Review of Surgical Techniques for Posterior Chamber Intraocular Lens Fixation in the Absence of Capsular Lens Support

Abstract

An ongoing challenge in complex anterior segment surgery continues to be the safe and effective management of long-term intraocular lens (IOL) fixation in the absence of capsular support. Although anterior chamber IOLs are still an option, especially with improved lens designs and relative ease in placement, complications can still occur including corneal decompensation, iris chaffing, and anterior chamber angle injury, especially when incorrectly sized or in an inadequately shallow anterior chamber.1 Therefore, additional options for posterior chamber IOL fixation in cases of capsular compromise are indicated. Posterior chamber IOLs are not only placed further from the corneal endothelium and anterior chamber angle with less risk for injury to these structures, but are also closer to the nodal point of the eye and may offer a benefit in optical outcomes. Etiology of Loss of Capsular Lens SupportCases of inadequate capsular support for IOL fixation can result from a multitude of causes including trauma, complicated cataract surgery, IOL exchange or replacement, and zonulopathies, such as pseudoexfoliation syndrome and, less commonly, congenital ectopia lentis (see Table 1). 1,2With the many potential causes of loss of capsular support with need for IOL fixation, the ongoing development of improved lens design and surgical techniques continues to be an ongoing challenge for surgeons. Preoperative ConsiderationsGiven the potential complexity of cases requiring IOL fixation when adequate capsular support is lacking, careful preoperative planning is required to determine the most appropriate technique for securing an IOL. A surgeon should also take into account their level of experience and comfort level in attempting potentially surgically demanding techniques in often challenging eyes.A surgeon should consider whether any capsular support is present.Having some capsular support may add additional support to the IOL during manipulation during a complex case. Noting the availability of some capsular support can be particularly useful in cases when an anterior chamber IOL is not appropriate. AbstractThis is a review of surgical options for posterior chamber intraocular lens (IOL) fixation in the absence of adequate capsular support. The indications, techniques, and outcomes for posterior chamber iris-sutured and scleral-fixated IOLs, including trans-scleral sutured and trans-scleral tunnel glued fixation, are reviewed. Iris-sutured IOL fixation may be appropriate in cases in which small corneal incisions with a foldable IOL are desired, but are only possible in cases of adequate iris tissue, and may be complicated by pupil ovaling and iris trauma, which can lead to prolonged inflammation in some studies. Scleral-sutured IOL fixation does not require robust iris tissue and decreases the risk for iris trauma, but is technically more demanding, may require larger incisions, and poses potentially more posterior segment complications.There are also ongoing concerns for suture exposure, erosion, and late suture breakage an...

Failure iridocapsular fixation of IOL in patients with lens subluxation (preliminary report)

“…Использование шовной фиксации дает шанс на более длительную стабильность ИОЛ, однако операция проходит намного дольше, технически сложнее и сопровождается 24 целым рядом дополнительных ранних послеоперационных осложнений (геморрагии, воспаление и др.). Кроме этого, шовный способ фиксации ИОЛ, несмотря на многочисленные поиски наиболее удачных модификаций, потенциально обременен риском деструкции, прорезания и деформации нити [13,15,16]. В данной работе представлен первый опыт применения внекапсульной ИОЛ RSP-3 в качестве комбинированного типа фиксации после ФЭ с сохранением капсульного мешка.…”

“…Неуверенность во внутрикапсульном способе фиксации ИОЛ после ФЭ при подвывихе хрусталика привела к разработке другой хирургической тактики: «удаляем капсульный мешок» на фоне слабости волокон цинновой связки с выбором внекапсульного (шовного) типа фиксации ИОЛ. Предлагаются варианты склеральной и зрачковой фиксации после внутрикапсульной ФЭ и капсулэктомии [3,[13][14][15]. Однако на фоне хороших результатов в первые годы после трудоемкой хирургии в литературе накопилось множество публикаций об осложнениях внекапсульной фиксации, в первую очередь дислокации ИОЛ за счет дефектов фиксирующей нити [16].…”

Skleraya sabitlenen göz içi lensi uygulama teknikleri

“…Saat 10 bölümünde aynı işlemler tekrarlanır. Sklera flepleri, üst kesi ve kornea 10-0 naylon sütürle kapatılır [3,12]. Bu teknikte sklera flebi hazırlanmadan polipropilen sütürün düz iğnesi 28-gauge iğne yardımıyla karşıya geçirildikten sonra farklı bir girişten girilerek yine aynı tarafa geçirilebilir.…”