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Surgical outcome of simultaneous intraocular lens (IOL) rescue and sutureless intrascleral tunnel fixation of dislocated IOLs

Session Details

Session Title: Quick Fire Free Paper 3

Session Date/Time: Thursday 11/09/2014 | 14:30-16:00

Paper Time: 15:30

Venue: Boulevard D

First Author: : M.Kim SOUTH KOREA

Co Author(s): :    D. Lee   Y.J. Cho           

Abstract Details

Purpose:

To report short-term surgical outcomes of single-stage simultaneous rescue and sutureless intrascleral fixation of dislocated IOLs.

Setting:

Retrospective interventional case series at a university hospital (Department of Ophthalmology, Gangnam Severance Hospital, Seoul, Korea)

Methods:

16 eyes of 16 patients who underwent simultaneous rescue and intrascleral fixation of dislocated IOLs were retrospectively evaluated. Partial thickness scleral flaps (2.0mm×2.0mm) were created and a 22-gauge(G) sclerotomy was made at 1.5 mm from the limbus under the scleral flap. After performing 23G pars plana vitrectomy, bimanual maneuvers using two 23-G end grasping forceps under chandelier illumination and a wide angle viewing system enabled one step rescue of IOLs from posterior segment and simultaneous haptic externalization through sclerotomy with the other hand. An externalized haptic was placed into the 3mm intrascleral tunnel created with a 26G needle and fixated with fibrin glue.

Results:

IOLs were successfully rescued and sclera-fixated through intrascleral tunnels in all 16 eyes(Mean age, 56.56 ±19.89 years). There were two cases with IOL capsular bag complex dislocation, all of which were successfully rescued and the IOLs were safely freed from the capsular bag complex by vitrectomy. The mean preoperative logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 0.92±0.68, and this significantly improved at 6 months to 0.289±0.36 (P=0.003). During the follow-up period(10.1 ± 3.21 months), no significant change of endothelial cell count or central foveal thickness were noted postoperatively (P=0.203 and p=0.979, respectively). There was one case of transient vitreous hemorrhage, iris capture by the IOL and transient ocular hypertension, but no other significant postoperative complications such as IOL dislocation, IOL decentration, retinal detachment, endophthalmitis, or postoperative hypotony were found.

Conclusions:

Single stage simultaneous rescue and sutureless intrascleral tunnel fixation of a dislocated IOL using bimanual maneuver under chandelier illumination and a wide angle visualization system achieved a significant improvement in visual acuity and is found to be an effective, safe and minimally invasive surgical method to rescue and fixate the dislocated IOL without having to explant it.

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