Long-term risk of suture breakage after scleral fixation of late in-the-bag intraocular lens dislocation with a polypropylene 10-0 suture

Medin, Helle; Kure, Ingeborg Slørdahl Hjort; Dalby, Marius; Drolsum, Liv; Kristianslund, Olav

doi:10.1097/j.jcrs.0000000000001010

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…Previous studies with a mean follow-up of 6 to 7 months reported that the rate of IOL subluxation/dislocation after transscleral-sutured fixation was 3.0% to 7.8% [ 38 , 39 ]. Also, due to suture degradation, IOL redislocation with a long-term incidence rate of 18% to 28% remains a major concern after transscleral-sutured fixation [ 9 ]. Though it was not observed in the present study, a longer follow-up is needed.…”

Section: Discussionmentioning

confidence: 99%

“…However, most transscleral-sutured methods are time-consuming and traumatic because of the need to create scleral fap(s)/pocket(s)/groove(s). In addition, concerns about the long-term stability of the conventionally used 10-0 polypropylene are growing due to the risk of suture breakage or degradation over time [6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Transscleral-sutured fxation, a commonly performed scleral-fxated technique, typically requires the large opening of conjunctival tissues and the creation of scleral faps to bury the suture ends and knots [6][7][8]. Te most commonly used 10-0 polypropylene in sutured-fxation methods is prone to loosening and breakage, leading to IOL tilt, decentration, or even up to a dislocation rate of 18% to 28%, and thus the occurrence of signifcant postoperative refractive errors, of which IOL tilt angle larger than 15 °cannot be corrected with spectacles [9,10]. We have previously described a fapless and conjunctiva-sparing technique for transscleral IOL fxation using the 8-0 polypropylene [5].…”

Section: Introductionmentioning

confidence: 99%

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Flapless and Conjunctiva‐Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support

Lou

Chen

Huang

et al. 2023

Journal of Ophthalmology

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Purpose. To evaluate refractive outcomes, intraocular lens (IOL) power calculation, and IOL position following a novel conjunctiva-sparing transscleral fixation technique. Methods. Forty-one eyes of 40 patients managed with a flapless transscleral-sutured technique were included. Preoperative and postoperative refractive errors (spherical equivalents, SE) were compared. IOL position was assessed on the Scheimpflug images. IOL power was calculated by SRK/T, Holladay 1, and Hoffer Q formulas. Results. The mean age was 57.39 ± 14.83 years (range: 26 to 79 years), and the mean follow-up was 7.46 ± 6.42 months (range: 1 to 24 months). Surgical indications were aphakia (n = 14), subluxated lenses (n = 3), and IOL dislocation (n = 24). The SE was 4.50 ± 6.38 diopter (D) (range: −3.75 to 13.75 D) preoperatively and −1.68 ± 1.57 D (range: −5.50 to 1.13 D) postoperatively ( P < 0.001 ). The mean tilt angle and decentration were 2.90° ± 1.93° (range: 0.39° to 9.10°) and 0.23 ± 0.19 mm (range: 0.02 to 0.94 mm) vertically, and 1.75° ± 1.41° (range: 0.24° to 7.65°) and 0.18 ± 0.19 mm (range: 0.02 to 1.06 mm) horizontally, which were clinically insignificant. All three IOL formulas produced myopic errors (range: −0.29 to −0.50 D). The SRK/T had the lowest median absolute error (0.55 D), followed by the Holladay 1 (0.70 D) and the Hoffer Q (0.74 D). The three formulas had the same percentage of prediction errors (PEs) within ±0.5 D (43.48%), while the Hoffer Q had the highest percentage of PEs within ±1.0 D (82.61%). Conclusion. The present technique can serve as an alternative approach for transscleral IOL fixation and refractive correction in eyes with compromised capsular support, ensuring the stability of IOLs and reasonable IOL power calculation accuracy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Flapless and Conjunctiva‐Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support

Lou

Chen

Huang

et al. 2023

Journal of Ophthalmology

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“…Moreover, standard polypropylene sutures are subjected to enzymatic and oxidative degradation in human tissues; the 10.0 sutures that are usually employed for scleral fixation have shown signs of degradation within 5 to 10 years, causing suture breakage, pseudophacodonesis, and IOL decentration. 17,18 Thus, some authors recommended the use of 9.0 polypropylene or Gore-Tex (off-label) sutures in order to increase implant durability. 17,19 Although long-term studies are missing, the 5.0 polypropylene sutures, being ten times thicker than the 10.0's, might provide better longevity and higher tensile strength.…”

