Recurrent vitreous hemorrhage secondary to haptic-induced chafing

Purpose To examine the clinical outcomes of intraocular lens (IOL) scleral fixation with the friction knot technique. Methods Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot IOL scleral fixation technique by a single surgeon. The fixated IOLs were one‐piece or three‐piece models all with open loop haptics. Main outcome measures were change in corrected distance visual acuity (CDVA) and postoperative complications. Results The mean follow‐up time was 11.7 months (median 4.9, range 0.7–64.8). The mean logarithm of the minimum angle of resolution CDVA improved from preoperative 0.77 ± 0.73 (Snellen 20/118 ± 7.3 lines) to 0.44 ± 0.56 (Snellen 20/55 ± 5.6 lines) at the final visit (p < 0.001). The main postoperative complications were ocular hypertension (30.3%), uveitis–glaucoma–hyphaema syndrome (12.5%; UGHS), vitreous haemorrhage (11.2%) and retinal detachment (8.6%). Two (1.3%) cases of suture breakage were seen. In multivariate Cox regression analysis, age under 60 years [hazard ratio (HR) = 5.41; 95% confidence interval (CI) 1.95–15.01] and scleral fixated one‐piece IOL (HR = 4.23; 95% CI 1.44–12.44) were found as significant independent risk factors for developing new UGHS. Conclusion The friction knot technique provides a firm scleral fixation. Scleral fixation may successfully be utilized in dislocated three‐piece IOLs with loop haptics. We recommend avoiding scleral fixation of one‐piece IOLs in young patients due to a high risk of UGHS.

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“…; Toma et al. ). In many such cases, we could find an iris transillumination defect of the shape of the optic and haptic edges.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of intraocular lens scleral fixation with the friction knot technique

Aaltonen

Oskala

Immonen

2018

Acta Ophthalmologica

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“…Two articles from one center support the use of SPA IOLs in the sulcus, 1,2 but there are several case reports of SPA IOLs inducing complications ranging from iris chafing and the uveitis-glaucoma-hyphema (UGH) syndrome to vitreous hemorrhage. [3][4][5][6] Finally, one study 7 showed good centration and acuity following SPA IOL sulcus placement but a high incidence of secondary glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Complications of sulcus placement of single-piece acrylic intraocular lenses

Chang

Masket²,

Miller³

et al. 2009

Journal of Cataract and Refractive Surgery

182

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Intraocular lenses designed solely for the capsular bag should not be placed in the ciliary sulcus. Backup IOLs in appropriate powers, sizes, and designs should be available for every cataract procedure. The development, investigation, and supply of IOLs specifically designed for placement in eyes that lack adequate capsule support represent clinically important endeavors for ophthalmology and the ophthalmic industry.

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“…Placement of IOL in the ciliary sulcus has the potential to cause complications such as pigment dispersion, uveitis–glaucoma–hyphema‐syndrome, and recurrent vitreous hemorrhage (Micheli et al, ; Toma et al, ). If there is posterior capsule damage and vitreous prolapse, an anterior vitrectomy is essential.…”

Section: Classification Of Ocular Traumamentioning

confidence: 99%

Methods of fixation of intraocular lenses according to the anatomical structures in trauma eyes

et al. 2017

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Ocular trauma can lead to severe visual impairment and morbidity, depending on the anatomical structures affected. The main causes of ocular trauma include foreign bodies, impact by an object, falls, and chemicals. Most ocular traumas occur in children or young male adults. A meticulous slit lamp examination is crucial for assessing all anatomical structures. Trauma to the crystalline lens can result in dislocation, an intralenticular foreign body, cataract, fragmentation, and capsular breach. An intraocular lens (IOL) can endure subluxation or luxation under the conjunctiva, into the anterior chamber or the vitreous, or can be extruded. The surgical approach depends on the condition and morphology of the lens and the anatomical structures surrounding it. If there is capsular bag support, a secondary IOL can be placed in the sulcus using remnants of the damaged capsule. If there is no capsular bag support, a secondary IOL can be fixated to the anterior chamber angle, to the iris, or to the sclera. A detailed history of injury cannot always be obtained in trauma settings. Proper education, supervision, and certified safety eye protectors could prevent up to 90% of ocular injuries. Lens trauma can be treated with various surgical procedures and fixation techniques, which nevertheless require advanced surgical skills owing to the fine anatomical structure of the anterior segment. A careful surgical strategy should be established for a globe reconstruction after trauma with secondary lens implantation. Clin. Anat. 31:6–15, 2018. © 2017 Wiley Periodicals, Inc.

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Recurrent vitreous hemorrhage secondary to haptic-induced chafing

Cited by 13 publications

References 11 publications

Outcomes of intraocular lens scleral fixation with the friction knot technique

Outcomes of intraocular lens scleral fixation with the friction knot technique

Complications of sulcus placement of single-piece acrylic intraocular lenses

Methods of fixation of intraocular lenses according to the anatomical structures in trauma eyes

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