Clinical outcomes of combined pars plana vitrectomy and trans-scleral 4-point suture fixation of a foldable intraocular lens

Goel, Neha

doi:10.1038/s41433-018-0018-2

Cited by 18 publications

(23 citation statements)

References 24 publications

(42 reference statements)

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“…[1,6,[14][15][16][17][18][19][20][21] Retrospective studies have shown good results of scleral fixation using the Akreos AO60 lens and Gore-Tex suture. [5,7,[9][10][11][12][13] To our knowledge and based on a computerized search of the Medline database, this is the first prospective study of Akreos A060 scleral fixation with Gore-Tex suture and it confirms that the technique is safe and promotes good visual results.…”

Section: Discussionmentioning

confidence: 68%

“…This group used a similar technique to that employed herein although, in addition to using prolene, they created scleral flaps, which can be a technique to reduce the risk of conjunctival erosion by the suture. Similarly, Goel et al (2018) [11] stated that the use of scleral flaps and the rotation of the suture knots decrease the risk of suture erosion. In their 2015 [7] and 2018 [9] publications, Khan et al did not observe any suture-related complications, including rupture, erosion, IOL dislocation or inclination, endophthalmitis, or persistent postoperative inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…[9] Recent studies using this technique have been published, although none were prospective. [5,7,[9][10][11][12][13] The objective of the current study was to evaluate the safety of Akreos AO60 scleral fixation using Gore-Tex suture, in the absence of capsular support, associated with pars plana vitrectomy (PPV), when necessary.…”

Section: Introductionmentioning

confidence: 99%

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Scleral Fixation Using a Hydrophilic Four-haptic Lens and Polytetrafluoroethylene Suture: A Phase I Clinical Trial

Junqueira

Chaves

Neto

et al. 2021

Preprint

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Purpose: To assess the safety of scleral fixation using Akreos AO60 IOL and Gore-Tex suture. Methods: Prospective evaluation of 20 patients who underwent scleral fixation of Akreos AO60 with Gore-Tex. Patients presenting with aphakia or dislocated IOL without capsular support were enrolled in the study. Main outcome measures included visual acuity, endothelial cell density, and postoperative complications over 6 months of follow-up.Results: Mean ± SD uncorrected logMAR visual acuity improved from 1.92 ± 0.23 (20/1600 Snellen equivalent) preoperatively to 0.80 ± 0.56 (20/125) post-surgery (p < 0.001). Mean ± SD BCVA logMAR was 0.43 ± 0.23 preoperatively and 0.37 ± 0.24 (20/50) post-surgery (p = 0.312). Exposure of suture occurred in 8/20 (40%) eyes over the 6 months of follow-up. The mean ± SD endothelial cell density was 1,740.50 ± 522.92 cells/mm2 and 1,187.19 ± 493.00 cells/mm2 (p < 0.001) pre and postoperatively, respectively. Mean ± SD postoperative spherical equivalent was -1.12 ± 1.50D. Postoperative complications included hypotony in 15% of the patients, ocular hypertension and transient vitreous hemorrhage in 10%, and retinal detachment and transient lens opacification in 5%. Conclusion: Scleral fixation with an Akreos AO60 and Gore-Tex appears safe. However, caution must be taken regarding suture exposure, and scleral flaps can be a technique to reduce the risk of this complication. Phase II studies are needed.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Scleral Fixation Using a Hydrophilic Four-haptic Lens and Polytetrafluoroethylene Suture: A Phase I Clinical Trial

Junqueira

Chaves

Neto

et al. 2021

Preprint

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“…Many studies evaluating scleral fixation have shown a mild myopic shift from targeted postoperative refraction. 17 , 20 , 23 , 24 Ohr et al specifically studied scleral fixation of Akreos lenses and has shown reliable postoperative refractive outcomes with a myopic shift. 20 Our evaluation corroborated the results of previous studies of Gore-Tex sutured lenses with a significant majority (75%) of our patients having a myopic shift in the difference between actual and targeted SE.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Secondary Scleral-Sutured Foldable Hydrophilic Acrylic Intraocular Lens Placement by Trainees: A Single-Site Analysis

