Intrascleral fixation of intraocular lens haptics: histological advantages in a comparison with scleral suture fixation in rabbits

Graefe's Archive for Clinical and Experimental Ophthalmology - To disclose histological advantages of intrascleral fixation of intraocular lens haptics, in comparison with scleral suture...     

Dislocated intraocular lens fixation using intraocular cowhitch knot

PURPOSE: To describe a technique for suturing a dislocated intraocular lens (IOL) using an intraocular cowhitch knot without IOL extraction. METHODS: Through the sideports of paracentesis, a cowhitch knot is made outside of the anterior chamber by looping 10-0 Prolene around the haptics of the IOL. The knot is then tied in the anterior chamber by pulling up the suture. After repeating this for the opposite side, the cowhitch knots are fixated to the ciliary sulcus. RESULTS: In 4 cases treated this way, the IOL remained well positioned. CONCLUSION: This technique enables secure fixation of the IOL haptics.     

Retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification

Purpose

To report a method of retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification.

Design

Interventional case report.

Methods

A 65-year-old man presented with a totally luxated crystalline lens in the vitreous cavity of the left eye. After total vitrectomy was performed, a viscoadaptive viscoelastic agent was applied over the retina and optic disk. Then the luxated lens was removed by intravitreal phacoemulsification. The lens dropped several times during the surgery but the thick viscoadaptive viscoelastic agent protected the posterior retina.

Results

In two cases treated this way, no complications occurred at six months after surgery.

Conclusion

This method may be useful for protecting the retina from damage by a luxated crystalline lens and is less costly than perfluorocarbon liquid.     

Suture fixation of an intraocular lens combined with pars plana vitrectomy and gas tamponade

We describe suturing an intraocular lens (IOL) after pars plana lensectomy and vitrectomy combined with gas tamponade in 4 patients with vitreoretinal disease and subluxated lenses that could not be managed with capsular tension rings. The IOL haptics were sutured before the fluid-gas exchange in a horizontal (case 1), oblique (cases 2 and 4), and vertical (case 3) manner. In a case of unavoidable horizontal fixation due to limited scleral space, the upper part of the IOL tilted anteriorly postoperatively because of the enhanced effect of the gas bubble. A peripheral anterior iris synechia also occurred. The IOL remained well positioned in cases with oblique and vertical fixations, and no other complications occurred. Careful preoperative planning of the surgical design can help avoid unnecessary horizontal fixation.     

Luxated intraocular lens fixation using intravitreal cow hitch (girth) knot

OBJECTIVE: To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity to the ciliary sulcus using intraocular cow hitch (girth) knots without IOL extraction. DESIGN: Non-comparative interventional case series. PARTICIPANTS: Five patients with a luxated IOL in the vitreous cavity. INTERVENTION: All patients underwent surgery to fixate the IOL using this technique. METHODS: A three-port vitrectomy was performed in all five cases. A needle with looped 10-0 polypropylene was introduced into the vitreous cavity through a sclerotomy incision, and only the needle was passed out of the eye, guided by a bent 27-gauge needle from the 3-o'clock position 1.5 mm from the limbus. A cow hitch (girth) knot at the end of the loop was made outside the globe, grasped with a straight intravitreal forceps, and introduced into the vitreous cavity. Hooking the cow hitch (girth) knot around the haptics of the IOL in the vitreous cavity, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. After the opposite haptic was brought into the anterior chamber, the 10-0 polypropylene was looped around the haptics of the IOL and manipulated with a push-and-pull hook in the anterior chamber through the two corneal side ports to make a cow hitch (girth) knot outside the anterior chamber. By pulling up the suture, the knot was brought back and tied in the anterior chamber. It was then fixated to the ciliary sulcus at the 9-o'clock position. MAIN OUTCOME MEASURES: Patients were evaluated for visual acuity, refraction, and surgical complications associated with the procedure. RESULTS: In all five cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred. CONCLUSIONS: This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.