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The tunnel IOL: a safe anchor in troubled times

Session Details

Session Title: Quick Fire Free Paper Session 01

Session Date/Time: Thursday 26/09/2013 | 08:30-10:30

Paper Time: 09:40

Venue: Hall G1 (Level 2)

First Author: R.Mukherjee INDIA

Co Author(s):    -.               

Abstract Details

Purpose:

Demonstrates a new and safe ,sutureless surgical technique of secondary implant ,in 4mm scleral tunnel supported haptics of a foldable 3-piece IOL in the posterior chamber with inadequate capsular support .Use of 23G vitrectomy trocar canula system inserted in prefabricated scleral tunnels forming a nasal and temporal port , for posterior or deep anterior vitrectomy,followed by IOL implantation, and pulling out the haptics on either side through the vitrectomy ports in the 4mm scleral tunnels fashioned in opposite directions 2mm from and parallel to the limbus, with the use of 23G serrated vitreous forceps.

Setting:

PRIVATE PRACTICE AT Oculus Dr.Mukherjees eye clinic, 1/1,Nav Bharatiya Bhavan CHS, 371,Tenth road, Chembur, Mumbai - 400071. INDIA.

Methods:

Corneal centre and limbus marked at 3 & 9 O'clock,and adjoining conjunctiva recessed. 'RULE OF 2' - made with Marker (devised) or caliper. 1st.mark made on the sclera at 2mm distance from the 3 & 9 O'clock limbus, 180 degree axis, and the 2nd. mark made at right angles from 1st. mark in an anticlockwise direction, 2mm from 1st mark, and 3rd. mark made again 2mm from the 2nd. mark and parallel to the limbus. 23G MVR blade used to enter sclera at 1/2 thickness at 3rd mark to craft the 4mm tunnel till the 1st.mark, exteriorising at the 2nd.mark while withdrawing the blade. 23G trocar canula inserted in the tunnel at the 2nd. mark till the 1st.mark to turn inwards to form the temporal port for vitrectomy and nasal port for infusion.If posterior vitrectomy is desired the infusion port is added inferotemporally. Vitrectomy performed,and 3 piece IOL inserted through superior corneal incision,and the haptics exteriorised through vitreous ports into the scleral tunnel by double handed technique using 23G serrated forceps,removing the trocars.Wound integrity checked,and conjunctiva apposed at the limbus with cautery.

Results:

16 eyes of 15 patients,aged 12-82 years were operated by myself as a single surgeon between September 2008 - March 2012, with followup ranging from 4 1/2 - 1 year. 14 patients - uniocular aphakia , 1 patient 82yrs/F had bilateral I/C aphakia operated at an interval of 4 weeks coupled with Xpress GFD with OCCI. Youngest patient 12yrs/M,had 6 months prior vitrectomy with lensectomy for a post-traumatic scleral perforating endophthalmitis. Scleral fixation of IOL was combined with removal of taut opaque posterior hyaloid with excellent visual results. In 73yrs/M,scleral fixation was coupled with vitrectomy for retrieval of posteriorly dislocated Iris-Claw IOL. 14 patients CDVA at 4 weeks were comparable to their preoperative vision at 20/40 or better and maintained the same till last followup in February 2013. 12yrs/M child had a preoperative CDVA of 20/200 ,due to the opaque posterior hyaloid, which improved to 20/40,J2 at 4 weeks postoperative and 20/20,J1 at the last followup in Feb. 2013. The procedure performed in all the patients was free of any intraoperative or postoperative complications.

Conclusions:

-Sutureless , safe , procedure of secondary IOL implantation with rigid and stable fixation of IOL haptics in 4mm half thickness scleral tunnels , preventing decentration , tilt , vaulting ,or phacodonesis of IOL optic . - does not require any IOL dioptric power calculations as it occupies the same position as a posterior chamber IOL. - Use of 23G MVS in uniplanar scleral tunnels created with 23G mvr blade allows an angled and shelved entry into the vitreous cavity to create better wound integrity to prevent hypotony and endophthalmitis , and also prevents inadvertent injuries to the vitreous base and uveal tissue during instrument exchange and haptic delivery. -The 23G MVS allows ergonomic ease of performing posterior segment procedures ,and is an insurance against accidental dropping of the IOL for retrieval , and obviates the use of AC maintainer or performing vitrectomy through corneal incisions. - the location of the vitrectomy ports 2mm from the limbus avoids the major arterial circle of iris thereby preventing bleeds, and location at 3 & 9 O'clock hours leaves the usually scarred superior limbus for IOL implantation . -the procedure is cosmetically good and can be performed in all age groups . -

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