Ultrasound biomicroscopic analysis of posterior chamber intraocular lenses with transscleral sulcus suture

doi:10.1016/S0161-6420(00)00412-7

Ophthalmology

Volume 107, Issue 12, December 2000, Pages 2172-2178

Presented in part at the Symposium on Cataract, IOL and Refractive Surgery, San Diego, California, April 1998.

https://doi.org/10.1016/S0161-6420(00)00412-7 Get rights and content

Abstract

Objective

To investigate the postoperative problems of intraocular lenses (IOLs) with transscleral sulcus suture.

Design

Retrospective observational case series.

Participants

Forty-one subjects (43 eyes) were included.

Intervention

All eyes had undergone transscleral sulcus suture of IOLs. Surgeries were all performed by surgeons in our clinic using the same technique.

Main outcome measures

Ultrasound biomicroscopy of the suture sites, their surrounding structures, and central anterior chamber depth. Other parameters studied included visual acuity, aqueous flare, and routine ophthalmic examinations.

Results

Thirty-two of 86 haptics were sutured at the ciliary sulcus (CS) region and 29 at the ciliary process region, which was the space between CS and pars plicata, and 25 posterior to pars plicata. We designated the cases with at least one haptic located in the CS region as the anterior group, and the other cases as the posterior group. In the anterior group, anterior chamber depth was significantly more shallow than in the fellow eye in which IOLs were fixed in the bag (P = 0.049). There was a statistically greater incidence of IOL iris contact in the anterior group than in the posterior group (P = 0.00057). Pigment dispersion was seen in seven cases, all of which were classified as anterior group. Eyes in the posterior group had more aqueous flare than their fellow eyes (P = 0.014). Two cases, in which more than two lines of postoperative best-corrected visual acuity was lost because of macular degeneration after cystoid macular edema, showed marked elevation of aqueous flare in the sutured eyes compared with their fellow eyes. Forty-one of 86 haptics had vitreous incarceration.

Conclusions

This technique has many limitations: the difficulty of suturing precisely at the ciliary sulcus, IOL iris contact, pigment dispersion, high aqueous flare, and vitreous incarceration. These induce two major postoperative complications: chronic inflammation and influence on the adjacent vitreous such as vitreous incarceration. The suturing technique and instruments need to be improved to diminish such complications.

Section snippets

Subjects and methods

We examined 43 eyes of 41 subjects, 17 women and 24 men, after transscleral sulcus suture of an IOL in which both haptics had been fixed. The ages of the subjects ranged from 46 to 85 years; mean (± standard deviation) was 72 ± 9 years. Follow-up duration ranged from 5 to 76 months; mean (± standard deviation) was 27 ± 21 months. Surgery was performed by surgeons in our clinic with the same technique as described by Lewis.1 We performed anterior vitrectomy before having the needle penetrate the

Visual acuity

Figure 4 shows the best-corrected visual acuity before and after surgery. The best-corrected visual acuity was achieved at 5 months after the operation. Surgical procedures might contribute to a final corrected visual acuity loss of more than 2 lines of the best postoperative corrected visual acuity in five cases. The causes of loss were macular degeneration after cystoid macular edema in two cases, macular hole in one, severe corneal astigmatism in one, and persistent inflammation of anterior

Discussion

Many articles introduce surgical techniques for transscleral sulcus suturing of an IOL and complications such as IOL decentration, cystoid macular edema, retinal detachment, and glaucoma,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 but few observe and analyze the fixation position directly in the living eyes22, 23, 24 Pavlin et al22 observed sutured eyes with UBM. Of 34 haptics in 17 subjects, 13 (38%) were adequately located in the sulcus region in their series.

