Related videosSFIOL TIPS AND TECHNIQUE (MADE EASY)- DR ASHISH MITRA SNC CHITRAKOOT
An ongoing challenge in complex anterior segment surgery continues to be the safe and effective management of long-term intraocular lens IOL fixation in the absence of capsular support.
Although anterior chamber IOLs are still an option, especially with improved lens designs and relative ease in placement, complications can still occur including corneal decompensation, iris chaffing, and anterior chamber angle injury, especially when incorrectly sized or in an inadequately shallow anterior chamber.
Posterior chamber IOLs are not only placed further from the corneal endothelium and anterior chamber angle with less risk for injury to these structures, but are also closer to the nodal point of the eye and may offer a benefit in optical outcomes. Etiology of Loss sfiol video er Capsular Lens Support Cases of inadequate capsular support for IOL fixation can result from a multitude of causes including trauma, complicated sfiol video er surgery, IOL exchange or replacement, and zonulopathies, such as pseudoexfoliation kxp soundcloud er and, less commonly, congenital ectopia lentis see Table 1.
Preoperative Considerations Given the potential complexity of cases requiring IOL fixation when adequate capsular support is lacking, careful preoperative planning is required to determine the most appropriate technique for securing an IOL.
A surgeon should also take into sfiol video er their level of experience and comfort level in attempting potentially surgically demanding techniques in often challenging eyes. A surgeon should consider whether any capsular support is present. Having some capsular support may add additional sfiol video er to the IOL during manipulation during a complex case. Noting the availability of some capsular support can be particularly useful in cases when an anterior chamber IOL is not appropriate.
The surgeon should also take into account whether there is sufficient iris support to consider an iris-sutured technique. In cases of absent or atrophic iris, a scleral-fixated IOL may be more appropriate for ensuring a secure IOL in the sfiol video er term without inciting additional trauma to the iris. US Ophthalmic Review, ;8 2: This is a review of surgical options for posterior chamber intraocular lens IOL fixation in the absence of adequate capsular support.
The indications, techniques, and outcomes for posterior chamber iris-sutured and scleral-fixated IOLs, including trans-scleral sutured and trans-scleral tunnel glued fixation, are reviewed. Iris-sutured IOL fixation may be appropriate in cases in which small corneal incisions with a foldable IOL are desired, but are only possible in cases of adequate iris tissue, and may be complicated by pupil ovaling and iris trauma, which can lead to prolonged inflammation in some studies.
Scleral-sutured IOL fixation does not require robust iris tissue and decreases the risk for iris trauma, but is technically more demanding, may require larger incisions, and poses potentially more posterior segment complications. There are also ongoing concerns for suture exposure, erosion, and late suture breakage and Sfiol video er dislocation. Scleral tunnel-glued IOL fixation is a more recent innovation that avoids sutures and concerns for suture-related complications, and can be completed through smaller incisions with a foldable IOL.
However, long-term studies are pending. Aphakia, absence of capsule support, iris fixation, scleral fixation, scleral tunnel-glue fixation, secondary intraocular lens implantation. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author s and source are given appropriate credit.
June 16, Accepted: September 11, Accompanying videos to this article can be found at www. Download PDF. View eJournal. Order reprints. Where do we stand? Steinert RF, ed. Techniques, Complications, and Management. Philadelphia, PA: Saunders, Analysis of indications and results, Am J Ophthalmol; A major review on surgical technique and results, Sfiol video er Opin Ophthalmol; A retrospective analysis of 1-year post-operative outcomes, Eye; Outcomes and insights, J Cataract Refract Surg; Out Now.
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