Glued intraocular lens implantation for eyes with defective capsules: A retrospective analysis of anatomical and functional outcome

Kumar, Dhivya Ashok; Athiya, Agarwal; Agarwal, Amar; Prakash, Gaurav; Jacob, Soosan

doi:10.1016/j.sjopt.2011.04.001

Cited by 49 publications

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“…A total of 210 glued IOL eyes with a follow-up of 6 to 41 months were analyzed. 5 Decentration was found in 4 eyes (1.9%) and chronic macular edema in 3 eyes (1.4%). There was no endophthalmitis or postoperative glaucoma.…”

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confidence: 96%

“…Glued IOLs have been shown to have good stability and therefore less pseudophacodonesis. 4,5 In follow-up examinations of glued IOL eyes, no haptic extrusions were noted. Moreover, good scleral flap appositions were observed.…”

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confidence: 97%

“…Over the long term, microhyphemas, intermittent spikes in intraocular pressure (IOP), and pigment dispersion lead to the uveitis-glaucomahyphema syndrome in sutured scleral-fixated PC IOLs, causing persistent raised IOP. Scharioth et al 2 reported postoperative elevated IOP in 3.17% of cases, and Agarwal et al 3 and Kumar et al 4,5 reported no persistent elevated IOP. We believe that the reduced uveal contact of the haptics is another major advantage of our technique.…”

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confidence: 99%

“…However, no significant retinal problems were seen in the follow-up of the glued IOL procedure. [3][4][5] We hypothesize that because a large part of the haptic is buried in scleral tunnels in sutureless scleral fixation techniques, the IOL is inherently more stable and less prone to pseudophacodonesis.McAllister and Hirst reported ocular hypertension as the most common complication in 30.5% of the operated eyes. Over the long term, microhyphemas, intermittent spikes in intraocular pressure (IOP), and pigment dispersion lead to the uveitis-glaucomahyphema syndrome in sutured scleral-fixated PC IOLs, causing persistent raised IOP.…”

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Sutureless scleral-fixated posterior chamber intraocular lens

Kumar¹,

Agarwal²,

Jacob³

et al. 2011

Journal of Cataract and Refractive Surgery

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In their article on the long-term results of scleralfixated posterior chamber intraocular lenses (PC IOLs), 1 McAllister and Hirst reviewed the records of patients with sutured scleral-fixated PC IOLs operated on from 1993 to 2008. In this retrospective case series, complications included suture breakage (6.1%), suture exposure (11%), and endophthalmitis. Sixteen surgical procedures were performed 1 week after scleral-fixated PC IOL insertion, and 6 of these were suture related (5 suture breakage, 1 scleral graft for suture exposure). We would like to share our experience with sutureless PC IOL implantation techniques in eyes with deficient capsule support.Scharioth et al. 2 introduced intrascleral haptic fixation of a standard 3-piece PC IOL without sutures and reported good intermediate results, with no cases of anterior or posterior chamber inflammation, acute postoperative endophthalmitis, or late endophthalmitis. In the glued IOL procedure introduced by Agarwal et al., 3 good IOL centration without sutures was documented. In the 1-year follow-up by Kumar et al., 4 there were no suture-related complications or endophthalmitis. A total of 210 glued IOL eyes with a follow-up of 6 to 41 months were analyzed. 5 Decentration was found in 4 eyes (1.9%) and chronic macular edema in 3 eyes (1.4%). There was no endophthalmitis or postoperative glaucoma. Glued IOLs have been shown to have good stability and therefore less pseudophacodonesis. 4,5 In follow-up examinations of glued IOL eyes, no haptic extrusions were noted. Moreover, good scleral flap appositions were observed. 4 When the eye moves, it acquires kinetic energy from the muscles and attachments and the energy is distributed to the internal fluids as it stops. Thus, pseudophacodonesis is the result of oscillations of the fluids in the anterior and posterior segment of the eye. In a scleral-fixated IOL suspended with the suture, there is more pseudophacodonesis and this may lead to posterior segment complications in the long term. This is seen by the incidence of retinal detachment (4.9%) and chronic macular edema (7.3%) in McAllister and Hirst's review. However, no significant retinal problems were seen in the follow-up of the glued IOL procedure. [3][4][5] We hypothesize that because a large part of the haptic is buried in scleral tunnels in sutureless scleral fixation techniques, the IOL is inherently more stable and less prone to pseudophacodonesis.McAllister and Hirst reported ocular hypertension as the most common complication in 30.5% of the operated eyes. Over the long term, microhyphemas, intermittent spikes in intraocular pressure (IOP), and pigment dispersion lead to the uveitis-glaucomahyphema syndrome in sutured scleral-fixated PC IOLs, causing persistent raised IOP. Scharioth et al. 2 reported postoperative elevated IOP in 3.17% of cases, and Agarwal et al. 3 and Kumar et al. 4,5 reported no persistent elevated IOP. We believe that the reduced uveal contact of the haptics is another major advantage of our technique.In both of the sutureless scle...

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confidence: 99%

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