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Pigment dispersion syndrome and pigmentary glaucoma after secondary sulcus transscleral fixation of single-piece foldable posterior chamber intraocular lenses in Chinese aphakic patients
2017, Journal of Cataract and Refractive Surgery
To describe secondary pigment dispersion syndrome (PDS) and pigmentary glaucoma after secondary sulcus transscleral fixation of 1-piece hydrophobic acrylic foldable posterior chamber intraocular lenses (PC IOLs) in aphakic patients in a Chinese population.
Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao, China.
Retrospective case series.
This chart review included eyes that had secondary sulcus transscleral fixation of a 1-piece hydrophobic acrylic foldable PC IOL (Tecnis ZCB00) between March 2011 and March 2014. The patients’ demographic data, clinical data, postoperative complications, intervals between initial surgery and the onset of PDS, pigmentary glaucoma occurrences, and findings on slitlamp biomicroscopy, gonioscopy, and ultrasound biomicroscopy (UBM) were recorded.
The study comprised 23 consecutive eyes of 21 patients. Seventeen eyes of 16 patients were diagnosed with PDS, and 7 eyes of 6 patients were diagnosed with pigmentary glaucoma. The slitlamp examination and UBM showed that the location between the IOL optic and the posterior surface of the iris was very close. Slitlamp examination of the anterior chamber angle using a gonioscope showed dense pigment deposition on the IOL surfaces. A reverse pupillary block was found in 10 eyes of 9 patients. Other postoperative complications included intraocular hemorrhage, pupillary capture of the IOL optic, IOL tilt, IOL decentration, IOL dislocation, and suture erosion.
The 1-piece hydrophobic acrylic foldable PC IOL was not suitable for sulcus transscleral fixation because of a high incidence of PDS and pigmentary glaucoma after surgery in a Chinese population.
Laser iridotomy to treat uveitis-glaucoma-hyphema syndrome secondary to reverse pupillary block in sulcus-placed intraocular lenses: Case series
2015, Journal of Cataract and Refractive Surgery
To present cases of uveitis-glaucoma-hyphema (UGH) syndrome due to reverse pupillary block in sulcus-placed posterior chamber intraocular lenses (PC IOLs) that were managed with laser peripheral iridotomy (LPI).
Community-based subspecialty clinics.
Retrospective interventional case series.
A chart review of patients with a sulcus-placed PC IOLs presenting with UGH syndrome and reverse pupillary block with posterior iris bowing as diagnosed by gonioscopy and anterior segment optical coherence tomography was carried out. Laser peripheral iridotomy was performed in the eyes included in the study. The main outcome measure was clinical resolution of UGH syndrome.
The study included 6 eyes of 6 patients with a mean age of 59.8 years (range 43.0 to 66.0 years) who presented with unilateral UGH syndrome a mean of 28.7 months (range 0.3 to 84.0 months) after PC IOL implantation. All patients were previously myopic, with 5 (83.3%) having a history of vitrectomy. The mean axial length was 27.0 mm ± 1.4 (SD). An LPI was used to treat the reverse pupillary block with resultant improvement in iris profile and resolution of UGH syndrome in all eyes. The mean intraocular pressure decreased from 30.5 ± 10.0 mm Hg on 0.5 ± 0.8 glaucoma medications to 15.5 ± 3.2 mm Hg postoperatively on 0.7 ± 1.2 medications.
The UGH syndrome due to reverse pupillary block occurred after sulcus-placed PC IOLs in susceptible patients, those with axial myopia, and post-vitrectomized eyes. The cases were managed with LPIs.
Dr. Ahmed is a consultant to Alcon Laboratories, Inc. and Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.
In vivo analysis of glued intraocular lens position with ultrasound biomicroscopy
2013, Journal of Cataract and Refractive Surgery
Citation Excerpt :
Sewelam et al.7 examined the haptic position with transscleral-fixated IOLs by UBM and found that 55% were located in the sulcus. Manabe et al.13 used UBM to identify haptic placement and found only 32 of 86 haptics were sutured at the sulcus. In a UBM analysis of scleral-fixated IOLs, Bellucci et al.14 found it difficult to suture the haptics precisely.
To report ultrasound biomicroscopic (UBM) findings of glued transscleral-fixated posterior chamber intraocular lenses (IOLs) in eyes with inadequate capsules.
Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.
Case series.
Eyes with glued IOLs for inadequate capsule support were examined with UBM. Optic tilt was measured in relation to the iris plane. Haptic location, iris–IOL contact, vitreous incarceration, and central anterior chamber depth (ACD) were measured and correlated clinically with vision and refractive error.
The mean follow-up was 24.6 months ± 14.3 (SD). Of the 46 eyes, 8 (17.4%) showed optic tilt and 38 (82.6%) showed no optic tilt. Of 92 haptics examined, 85 (92.4%) were in the ciliary sulcus and 7 (7.6%) in the pars plicata. There was no significant association between the presence of optic tilt and haptic location (P=.585, chi-square test). The mean ocular residual astigmatism (ORA) was 0.5 ± 0.2 diopter (D). There was no significant difference in ORA between eyes with tilt and eyes without tilt (P=.079). There was no significant correlation between ORA and IOL position. There was no correlation of optic tilt and postoperative vision or cylinder. Other features included iris–IOL contact (6.5%), vitreous incarceration (5.4%), and ACD difference (P=.002).
No significant IOL optic tilt affecting the postoperative vision was detected with glued transscleral-fixated IOLs. The technique reliability was good, with the haptics located in the intended position in more than 90% of eyes.
Dr. Amar Agarwal is a paid consultant to Staar Surgical Co. No other author has a financial or proprietary interest in any material or method mentioned.
Intrascleral fibrin glue intraocular lens fixation combined with Descemet-stripping automated endothelial keratoplasty or penetrating keratoplasty
2012, Journal of Cataract and Refractive Surgery
To evaluate the outcomes of intrascleral haptic fixation of an intraocular lens (IOL) with fibrin glue combined with penetrating keratoplasty (PKP) or Descemet-stripping automated endothelial keratoplasty (DSAEK) for aphakic or pseudophakic bullous keratopathy (BKP).
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Case series.
Eyes with BKP had combined PKP or DSAEK with fibrin glue-assisted intrascleral posterior chamber (PC) IOL fixation; PKP was performed in eyes with a corneal scar and DSAEK in eyes without a scar. The parameters evaluated were corrected distance visual acuity (CDVA), anterior segment biomicroscopy, intraocular pressure, central corneal thickness (CCT), and IOL status. Intraoperative events and postoperative complications were recorded.
The study evaluated 11 patients (11 eyes). Intrascleral fixation of a PC IOL with PKP or DSAEK was successfully performed in all eyes; PKP was performed in 6 eyes (54.54%) and DSAEK in 5 eyes. The mean CDVA improved from 1.95 logMAR ± 0.29 (SD) to 0.40 ± 0.16 logMAR (P<.001). The mean CCT was 0.741 ± 0.71 mm preoperatively and 0.579 ± 0.20 mm postoperatively (P<.001). There were no cases of intraoperative or postoperative IOL decentration or other complications.
Fibrin glue-assisted intrascleral fixation of a PC IOL combined with DSAEK or PKP was a safe, effective method to manage BKP with aphakia or malpositioned IOLs. The IOL fixation was strong enough to sustain the manipulation required for corneal procedures.
No author has a financial or proprietary interest in any material or method mentioned.
Corneal Diseases
2011, Ophthalmic Ultrasonography: Expert Consult - Online and Print
Secondary pigment dispersion syndrome with single-piece acrylic IOL
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Ultrasound biomicroscopic analysis of posterior chamber intraocular lenses with transscleral sulcus suture

