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BMC Ophthalmology Jan 2021However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying...
BACKGROUNDS
However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar.
METHODS
Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o'clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications.
RESULTS
The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was - 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.
CONCLUSIONS
IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Retrospective Studies; Sclera; Surgical Instruments; Suture Techniques
PubMed: 33407262
DOI: 10.1186/s12886-020-01758-6 -
Canadian Journal of Ophthalmology.... Oct 2020
Topics: Humans; Sclera; Trabeculectomy
PubMed: 32589915
DOI: 10.1016/j.jcjo.2020.05.009 -
Ceska a Slovenska Oftalmologie :... 2024To summarize the history and current trends in the use of scleral grafts in ophthalmology. (Review)
Review
AIM
To summarize the history and current trends in the use of scleral grafts in ophthalmology.
MATERIALS AND METHODS
We conducted a review of the literature through the MEDLINE and Cochrane Library databases. The search terms were "sclera", "graft", and "surgery". The search resulted in 1596 articles, of which we evaluated 192 as relevant. The relevant articles were sorted chronologically and according to the method of using scleral grafts, which enabled the development of a review article.
RESULTS
The sclera has been routinely used in ophthalmology since the 1950s in many different indications. Some of these indications have become practically obsolete over time (for example, use in the surgical management of retinal detachment), but a large number still find application today (especially use in glaucoma or oculoplastic surgery, or as a patch for a defect in the sclera or cornea).
CONCLUSION
Even though allogeneic sclera is currently used less frequently in ophthalmology compared to other tissue banking products and the range of its indications has partially narrowed, it remains a useful material due to its availability and properties.
Topics: Humans; Ophthalmology; Sclera; Glaucoma; Retinal Detachment; Cornea
PubMed: 38413226
DOI: 10.31348/2024/11 -
Journal of Glaucoma Jul 2020Micropulse transscleral cyclophotocoagulation is a promising and relatively new technique that uses repetitive micropulses of diode laser energy, delivered with the... (Review)
Review
Micropulse transscleral cyclophotocoagulation is a promising and relatively new technique that uses repetitive micropulses of diode laser energy, delivered with the Cyclo G6 Glaucoma Laser System (Iridex Corporation), in an off-and-on cyclical manner. This review article provides an update on the latest data available for this technique, including a discussion of the aspects in which there is still limited data, such as the precise mechanism of action, the ideal laser parameters based on total energy levels, as well as an overview of other potentially relevant variables that may be playing an important role in outcomes.
Topics: Ciliary Body; Glaucoma; Humans; Intraocular Pressure; Laser Coagulation; Lasers, Semiconductor; Sclera; Treatment Outcome
PubMed: 32398591
DOI: 10.1097/IJG.0000000000001539 -
Journal of Cataract and Refractive... Apr 2021
Topics: Cornea; Humans; Intraocular Pressure; Sclera
PubMed: 33901115
DOI: 10.1097/j.jcrs.0000000000000626 -
Current Opinion in Ophthalmology Jan 2021To review variations of flanged intraocular lens fixation (Yamane technique) and their outcomes. (Review)
Review
PURPOSE OF REVIEW
To review variations of flanged intraocular lens fixation (Yamane technique) and their outcomes.
RECENT FINDINGS
Sutureless intrascleral IOL fixation has become popular, and many techniques have been reported. Among them, the Yamane technique has been widely used in recent years, and there are many variations. However, there are no reports that systematically compare them.
SUMMARY
There are variations of the Yamane technique, such as those used to create a scleral tunnel or to dock needles and haptics. Although few reports have directly compared each technique, small scleral wounds appear to be beneficial for long-term stability of the IOL. A method of fixing a capsule tension segment or iris using a flange has also been reported, demonstrating the diverse range of uses of the flange.
Topics: Humans; Iris; Lens Implantation, Intraocular; Lenses, Intraocular; Needles; Phacoemulsification; Sclera; Suture Techniques
PubMed: 33196545
DOI: 10.1097/ICU.0000000000000720 -
PloS One 2019To present a three-dimensional non-parametric method for detecting scleral asymmetry using corneoscleral topography data that are free of edge-effect artefacts.
PURPOSE
To present a three-dimensional non-parametric method for detecting scleral asymmetry using corneoscleral topography data that are free of edge-effect artefacts.
METHODS
The study included 88 participants aged 23 to 65 years (37.7±9.7), 47 women and 41 men. The eye topography data were exported from the Eye Surface Profiler software in MATLAB binary data container format then processed by custom built MATLAB codes entirely independent from the profiler software. Scleral asymmetry was determined initially from the unprocessed topography before being determined again after removing the edge-effect noise. Topography data were levelled around the limbus, then edge-effect was eliminated using a robust statistical moving median technique. In addition to comparing raw elevation data, scleral elevation was also compared through fitting a sphere to every single scleral surface and determining the relative elevation from the best-fit sphere reference surface.
