Scleral-Fixated Intraocular Lenses: An Update on the Current Surgical Approaches

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• 作者：Malav Joshi (1)
  Mark K. Walsh (2)
  
  1. Duke Eye Center ; 2351 Erwin Road ; Durham ; NC ; 27710 ; USA
  2. Retina Associates Southwest ; 6561 East Carondelet Drive ; Tucson ; AZ ; 85710 ; USA
  
• 关键词：Scleral fixated ; Sutured ; Sutureless ; Intrascleral ; Scleral tunnel ; Intraocular lens
• 刊名：Current Surgery Reports
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：3
• 期：5
• 全文大小：170 KB
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  36. 鈥?Gabor SG, Pavlidis MM. Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg. 2007;33(11):1851鈥?. / This was the first paper describing the sutureless intrascleral technique along with a link to their surgical video.
  37. 鈥⑩€?Scharioth GB, et al. Intermediate results of sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg. 2010;36(2):254鈥?. / This was the first time a major review of the results and complications of the suture-less intrascleral IOL fixation technique was reported by Scharioth and colleagues, who were the pioneers of this technique. They reported a very low rate of complications compared to scleral sutured IOL techniques. They only had 2 out of 63 cases of IOL decentration.
  38. 鈥?Prenner JL, Wheatley HM, Wilgucki JD. A novel approach for rescuing and scleral fixating a posterior dislocated intraocular lens/bag complex without conjunctival opening. Retina. 2013;33(9):1980鈥?. / In this paper, Prenner et al report a modification of the Scharioth technique of sutureless intrascleral IOL fixation using the instrumentation and the skill set of a posterior surgeon. They also reported to have no early significant complications in their first 24 cases.
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  44. Kumar, DA (2010) Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes. Eye (Lond) 24: pp. 1143-1148 CrossRef
  45. Kumar, DA (2013) Complications and visual outcomes after glued foldable intraocular lens implantation in eyes with inadequate capsules. J Cataract Refract Surg 39: pp. 1211-1218 CrossRef
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  48. Benayoun, Y (2013) Sutureless scleral intraocular lens fixation: report of nine cases and literature review. J Fr Ophtalmol 36: pp. 658-668 CrossRef
  49. 鈥⑩€?Kumar DA, Agarwal A. Glued intraocular lens: a major review on surgical technique and results. Curr Opin Ophthalmol. 2013;24(1):21鈥?. / This paper reports the results and complication profile of glued intraocular lenses by Dr. Agarwal鈥檚 group. They report a large sample size of 735 patients, which is the largest series on glued IOLs published to date. We feel that such a large-scale study is a good representation of the possible complications that can arise from glued IOL fixation.
  50. 鈥⑩€?Walsh MK, Joshi M. Sutureless scleral tunnel intraocular lens fixation in the pediatric population. Retina. 2014;34(4):807鈥?1. / In this article, we have reported our preliminary results of our single surgeon (MKW) series of a modified sutureless intrascleral IOL fixation technique in children. MKW also angles the tunnels towards the limbus as opposed to limbus parallel in both children and adult cases. He has noticed less IOL tilt with this technique. Our paper also has three links to surgical videos that demonstrates this technique.
  
• 刊物主题：Surgery;
• 出版者：Springer US
• ISSN：2167-4817

文摘

In the past, the available surgical options for patients with a lack of capsulozonular support or aphakia were limited to placing an intraocular lens (IOL) in the anterior chamber, suturing an IOL to the iris, or suturing it to the sclera. The first two options involve leaving the IOLs in close proximity to the iris and the cornea and are not ideal for patients with compromised corneas, peripheral anterior synechiae, shallow anterior chambers, or glaucoma. Scleral-sutured IOL fixation allows the IOL to sit away from the cornea and closer to the nodal point of the eye, but the suture-related complications and the technically challenging nature of the surgery are unappealing. In recent years, with the advent of novel sutureless scleral fixation techniques, an increasing number of surgeons are adopting the sutureless techniques, such as the fibrin glue and the intrascleral tunnel IOL fixation techniques. We discuss the pros and cons as well as the preliminary results of these techniques as reported in the recent literature.