Glue Assisted Intrascleral Fixation of Posterior Chamber Intraocular Lens
Raghda Reda Ibrahim;
Abstract
There have been sutureless scleral fixation techniques for posterior chamber intraocular lens (PC IOL) implantation in eyes with inadequate capsular support in the recent past. Fibrin glue assisted IOL fixation differes from other sutureless methods by the externalisation of haptics under the scleral flaps instead of sclerotomy and also the use of fibrin glue. Biological glue is preferred to stick the flaps, as it prevents formation of subconjunctival bleb, which may happen when the scleral flaps are sutured.
The risk of bleb-related endophthalmitis and suture-related complications are less when the flaps are closed with fibrin glue.
Moreover, this method can be performed in both rigid and three-piece foldable intraocular lens . Hence, there is no need for specially designed scleral fixated intraocular lens . Now , it is preferred to use a three-piece foldable or non-foldable IOL, as the optic haptic junction does not break, which can happen when implanting a single-piece non-foldable IOL. With a three-piece foldable IOL, the incision size is reduced as the IOL can be injected.
It is reported that sutured scleral- fixated PC IOL seemed to provide a more favourable outcome and a lower complication rate than the openloop anterior chamber intraocular lens (AC IOL) in complicated cataract cases. There is no significant differences in outcome on comparing AC IOLs with sutured PC IOLs in complicated cataract extraction with poor capsular support.
The haptics of the sulcus-fixated IOL in direct contact with the posterior surface of the overlying iris can cause focal iris atrophy and pigment dispersion. The IOL rotation and recurrent irritation of the iris are known to cause uveitis-glucoma-hypehma (UGH) syndrome. Moreover, rubbing between the IOL optic and iris seems to contribute to the high flare counts in eyes with a sulcus-to-sulcus IOL fixation.
A consistent vault is maintained between the iris and the IOL, which we consider as one of the reasons for less post-operative uveitis and pigment dispersion. The pseudophakodonesis due to the oscillations of the fluids in the anterior and posterior segment is known to cause permanent damage on the corneal endothelium.
However, there was no clinical pseudophakodonesis observed in fibrin glue intraocular lens fixation, and the endothelial cell loss was not more than any phacoemulsification procedure and less than an AC IOL implantation.
Complications as suture erosion (17.9%), cystoid macular oedema (5.8%), retinal detachment (1.4%), vitreous haemorrhage (1.0%), and uveitis (0.5%) occur in a 1 year post-operative outcome of sclera-fixated IOL. There is a high risk from repeated surgeries in sutured SF IOL due to suture-related complications.
It was noted that none of the intra-operative complications in fibrin glue method affected the final functional outcome. It has been shown that the overall length (12.5–14.0 mm) of the IOL helps ensure firm, stable fixation in the posterior chamber behind the iris, where in the average diameter in emmetropic eyes is B13.0 mm. In addition, the large globes lower the risk of clinically significant postoperative decentration.
As the overall diameter of the routine IOL is about 12–13 mm, with the haptic being placed in its normal curved configuration and without any traction, there is no distortion or change in the shape of the IOL.
The externalisation of the greater part of the haptics into the scleral tunnel along its curvature stabilises the axial positioning of the IOL preventing tilt. This is well shown by 1 year follow-up results showing no haptic extrusion and good flap apposition.
The follow-up is only 1 year and a longer follow-up might be required to confirm the long-term outcome. A randomised control trial with SF and AC IOLs would be interesting in future, as the current study lacks a control group.
Nevertheless, it is considered that 1 year results of fibrin glue-assisted posterior chamber IOL implantation provided good visual prognosis with minimal complications in eyes with deficient capsular support. However, long-term follow-up would be required to determine the functional and anatomical results of the procedure.
The risk of bleb-related endophthalmitis and suture-related complications are less when the flaps are closed with fibrin glue.
Moreover, this method can be performed in both rigid and three-piece foldable intraocular lens . Hence, there is no need for specially designed scleral fixated intraocular lens . Now , it is preferred to use a three-piece foldable or non-foldable IOL, as the optic haptic junction does not break, which can happen when implanting a single-piece non-foldable IOL. With a three-piece foldable IOL, the incision size is reduced as the IOL can be injected.
It is reported that sutured scleral- fixated PC IOL seemed to provide a more favourable outcome and a lower complication rate than the openloop anterior chamber intraocular lens (AC IOL) in complicated cataract cases. There is no significant differences in outcome on comparing AC IOLs with sutured PC IOLs in complicated cataract extraction with poor capsular support.
The haptics of the sulcus-fixated IOL in direct contact with the posterior surface of the overlying iris can cause focal iris atrophy and pigment dispersion. The IOL rotation and recurrent irritation of the iris are known to cause uveitis-glucoma-hypehma (UGH) syndrome. Moreover, rubbing between the IOL optic and iris seems to contribute to the high flare counts in eyes with a sulcus-to-sulcus IOL fixation.
A consistent vault is maintained between the iris and the IOL, which we consider as one of the reasons for less post-operative uveitis and pigment dispersion. The pseudophakodonesis due to the oscillations of the fluids in the anterior and posterior segment is known to cause permanent damage on the corneal endothelium.
However, there was no clinical pseudophakodonesis observed in fibrin glue intraocular lens fixation, and the endothelial cell loss was not more than any phacoemulsification procedure and less than an AC IOL implantation.
Complications as suture erosion (17.9%), cystoid macular oedema (5.8%), retinal detachment (1.4%), vitreous haemorrhage (1.0%), and uveitis (0.5%) occur in a 1 year post-operative outcome of sclera-fixated IOL. There is a high risk from repeated surgeries in sutured SF IOL due to suture-related complications.
It was noted that none of the intra-operative complications in fibrin glue method affected the final functional outcome. It has been shown that the overall length (12.5–14.0 mm) of the IOL helps ensure firm, stable fixation in the posterior chamber behind the iris, where in the average diameter in emmetropic eyes is B13.0 mm. In addition, the large globes lower the risk of clinically significant postoperative decentration.
As the overall diameter of the routine IOL is about 12–13 mm, with the haptic being placed in its normal curved configuration and without any traction, there is no distortion or change in the shape of the IOL.
The externalisation of the greater part of the haptics into the scleral tunnel along its curvature stabilises the axial positioning of the IOL preventing tilt. This is well shown by 1 year follow-up results showing no haptic extrusion and good flap apposition.
The follow-up is only 1 year and a longer follow-up might be required to confirm the long-term outcome. A randomised control trial with SF and AC IOLs would be interesting in future, as the current study lacks a control group.
Nevertheless, it is considered that 1 year results of fibrin glue-assisted posterior chamber IOL implantation provided good visual prognosis with minimal complications in eyes with deficient capsular support. However, long-term follow-up would be required to determine the functional and anatomical results of the procedure.
Other data
| Title | Glue Assisted Intrascleral Fixation of Posterior Chamber Intraocular Lens | Other Titles | تثبيت العدسة بالغرفة الخلفية للعين خلال الصلبة بمساعدة الغراء | Authors | Raghda Reda Ibrahim | Issue Date | 2015 |
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