Glued IOL scaffold can be used for IOL exchange in open posterior capsule
Click Here to Manage Email Alerts
IOL exchange is often necessary to optimize the visual potential of a patient.
Multiple techniques have been described in peer literature for performing an IOL exchange. One of the most widely adapted methods is to bisect the IOL and explant it. But many aspects need to be assessed properly before an IOL exchange can be performed because it becomes much trickier when associated with an open posterior capsule.
Source: Ashvin Agarwal, MD, Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth
IOL scaffold has been described as a procedure wherein a three-piece IOL is placed inside the eye and the optic of the IOL plugs the posterior capsular opening and allows emulsification of the residual nuclear material. The authors have also described IOL scaffold for IOL exchange in which the IOL is rotated and manipulated outside the capsular bag. The new IOL is injected and placed inside the bag followed by cutting and explantation of the previous IOL.
The authors currently performed IOL exchange in the setting of posterior capsular rupture in which glued IOL was performed initially followed by emulsification of the nuclear material.
Technique
The technique of glued IOL scaffold for management of non-emulsified nuclear fragments and Soemmering ring has been described before. The IOL is manipulated into the anterior chamber and is placed above the iris tissue. Two partial-thickness scleral flaps are made 180° opposite to each other. Two sclerotomy sites are made with a 23-gauge needle beneath the scleral flaps. A three-piece IOL is loaded onto the cartridge, and the tip of the leading haptic is extruded from the cartridge tip. End-opening forceps are introduced from the left sclerotomy site, and the tip of the leading haptic is held. The IOL is injected in a way that the trailing haptic lies outside the corneal incision.
Once the entire IOL has unfolded, the leading haptic is pulled and exteriorized. The trailing haptic is then flexed inside the anterior chamber, the handshake technique is performed, and the trailing haptic is exteriorized from the right sclerotomy site (Figure 1). Scleral pockets are created with a 26-gauge needle, and the haptics are tucked into them. The levitated IOL is then cut with IOL cutting scissors and is explanted (Figure 2).
Discussion
Although newer techniques have been described for IOL explantation, the widely adapted method is to bisect the IOL before explantation. However, in cases with an open posterior capsule, there is always a fear of slippage of the IOL into the vitreous cavity. Moreover, there will be enhanced manipulation of vitreous strands while the IOL is being cut. Performing glued IOL scaffold acts as an artificial posterior capsule, thereby barring the vitreous in the anterior chamber. Additionally, there is no fear of losing the IOL into the vitreous cavity while bisecting.
The limitation would be that the technique requires a surgeon who is well acquainted with performing glued IOL as it is a technically demanding procedure.
- References:
- Agarwal A, et al. J Cataract Refract Surg. 2013;doi:10.1016/j.jcrs.2013.01.018.
- Narang P, et al. J Cataract Refract Surg. 2014;doi:10.1016/j.jcrs.2014.07.015.
- Narang P, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2013.05.011.
- For more information:
- Amar Agarwal, MS, FRCS, FRCOphth, director of Dr. Agarwal’s Eye Hospital and Eye Research Centre, is the author of several books published by SLACK Books, sister company of Healio publisher Ocular Surgery News, including Phaco Nightmares: Conquering Cataract Catastrophes, Bimanual Phaco: Mastering the Phakonit/MICS Technique, Dry Eye: A Practical Guide to Ocular Surface Disorders and Stem Cell Surgery and Presbyopia: A Surgical Textbook. He can be reached at 19 Cathedral Road, Chennai 600 086, India; email: aehl19c@gmail.com; website: www.dragarwal.com.
- Ashvin Agarwal, MD, can be reached at Dr. Agarwal’s Eye Hospital, #222, TT Krishnamachari Road, Alwarpet, Chennai, 600018, India; email: agarwal.ashvin@gmail.com.
- Priya Narang, MS, can be reached at Narang Eye Care & Laser Centre, Ahmedabad, India; email: narangpriya19@gmail.com.
Collapse
Read more about
Click Here to Manage Email Alerts