RESULTS
When considering the averaged raw topography elevation data in the scleral section of the eye at radius 8 mm, the average raw elevations of the right eyes' sclera were -1.5±1.77, -1.87±2.12, -1.36±1.82 and -1.57±1.87 mm. In the left eyes at the same radius the average raw elevations were -1.62±1.78, -1.82±2.07, -1.28±1.76 and -1.68±1.93 mm. While, when considering the average raw elevation of the sclera after removing the edge effect, the average raw elevations of the right eyes were -3.71±0.25, -4.06±0.23, -3.95±0.19 and -3.95±0.23 mm. In the left eyes at the same radius the average raw elevations were -3.71±0.19, -3.97±0.22, -3.96±0.19 and -3.96±0.18 mm in the nasal, temporal, superior and inferior sides respectively. Maximum raw elevation asymmetry in the averaged scleral raw elevation was 1.6647±0.9015 mm in right eyes and 1.0358±0.6842 mm in left eyes, both detected at -38° to the nasal side. Best-fit sphere-based relative elevation showed that sclera is more elevated in three main meridians at angles -40°, 76°, and 170° in right eyes and -40°, 76°, and 170° in left eyes, all measured from the nasal meridian. Maximum recorded relative elevation asymmetries were 0.0844±0.0355 mm and 0.068±0.0607 mm at angular positions 76° and 63.5° for right and left eyes in turn.
CONCLUSIONS
It is not possible to use corneoscleral topography data to predict the scleral shape without considering a method of removing the edge-effect from the topography data. The nasal side of the sclera is higher than the temporal side, therefore, rotationally symmetric scleral contact lenses are more likely to be translated towards the temporal side. The scleral shape is best described by levelled raw elevation rather than relative elevation.
Topics: Adult; Aged; Algorithms; Artifacts; Corneal Topography; Female; Humans; Male; Middle Aged; Sclera; Young Adult
PubMed: 31348792
DOI: 10.1371/journal.pone.0219789 -
Journal of Biomechanics Apr 2023Despite presumed relevance to ocular diseases, the viscoelastic properties of the posterior human eye have not been evaluated in detail. We performed creep testing to...
PURPOSE
Despite presumed relevance to ocular diseases, the viscoelastic properties of the posterior human eye have not been evaluated in detail. We performed creep testing to characterize the viscoelastic properties of ocular regions, including the sclera, optic nerve (ON) and ON sheath.
METHODS
We tested 10 pairs of postmortem human eyes of average age 77 ± 17 years, consisting of 5 males and 5 females. Except for the ON that was tested in native shape, tissues were trimmed into rectangles. With physiologic temperature and constant wetting, tissues were rapidly loaded to tensile stress that was maintained by servo feedback as length was monitored for 1,500 sec. Relaxation modulus was computed using Prony series, and Deborah numbers estimated for times scales of physiological eye movements.
RESULTS
Correlation between creep rate and applied stress level was negligible for all tissues, permitting description as linear viscoelastic materials characterized by lumped parameter compliance equations for limiting behaviors. The ON was the most compliant, and anterior sclera least compliant, with similar intermediate values for posterior sclera and ON sheath. Sensitivity analysis demonstrated that linear behavior eventually become dominant after long time. For the range of typical pursuit tracking, all tissues exhibit Debora numbers less than 75, and should be regarded as viscoelastic. With a 6.7 Deborah number, this is especially so for the ON during pursuit and convergence.
CONCLUSIONS
Posterior ocular tissues exhibit creep consistent with linear viscoelasticity necessary for describing biomechanical behavior of the ON, its sheath, and sclera during physiological eye movements and eccentric ocular fixations. Running Head: Tensile Creep of Human Ocular Tissues.
Topics: Male; Female; Humans; Middle Aged; Aged; Aged, 80 and over; Sclera; Elasticity; Biomechanical Phenomena; Compliance
PubMed: 36933327
DOI: 10.1016/j.jbiomech.2023.111530 -
Klinische Monatsblatter Fur... Aug 2021Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex... (Review)
Review
BACKGROUND
Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique.
MATERIAL AND METHODS
Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z).
RESULTS
Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up.
CONCLUSION
The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Retrospective Studies; Sclera; Visual Acuity
PubMed: 33853190
DOI: 10.1055/a-1333-3199 -
Seminars in Ophthalmology Apr 2023Scleritis and episcleritis are an overlapping spectrum of diseases and accurate diagnosis is of utmost importance as the treatment and prognosis are vastly different.... (Review)
Review
BACKGROUND
Scleritis and episcleritis are an overlapping spectrum of diseases and accurate diagnosis is of utmost importance as the treatment and prognosis are vastly different. Predominantly a clinical diagnosis, the challenge lies in those cases with equivocal clinical features. Furthermore, clinical grading of scleritis is subjective and hence is neither very reliable nor reproducible. Existing modalities such as slit lamp examination and clinical photographs in scleritis describe macroanatomy but do not provide details on the microanatomy of the sclera. A recent adjusted algorithm for anterior segment optical coherence tomography (AS-OCT) imaging has improved the ability of this device to aid in the diagnosis of all the major forms of scleritis.
PURPOSE
To highlight the role of AS-OCT in delineating various anatomical forms of episcleritis and scleritis and explore this tool in monitoring disease course and response to therapy.
METHODS
A comprehensive literature search was carried out in various medical databases using keywords AS-OCT and scleritis; AS-OCT and episcleritis; anterior segment imaging in scleritis; scleritis and episcleritis; Recent advances in anterior segment imaging. Original articles and novel reports describing the potential role of AS-OCT in the diagnosis and management of scleritis and episcleritis were included.
RESULTS
After a thorough assessment, it was clear that published literature lacks guidelines for uniform interpretation and also for classification and follow-up in scleritis. We describe a uniform protocol for AS-OCT image acquisition, interpretation of images and list the advantages and limitations.
CONCLUSIONS
AS-OCT can be used to localize the level of scleral inflammation thus helping in the diagnosis of scleral inflammatory disease. It can be a valuable tool in studying progression.
Topics: Humans; Scleritis; Tomography, Optical Coherence; Sclera; Anterior Eye Segment
PubMed: 35996334
DOI: 10.1080/08820538.2022.2112700