Shah¹,

Zhu²,

Zafar³

et al. 2021

OPTH

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Purpose To evaluate the outcomes of a 4-point scleral-fixated foldable Akreos AO60 intraocular lens (IOL) insertion using Gore-Tex suture performed by trainees under supervision of a single attending surgeon. Methods Retrospective chart review for 53 eyes of 50 patients whose surgery was performed by trainees under supervision of a single surgeon between 2015 and 2018 at a tertiary care hospital (Johns Hopkins Wilmer Eye Institute, Baltimore, MD). Indications for surgery, preoperative risk factors, and intraoperative techniques were analyzed. Outcome measures included final best-corrected visual acuity (BCVA), change in BCVA, difference between expected and final spherical equivalent (SE), and postoperative complications. Results Mean patient age was 62.8 years (range 26.9 to 88.4). The most common indication for surgery was IOL dislocation (59.6%) due to trauma in 21 cases (40.4%) and pseudoexfoliation in 6 (11.5%). Combined pars plana vitrectomy was performed simultaneously in 46 cases (88.5%). Mean BCVA improved from 20/100 to 20/40 (p < 0.001). The difference between expected and final SE was within 1.0 D in 28 cases (53.8%). Postoperative hypotony occurred in 12 eyes (21.2%) on day 1; all were resolved at last follow-up. Postoperative cystoid macular edema (CME) occurred in 20 cases (38.5%); 11 (21.2%) persisted through last follow-up. Conclusion Scleral-fixation of Akreos AO60 IOL in absence of capsular support can be performed by trainees under supervision and results in effective visual rehabilitation. Postoperative CME occurred at a higher rate than previously reported in the literature. Future studies should assess the rates of postoperative complications amongst different techniques of secondary IOL fixation performed by trainees to determine which is the safest.

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“…Finally, if we fixed the sutures at the both symmetrical points of the middle haptics, pulled the haptics just touching the ciliary sulcus, and completely removed the residual capsule and anterior vitreous body, it is easier to maintain the IOL balance and centralization (Figure 4). Besides, a little study uses three or four haptics, but there are many disadvantages such as many incisions, increased damages, complex operative procedures, easy deformation of IOLs, eccentricity and so on [46].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of scleral-fixated intraocular lens implantation without conjunctive peritomies or sclerotomy in ocular trauma patients

Han¹,

Wang²,

Zheng³

et al. 2019

Preprint

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Background To investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctive peritomies or sclerotomy in patients with a history of ocular trauma during primary pars plana vitrectomy or silicone oil removal. Methods Records of patients who underwent implantation of SFIOL during primary pars plana vitrectomy or silicone oil removal. Results Sixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6-99 months). The average patient age at the time of surgery was 44 years old (range, 4-80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively (P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (6.6%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%). Conclusion Use of a scleral-fixated intraocular lens implantation without conjunctive peritomies or sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support.

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Clinical outcomes of combined pars plana vitrectomy and trans-scleral 4-point suture fixation of a foldable intraocular lens

Abstract: Trans-scleral 4-point suture fixation of a foldable Akreos AO60 IOL can be performed safely along with concurrent PPV across varying surgical indications resulting in a substantial improvement in visual acuity with minimal complications.

Cited by 18 publications

References 24 publications

Scleral Fixation Using a Hydrophilic Four-haptic Lens and Polytetrafluoroethylene Suture: A Phase I Clinical Trial

Scleral Fixation Using a Hydrophilic Four-haptic Lens and Polytetrafluoroethylene Suture: A Phase I Clinical Trial

Clinical Outcomes of Secondary Scleral-Sutured Foldable Hydrophilic Acrylic Intraocular Lens Placement by Trainees: A Single-Site Analysis

Long-term outcome of scleral-fixated intraocular lens implantation without conjunctive peritomies or sclerotomy in ocular trauma patients

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