No scleral fixation technique comes without challenges
Click Here to Manage Email Alerts
FORT LAUDERDALE, Fla. — Secondary IOL implantation techniques have equivalent visual acuity results and safety profiles, along with inherent risks and postoperative complications, according to a speaker at the Retina World Congress.
Secondary IOLs can be implanted in three locations: in the anterior chamber, on top of or behind the iris, or to the sclera with or without sutures, and “there is insufficient evidence to recommend one type of IOL over another for a patient in whom all three options are available,” Andre V. Gomes, MD, PhD, said.
Gomes reviewed the history and evolution of scleral fixation techniques, from the Malbran technique, with 10-0 polypropylene sutures at 3 o’clock and 9 o’clock, to the Lewis scleral flap technique and the Hoffman pocket technique. To overcome slippage and instability, IOLs with four eyelets and four-point fixation have been developed, and recently there has been a trend toward the use of thicker 9-0 polypropylene or 7-0 Gore-Tex sutures.
Complication rates with scleral fixation IOLs range between 10% and 54%, Gomes said. The main complications are dislocation, tilting, vitreous or suprachoroidal hemorrhage, retinal detachment and endophthalmitis.
Sutureless techniques, first developed by Scharioth and later by Prenner, Abbey and Yamane, have reduced the rate of these complications but are not without challenges.
“We have also the Carlevale lens, which is an interesting lens that is popular in Europe, but there is a problem with it because of the tiny little plugs that are very fragile and can be broken during the procedure,” Gomes said.
There is no evidence to show superiority of any technique, and larger prospective studies are needed, according to Gomes.
“The challenge is to develop an easy to learn technique with low cost and few complications that provides patients with a very stable IOL and good visual acuity,” he said.
Collapse
Gomes AV. Secondary IOL implantation: Everlasting challenges. Presented at: Retina World Congress; May 9-12, 2024; Fort Lauderdale, Florida.
Read more about
Click Here to Manage Email Alerts