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      Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience

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          Abstract

          Purpose:

          The purpose of the study was to report our initial experience with the transconjunctival Intrascleral Intraocular Lens (SFIOL) fixation with modified Yamane's double-needle technique and flanged haptics.

          Methods:

          This was a prospective interventional study that enrolled 31 consecutive patients undergoing SFIOL with the modified Yamane's technique. All patients underwent comprehensive evaluation including uncorrected and best-corrected vision, intraocular pressure, ultrasound biomicroscopy, endothelial cell density, and macular thickness using optical coherence tomography (OCT). We excluded patients with visually significant coexistent pathology such as corneal scars, macular pathology, and glaucoma.

          Results:

          The mean age of subjects was 57 ± 16.9 years and 23 were men (74%). Surgery was performed for aphakia following complicated cataract surgery in 10 eyes (32%), with lensectomy for subluxated/dislocated cataract in 6 eyes (19%), and with IOL explantation for subluxated/dislocated IOL in 15 eyes (48%). There were no intraoperative complications. Uncorrected visual acuity improved from median of 1.48 logarithm of minimum angle of resolution (logMAR) units (interquartile range [IQR] = 1.3–2 logMAR) at baseline to 0.3 logMAR (IQR = 0.2–0.4 logMAR) at 6 weeks ( P < 0.001) which was maintained at 6 months. There were no significant changes in endothelial cell density ( P = 0.34) and OCT-based macular thickness ( P = 0.31) at 6 months. Two eyes had slight IOL decentration.

          Conclusion:

          Our initial experience suggests that the Yamane's technique for SFIOL is a simple procedure with a short-learning curve and is independent of scleral flaps, tunnels, sutures, and fibrin glue. Using widely available 27-gauge needle instead of 30-gauge thin wall needle as originally described by Yamane makes it possible for the use of various three-piece IOLs available globally. Further studies are required for widespread acceptance of this technique.

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          Most cited references14

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          Flanged Intrascleral Intraocular Lens Fixation with Double-Needle Technique.

          To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL).
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            Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules.

            We report a new surgical technique that uses biological glue to implant a posterior chamber intraocular lens (PC IOL) in eyes with a deficient or absent posterior capsule. Two partial-thickness limbal-based scleral flaps are made 180 degrees apart diagonally, and the haptics of the PC IOL are externalized to place them beneath the flaps. Fibrin glue is used to attach the haptics to the scleral bed, beneath the flap. This simple method of PC IOL implantation requires no specially designed haptics. It provides good flap closure and IOL centration and stability without suture-related complications.
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              Sutureless intrascleral posterior chamber intraocular lens fixation.

              We report a technique for sutureless fixation of standard 3-piece posterior chamber intraocular lenses (PC IOLs) in the ciliary sulcus in eyes without capsule support, which we have used in cases of subluxated and luxated cataract and for secondary IOL implantation. Fixation of the haptics in a limbus-parallel scleral tunnel allows exact centration and provides axial stability of the PC IOL to prevent distortion. The technique uses uncomplicated maneuvers for standard 3-piece PC IOL fixation without the need for special haptic architecture or preparation.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                December 2017
                : 65
                : 12
                : 1450-1453
                Affiliations
                [1]Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
                [1 ]Department of Ophthalmology, Apollo Health City, Hyderabad, Telangana, India
                [2 ]Department of Ophthalmology, University of Nottingham, Nottingham, UK
                Author notes
                Correspondence to: Dr. Aditya Shrikant Kelkar, National Institute of Ophthalmology, 1187/30, Off Ghole Road, Near Mahatma Phule Museum, Shivaji Nagar, Pune - 411 005, Maharashtra, India. E-mail: adityapune4@ 123456gmail.com
                Article
                IJO-65-1450
                10.4103/ijo.IJO_659_17
                5742981
                29208833
                7b330619-8d9e-4639-81d1-1539d9b4f489
                Copyright: © 2017 Indian Journal of Ophthalmology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 04 August 2017
                : 26 September 2017
                Categories
                Original Article

                Ophthalmology & Optometry
                endothelial cell density,intraocular pressure,macular thickness,modified yamane's double-needle technique and flanged haptics,transconjunctival intrascleral intraocular lens fixation,visual outcomes

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