Kim Min, Lee Dong H, Koh Hyoung J, Lee Sung C, Kim Sung S
*Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; and †Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Retina. 2015 Jul;35(7):1450-7. doi: 10.1097/IAE.0000000000000484.
To report short-term surgical outcomes of single-stage simultaneous rescue and sutureless intrascleral fixation of dislocated intraocular lens (IOLs).
Sixteen eyes of 16 patients who underwent simultaneous rescue and intrascleral fixation of dislocated 3-piece IOLs were retrospectively evaluated. Partial thickness limbal-based scleral flaps (2.0 × 2.0 mm) were created, and a 22-gauge round needle was used to create a sclerotomy at 1.5 mm from the limbus under the previously created scleral flap, and a 23-gauge trans pars plana vitrectomy was performed. Bimanual maneuvers using two 23-gauge end-grasping forceps under chandelier illumination and a wide-angle viewing system enabled 1 step rescue of IOLs from the posterior vitreous cavity with 1 hand and simultaneous haptic externalization through sclerotomy with the other hand. An externalized haptic was placed into the 3-mm intrascleral tunnel created using a bent 26-gauge needle. Fibrin glue was used to fixate haptics and close the scleral flaps.
Intraocular lenses were successfully rescued and sclera-fixated through intrascleral tunnels in all 16 eyes (mean age, 56.56 ± 19.89 years). The mean preoperative logarithm of the minimum angle of resolution best-corrected visual acuity was 0.92 ± 0.68, and this significantly improved at 6 months to 0.289 ± 0.36 (P = 0.003). During the follow-up period (10.1 ± 3.21 months), no significant change of endothelial cell count or central foveal thickness was noted postoperatively (P = 0.203 and P = 0.979, respectively). There were no significant postoperative complications such as IOL dislocation, IOL decentration, retinal detachment, endophthalmitis, or postoperative hypotony.
Simultaneous rescue and sutureless intrascleral haptic fixation of dislocated 3-piece IOLs using bimanual maneuvers is an effective, safe, and minimally invasive surgical method to rescue and fixate the dislocated IOL without further explant.
报告脱位人工晶状体（IOL）单阶段同步挽救与无缝线巩膜内固定的短期手术效果。
回顾性评估16例患者的16只眼，这些患者接受了脱位的三片式IOL同步挽救与巩膜内固定术。制作基于角膜缘的部分厚度巩膜瓣（2.0×2.0mm），使用22号圆针在先前制作的巩膜瓣下距角膜缘1.5mm处制作巩膜切口，并进行23号经睫状体平坦部玻璃体切除术。在吊灯照明和广角观察系统下，使用两把23号末端抓取镊进行双手操作，一只手将IOL从玻璃体后腔一步挽救出来，另一只手同时通过巩膜切口将襻引出眼外。将引出的襻放入使用弯曲的26号针制作的3mm巩膜内隧道中。使用纤维蛋白胶固定襻并关闭巩膜瓣。
所有16只眼（平均年龄56.56±19.89岁）的IOL均成功挽救并通过巩膜内隧道固定于巩膜。术前最佳矫正视力最小分辨角对数平均值为0.92±0.68，6个月时显著改善至0.289±0.36（P = 0.003）。在随访期（10.1±3.21个月）内，术后内皮细胞计数或中央凹厚度无显著变化（分别为P = 0.203和P = 0.979）。术后无IOL脱位、IOL偏心、视网膜脱离、眼内炎或术后低眼压等显著并发症。
使用双手操作对脱位的三片式IOL进行同步挽救与无缝线巩膜襻固定是一种有效、安全且微创的手术方法，可挽救并固定脱位的IOL，无需进一步取出。
