Abstract: Combined pars plana vitrectomy and ab externo scleral fixation of an intraocular lens with Gore-Tex suture was well tolerated at a minimum of 1-year follow-up. No suture-related complications were encountered.

Cited by 53 publications

References 25 publications

Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture

Clinical outcomes of 4-point scleral fixated 1-piece hydrophobic acrylic equiconvex intraocular lens using polytetrafluoroethylene suture

Outcomes of intraocular lens scleral fixation with the friction knot technique

Sutureless intrascleral fixation using different three‐piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study

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