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Eyes with significant trauma may benefit from new IOL fixation process
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A newly tailored surgical solution for implanting IOLs in patients who may not be good candidates for anterior chamber IOLs reduced complications and showed excellent initial results in eyes with significant trauma.
Jonathan L. Prenner, MD, and colleagues developed the Gore-Tex suture fixation technique using a cow-hitch knot and CZ70 IOL (Alcon), which has shown excellent initial results in patients who have aphakia or a subluxated IOL.
“This technique is best suited for eyes that have insufficient capsular support and are not good candidates for anterior chamber intraocular lenses. These often will be eyes that have had significant trauma. This is a novel approach to secondary IOL placement that is a viable option for eyes, particularly after trauma,” Prenner told Ocular Surgery News.
Effective for severe trauma
Prenner presented the initial results of the new technique at the American Society of Retina Specialists annual meeting in San Francisco.
Patients with severe eye trauma can receive a traditional anterior chamber IOL, but it is not ideal if there is angle compromise. In addition, traditional sutures in younger patients are at risk to break over time, he said.
Prenner said a CZ70 lens is affixed to the eye with Gore-Tex sutures. The large lens limits iris mobility, which can be problematic with smaller lenses, resulting in iris chaffing and possibly uveitis-glaucoma-hyphema type syndromes.
“The CZ70 lens is large and therefore is advantageous if there is an irregular or damaged pupil in terms of seeing around a smaller optic. In addition, the larger IOL tends to limit significant iridodonesis, which can be a problem in eyes after trauma and can be a liability with smaller sulcus-based lenses,” he said.
Advantages
Additionally, Gore-Tex is an easy material to work with. It has a small caliber, is difficult to break and has a long lifespan. Its advantages, however, are theoretical in ophthalmology, and Gore-Tex has not been used for ocular sutures for very long, Prenner said.
Researchers believe the new technique has several advantages over anterior chamber lenses, Prenner said.
“Because this lens is sutured into the posterior segment, [anterior chamber] IOL complications such as corneal endothelial damage can be avoided. In addition, if the angle is compromised, an [anterior chamber] IOL may not be the ideal choice for a secondary lens,” he said.
Initial results
Prenner and colleagues reported the technique has yielded excellent initial results so far in 11 patients who have undergone the procedure. The patients had a 14-month maximum follow-up, and the technique yielded no significant complications.
“But the key to surgical success is short-term follow-up, so we will have to wait and see how these hold up over time,” Prenner said.
Prenner said he and his colleagues would continue to use the new technique and bring updated results to the 2017 ASRS annual meeting. – by Robert Linnehan
- Reference:
- Prenner J, et al. A novel approach for IOL fixation. Presented at: American Society of Retina Specialists meeting; Aug. 10-14, 2016; San Francisco.
- For more information:
- Jonathan L. Prenner, MD, can be reached at Rutgers, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, CAB Room 4100, New Brunswick, NJ 08901; email: jonathanprenner@gmail.com.
Disclosure: Prenner reports he is an equity owner of Ophthotech and PanOptica, a consultant for Regeneron and Alcon, and a data and safety monitoring board for Neurotech.