In office management of optic capture of scleral fixated posterior chamber intraocular lenses

Abstract

Introduction Optic capture of sutured scleral fixated posterior chamber intraocular lenses (PC IOLs) is an occasional complication resulting in blurred vision and discomfort. Methods A retrospective study of the management of 18 eyes (3.6%) with optic capture out of 495 eyes with scleral fixated IOLs during the study period. 54 procedures were performed in the management of optic capture of sutured scleral fixated PC IOLs. An in-office technique was utilized to relieve the optic capture by repositioning the optic posterior to the iris. This technique was performed after topical anesthesia and topical 5% betadine with the patient stably positioned at the slit lamp. Using a 30-gauge needle, sometimes after a 15-degree paracentesis blade, the needle was advanced in a parallel plane above the iris until the tip reached the edge of the captured optic. The optic is engaged in the inferior periphery away from the central visual axis, and pushed gently posteriorly just enough to reposition the optic posterior to the iris. In some cases, pilocarpine 2% drops were utilized after the procedure to decrease the risk of recapture of the optic. Results All 54 procedures were successfully performed in the office without significant pain or discomfort. Vision before optic capture, during optic capture, and at the first office visit after optic capture were comparable. There were not any cases of endophthalmitis, hyphema, iris trauma, iris prolapse or keratitis. While eight patients only had one episode of optic capture, 10 patients had multiple episodes of optic capture, all managed with this in office procedure. Recurrent optic capture occurred more frequently in eyes with fixation at less than 2 mm from the limbus than eyes with scleral fixation at 2 mm from the limbus. Conclusion Reposition of the optic after pupillary capture of a scleral fixated PC IOL can be successfully performed in the office without discomfort or significant complications and is an alternative management option to a return to the operating room. This procedure may be especially important when there is poor access to the operating room or restricted access to the operating room as during the COVID19 pandemic.

Comparison of the Postoperative Outcomes in Combined Vitrectomy with Sutured Scleral Intraocular Lens Fixation versus Sutureless Intrascleral Haptic Fixation

“…This xed position close to the iris may increase the risk of iris-optic capture and subsequent complications. In this study, iris-optic capture was found in approximately 17% of patients (4 of 24 eyes) who only underwent sutured SF IOL surgery, which could lead to visual impairments such as intraocular hemorrhage and CME [9].…”

“…1). This complication can result in problems such as pain, high intraocular pressure, uveitis, pupillary block glaucoma, iris cha ng, pigment dispersion glaucoma, cystoid macular edema (CME), hyphema, or vitreous hemorrhage [9].…”

Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7–0 polypropylene flange

“…Kokame et al ( 8 ) suggested that in-office management was a good option for managing optic capture. Although this procedure can be performed in the office without discomfort or significant complications, pupillary optic capture may recur after the procedure.…”

“…Most cases of optic capture have been managed in the office by pushing the optic posterior to the iris using a 30-guage needle (8). However, repeated recurrence of pupillary optic capture despite these techniques may warrant surgical interventions, including IOL repositioning (9)(10)(11) and exchange (10).…”

Letter to the Editor on ‘Risk Factors for Pupillary Optic Capture Following Sutureless Flanged Intraocular Lens Fixation for Intraocular Lens Dislocation’

“…Because the importance of postoperative miotic agent use in optic capture has been reported in many studies. 6 Also, was a myotic agent injected into the anterior chamber during correction? I congratulate the authors once again for this beautiful work.…”