Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses

Forlini, Matteo; Bedi, Raman

doi:10.1097/j.jcrs.0000000000000529

Cited by 8 publications

(5 citation statements)

References 104 publications

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“…Additionally, regarding postoperative complications, in group 1, there were two cases of IOL dislocation, one case of vitreal hemorrhage and one case of hyphema. This may be a consequence of the stress that the iris claw implantation causes on the iris diaphragm, which, in some cases, may be damaged during the enclavation procedure, as already reported in the literature[15]. Bogumiła Sędziak-Marcinek et al[16] recently reported the results of the secondary anterior-chamber implantation of iris claw on a large cohort of 132 patients, describing the procedure to be easier and shorter than posterior chamber iris claw lens fixation, to minimize the risk of postoperative macular edema, intraocular hemorrhagic complications and also retinal detachments with a mild reduction in the number of corneal endothelial cells.…”

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confidence: 75%

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

Seknazi

Colantuono

Tahiri

et al. 2021

JCM

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Background. The management of patients with aphakia and/or lack of capsular support remains debated. The sutureless posterior chamber IOL (PCIOL) fixation is a very useful surgical option. The purpose of the study was to compare the early outcomes as well as post-operative best corrected visual acuity, refractive errors and complications of two different techniques of sutureless PCIOL secondary implantation. Methods. Patients who underwent secondary implantation from December 2019 to January 2021 in the Department of Ophthalmology of Creteil Hospital, and in the Granville Ophthalmology Center, were retrospectively included. Eyes implanted with the iris claw lens (Artisan Aphakia IOL model 205, Ophtec BV, Groningen, The Netherlands) were included in group 1, and eyes implanted with a newly developed sutureless trans-scleral plugs fixated lens (STSPFL, Carlevale lens, Soleko, Pontecorvo, Italy) were included in group 2. Results. Twenty-two eyes of 22 patients were enrolled in group 1, and twenty eyes of 20 patients in group 2. No difference was found in visual acuity between two groups (0.35 +/− 0.29 logmar for group 1 and 0.23 +/− 0.51 logmar for group 2) (p = 0.15) at mean post-operative follow up (6.19 +/− 3.44 months for group 1 and 6.42 +/− 3.96 months for group 2) (p = 0.13). Both the mean refractive error (MRE) and induced astigmatism (IA) were greater in group 1 compared to group 2, respectively: the MRE was 0.99 +/− 0.57 vs. 0.46 +/− 0.36 (p < 0.01), and IA was 1.72 +/− 0.96 vs. 0.72 +/− 0.52 (p < 0.01). Conclusions. No significant differences in terms of the recovery of visual acuity were found between the two groups. Group 2 (STPFL) gives better results in our sample due to less post-operative induced astigmatism and less refractive error.

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confidence: 75%

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

Seknazi

Colantuono

Tahiri

et al. 2021

JCM

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“…The capsular bag could not be saved in most cases. Implantation of AC IOL or sutured IOL to the sclera can cause several complications, such as glaucoma or retinal detachment [9][10] . Cionni et al [5] reported an endocapsular ring with a fixed hook for use in eyes with zonular insufficiency.…”

Section: Resultsmentioning

confidence: 99%

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation

Jiang¹,

Chu²

2023

Int J Ophthalmol

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AIM: To investigate the effect of Cionni-modified capsular tension ring (CTR) implantation in patients with severely traumatic subluxated cataracts. METHODS: All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed. Corrected distance visual acuity (CDVA), extent of zonulysis, intraocular lens (IOL) position, intraoperative presentation, and complications were assessed. The primary outcomes included IOL centration stability and other postoperative complications. RESULTS: Twenty patients (20 eyes) were included in this study. The mean age in this study was 58.0±11.3y, and the average follow-up time was 17.3±12.8mo. Capsule bags were saved by Cionni-modified CTR. Nine eyes (45%) underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber. The preoperative mean CDVA was 0.83±0.24 logMAR, and the postoperative average CDVA was 0.23±0.30 logMAR (P<0.05). The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm, respectively; the vertical and horizontal IOL tilt after surgery was 5.5°±2.5° and 6.1°±2.2°, respectively. None of the eyes had obvious IOL decentration during the follow-up time. Eight eyes (40%) had posterior capsule opacification (PCO) that was severe enough to cause poor vision. Neodymium: YAG laser capsulotomy were performed on these eyes when the CTR was stabilized. CONCLUSION: With the help of Cionni-modified CTR, capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.

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“…S cleral fixation is a major strategy for intraocular lens (IOL) implantation in eyes with inadequate capsular support for the IOL 1 because of previous ocular trauma, severe damage to the capsular bag during cataract surgery, and spontaneous loss of zonular suspension such as in Marfan or pseudo-exfoliation syndrome. 2,3 Compared with iris fixation of anterior chamber IOL, scleral fixation technique has the advantage of fewer complications such as glaucoma, peripheral anterior synechia, and corneal endothelial decompensation.…”

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confidence: 99%

Contribution Factors of Effective Lens Position, Tilt, and Decentration during Flanged Scleral Fixation of Intraocular Lens: A Model Eye Study

Park,

Moon,

Kim

et al. 2023

Retina

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Purpose: We aimed to elucidate the factors related to effective lens position (ELP), tilt, and decentration of scleral fixed intraocular lenses (IOLs) with a flanged haptic technique in an artificial eye model using anterior segment optical coherence tomography (AS-OCT). Methods: Two bent 27-gauge needles were passed through a 1.0- or 2.0-mm scleral tunnel, 2.0 mm posterior to the limbus and 180° apart. Both haptics of a 3-piece IOL were docked with guide needles and externalized. Factors related to the IOL position were analyzed using AS-OCT and a stereomicroscope. Results: The 1.0-mm scleral tunnel induced a significantly longer ELP than the 2.0-mm tunnel and suture fixation (p<0.05 and p<0.01, respectively). Discrepancy in scleral tunnel length induced higher decentration of the optic to the opposite side of the haptic-embedded shorter tunnel and tilt perpendicular to the fixed axis than that in the scleral tunnel of the same length (p<0.001 and p<0.05, respectively). If the scleral fixation points of both haptics are not exactly 180° apart, the IOL may become decentered and tilted (p<0.01 and p<0.05, respectively). Conclusion: In the flanged haptic technique, the length, balance, and position of both scleral tunnels determine IOL ELP, tilt, and decentration.

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Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses

Abstract: Retropupillary iris-claw IOL implantation provides similar efficacy and equivalent or potentially better safety profile than scleral-fixated IOL implantation in eyes with poor capsular/zonular support.

Cited by 8 publications

References 104 publications

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation

Contribution Factors of Effective Lens Position, Tilt, and Decentration during Flanged Scleral Fixation of Intraocular Lens: A Model Eye Study

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