Transscleral Fixation of Intraocular Lenses Using Modified Injector

Sang Hyup Lee; Min Jee Lee; Han Woong Lim; Min Cheol Seong; Hee Yoon Cho; Min Ho Kang

doi:10.7469/JKOS.2015.56.03.345

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Lee, Lee, Lim, Seong, Cho, and Kang: Transscleral Fixation of Intraocular Lenses Using Modified Injector

Original Article

J Korean Ophthalmol Soc 2015;56(3):345-350.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.345

Transscleral Fixation of Intraocular Lenses Using Modified Injector

Sang Hyup Lee, MD, Min Jee Lee, MD, Han Woong Lim, MD, PhD, Min Cheol Seong, MD, PhD, Hee Yoon Cho, MD, PhD, Min Ho Kang, MD, PhD

Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea

￭ Address reprint requests to Min Ho Kang, MD, PhD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 471-701, Korea Tel: 82-31-560-2359, Fax: 82-31-564-9479 E-mail: ocularimmunity@gmail.com

Received 21 June 201422 September 2014 Accepted 17 February 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector.

Methods:

We have modified and used the Sapphire unfolder injector system (Allergan^®, USA). This involved, cutting a slit longi-tudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o’clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o’clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o’clock) is tied to the haptic on the opposite side and inserted.

Results:

The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly.

Conclusions:

This technique is an effective procedure for minimizing entangled thread and corneal astigmatism.

Keywords: Injector, IOL dislocation, Transscleral fixation

References

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Figure 1.

Modification of injector system: (Upper)-Injector before modification. (Lower)-After modification. Grinding between tip of injector and cartridge equip space was done.

Figure 2.

The method of transscleral fixation using modified injector system. (A) The 10-0 polypropylene from the 7-o’clock posi-tion of the sclera is passed through the cartridge. (B) The thread is fixed to the leading haptic 2 mm away from the terminal end. (C) The cartridge is mounted on the injector. 10-0 polypropylene tied to the haptic is passed through the modified side groove of the injector. (D) Combined injector. 10-0 polypropylene is shown at the end of the injector.

Figure 3.

Clinical outcomes of transscleral fixation using injector system. (A) Mean best corrected visual acuity (BCVA, log MAR), (B) SE (diopter) and (C) corneal astigmatism (diopter) of preoperative and posterative data. All clinical outcomes showed statistically significant differences after surgery ( p < 0.001, p = 0.004, p = 0.012). SE = spherical equivalent.

Table 1.

Patients’ characteristics

Mean age (years, range)	62.8 ± 13.0 (range: 37-88)
Sex ratio (male/female)	14/6
Mean follow-up period (months, range)	9.8 ± 7.1 (range: 6-24)
Causes of surgery (number of cases)
IOL dislocation	2
Lens subluxation	4
Aphakia	11
Post. capsule rupture	3

Values are presented as mean ± SD unless otherwise indicated.

IOL = intraocular lens; SD = standard deviation.

Table 2.

Best corrected visual acuity (BCVA) and refractive indexes change after surgery

	Preoperative	Postoperative	p-value
Mean BCVA (log MAR)	1.21 ± 0.61	0.32 ± 0.39	<0.001
Mean SE (diopter)	+5.46 ± 6.67	-0.98 ± 1.35	0.004
Mean Sph (diopter)	+6.44 ± 6.81	-0.09 ± 1.30	0.003
Mean Cyl (diopter)	-1.95 ± 1.60	-1.78 ± 1.35	0.571
Mean corneal astigmatism (diopter)	-1.89 ± 1.78	-1.13 ± 0.69	0.012

Values are presented as mean ± SD.

SE = spherical equivalent.

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