Dislocated 4-haptic intraocular lens rescue with Gore-tex suture scleral re-fixation.

Luke Michaels, George Moussa, Hadi Ziaei, Andrew Davies
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Abstract

Background: Dislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques.

Methods: Retrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years.

Surgical technique: A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure.

Results: Seven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2-2.1) to 0.07 (0.02-0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment.

Conclusions: Transscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs.

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通过 Gore-tex 缝合线巩膜复位术抢救脱位的 4 型人工晶体。
背景:传统的脱位人工晶体置换术需要在前房进行操作,这有可能对前房结构造成二次伤害。我们描述并评估了一种避免进入前房的 4 触觉人工晶体置换技术,与传统的人工晶体摘除和置换技术相比,该技术可最大限度地减少术后炎症、散光和恢复时间:回顾性、非随机、介入性研究,对英国一家中心的两名独立玻璃体视网膜外科医生在两年内进行 4 触觉人工晶体置换术的所有患者进行研究:手术技术:进行有限的周边切除术,放置四个 25 号巩膜孔,以便使用两把镊子、输液器和吊灯。在鼻巩膜和颞巩膜上对称放置四个 27 号巩膜切口,距离边缘 3 毫米,两侧垂直间隔 5 毫米。进行玻璃体旁切除术,然后使用 27 号锯齿状镊子,在吊灯照明下用双手清理脱位的人工晶体。将 Gore-tex 缝线穿过玻璃体腔内的 IOL 小体,并通过巩膜切口外露,以重新固定巩膜,然后结膜闭合:结果:七名患者接受了人工晶体回收术和 Gore-Tex 缝合巩膜固定术。所有手术都成功地重新定位了人工晶体,所有患者都对术后效果表示满意。人工晶体脱位的平均(标准差)时间为 13(3)年。术后中位视力从 0.85 logMAR(四分位间距 [IQR]:0.2-2.1)明显提高到 0.07 (0.02-0.60) logMAR(p = 0.02)。除了一名术后治疗不合规的患者出现持续性囊样黄斑水肿外,没有发现明显的术后并发症:结论:使用 Gore-Tex 缝合线进行经巩膜复位术是治疗四片式人工晶体脱位的一种有效、安全且实用的方法。
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来源期刊
CiteScore
3.50
自引率
4.30%
发文量
81
审稿时长
19 weeks
期刊介绍: International Journal of Retina and Vitreous focuses on the ophthalmic subspecialty of vitreoretinal disorders. The journal presents original articles on new approaches to diagnosis, outcomes of clinical trials, innovations in pharmacological therapy and surgical techniques, as well as basic science advances that impact clinical practice. Topical areas include, but are not limited to: -Imaging of the retina, choroid and vitreous -Innovations in optical coherence tomography (OCT) -Small-gauge vitrectomy, retinal detachment, chromovitrectomy -Electroretinography (ERG), microperimetry, other functional tests -Intraocular tumors -Retinal pharmacotherapy & drug delivery -Diabetic retinopathy & other vascular diseases -Age-related macular degeneration (AMD) & other macular entities
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