Abstract

Objective

Design

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Subjects and methods

Visual acuity

Discussion

Ab externo sulcus fixation

Ophthalmic Surg

Pars plana phacoprosthesis (aphakic intraocular implant)a preliminary report

Ophthalmic Surg

Posterior chamber intraocular lens implantation in the absence of posterior capsular support

Ophthalmic Surg

Transscleral fixation of posterior chamber intraocular lenses in the absence of capsular support

Ophthalmic Surg

Implantation of a posterior chamber lens without capsular support during penetrating keratoplasty or as a secondary lens implant

Ophthalmic Surg

Fixation of posterior chamber lenses by transscleral suturestechnique and preliminary results

Arch Ophthalmol

Implantation of posterior chamber lens in the absence of capsular and zonular support

Arch Ophthalmol

Modified needle and a “one-port plus” approach for ciliary sulcus fixation of a dislocated IOL

J Cataract Refract Surg

Postoperative refraction and anterior chamber depth after complicated cataract surgery with vitreous loss and transscleral suture fixation of posterior chamber lenses

Ophthalmic Surg

A refined technique of transscleral suture fixation of posterior chamber lenses developed for cases of complicated cataract surgery with vitreous loss

Ophthalmic Surg

Sulcus fixation without flaps

Ophthalmology

Implantation of scleral-fixed posterior chamber intraocular lenses

J Cataract Refract Surg

Sutured retropupillary posterior chamber intraocular lenses for exchange or secondary implantation. The 12th Annual Binkhorst Lecture, 1988

Ophthalmology

Endoscope with built-in needle for transscleral ciliary sulcus fixation of posterior chamber intraocular lens in secondary implantation

Jpn J Ophthalmic Surg