Section: Discussionmentioning

confidence: 99%

Double-flanged knotless technique for iris prosthesis and IOL implantation associated with keratoplasty

Lupardi

Moramarco

Iannetta

et al. 2023

European Journal of Ophthalmology

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Introduction Anterior segment reconstruction and penetrating keratoplasty combined with iris prosthesis (IP) and intraocular lens (IOL) scleral fixation require prolonged open-sky surgery and complex suturing. Herein we present a novel double-flanged knotless surgical technique that minimizes the open sky duration and facilitates the fixation of the IP and IOL complex to the sclera. Methods After corneal trephination and removal, a temporary keratoprosthesis is fixated. Three 5.0 polypropylene suture segments are introduced in the anterior chamber transconjunctivally and then externalized through keratoprosthesis. Each suture is threaded through the eyelets of the IP and then flanged. The temporary keratoprosthesis is removed, and the IP and IOL complex is positioned in the sulcus. A donor cornea button is sutured in place and the IP is centred on the optical axis by adjusting the polypropylene sutures. Finally, the suture ends are shortened, flanged, and buried under the conjunctiva. Results Surgery was performed on three eyes of three patients. No intraoperative complications occurred, while cystoid macular edema and ocular hypertension occurred in two patients during the follow-up period. The best corrected visual acuity was 6/20, 8/20, and 13/20. So far the IPs remained stable in the three eyes with a maximum follow-up of 18 months. Conclusion This novel technique of penetrating keratoplasty combined with an intraocular lens (IOL) and iris prosthesis implantation makes it possible to reduce open sky surgery time, avoid complex suturing, and ensure optimal IOL visual axis alignment by adjusting suture tension.

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“…4 Sutured irisfixated IOLs and sutured SFIOLs are prone to suture failure and subsequent IOL dislocation. 5,6 More recently developed methods of secondary IOL placement avoid these complications and thus have gained popularity, particularly sutureless scleral tunnel (SST). Unfortunately, long-term data are lacking.…”

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confidence: 99%

Long-term outcomes of sutureless intrascleral IOL fixation in children and adults: single surgeon case series with and without haptic flanging with up to 11 years of follow-up

Moore,

Bullock,

Walsh

2023

Retina

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Purpose: Report and compare long-term outcomes and complications of sutureless scleral tunnel (SST) and flanged haptic (FH) scleral fixated IOLs (SFIOL), with spontaneous IOL dislocation as primary outcome measure. Methods: Retrospective single-surgeon case series of 95 SST and 458 FH eyes from 2011-2022 (553 total eyes). Demographics, surgical indications, ocular history, visual acuity and complication rates were collected. Results: Reoperation-requiring spontaneous IOL dislocation rate was significantly different (P=0.0167) between FH (3.7%) and SST (10.5%). Mean follow-up was 3.31±0.30 vs. 1.58±0.07 years for SST and FH, respectively. There was no significant difference between preoperative (20/305 vs. 20/300) or final postoperative (20/77 vs. 20/62) visual acuity. Other complications included any cystoid macular edema (20.0% vs. 25.3%), elevated IOP (16.8 vs. 9.6%), IOL tilt requiring re-operation (5.3 vs. 0%), haptic exposure (2.1 vs. 3.3%), and reverse pupillary block (4.2 vs. 1.1%). Conclusions: Haptic flanging resulted in fewer eyes meeting the primary endpoint of IOL dislocation. We report the longest-to-date follow-up of both non-flanged SST IOL fixation and our FH modified Yamane technique. Our FH modified Yamane technique represents a safe, durable, and potentially superior option for SFIOL.

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Long-term risk of suture breakage after scleral fixation of late in-the-bag intraocular lens dislocation with a polypropylene 10-0 suture

Abstract: To investigate the long-term risk of suture breakage after scleral fixation with a polypropylene 10-0 suture in eyes with late in-the-bag intraocular lens (IOL) dislocation.

Cited by 6 publications

References 35 publications

Flapless and Conjunctiva‐Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support

Flapless and Conjunctiva‐Sparing Technique for Transscleral Fixation of Intraocular Lens to Correct Refractive Errors in Eyes without Adequate Capsular Support

Double-flanged knotless technique for iris prosthesis and IOL implantation associated with keratoplasty

Long-term outcomes of sutureless intrascleral IOL fixation in children and adults: single surgeon case series with and without haptic flanging with up to 11 years of follow-up

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