Khatri Anadi, Singh Sweta, Rijal Roshija, Khatri Bal Kumar, Kharel Muna
Lumbini Eye Institute, Lumbini, Nepal,
Birat Eye Hospital.
Clin Ophthalmol. 2018 Aug 14;12:1441-1447. doi: 10.2147/OPTH.S166354. eCollection 2018.
To report a modified technique of sutureless intrascleral fixation of a posterior chamber intraocular lens with use of instruments of anterior segment surgery and its outcomes.
Prospective, noncomparative, interventional case series.
Ninety-two eyes of 92 patients with aphakia and subluxated lens who underwent surgery were evaluated.
27-gauge needles were introduced transclerally and guided by the viscocanula to externalize via the main wound. The haptics were loaded into the lumen and externalized from entry points. The haptics were then fixed in a scleral tunnel made by a 27-gauge needle. The best-corrected visual acuity (BCVA) and complications were determined.
Ninety two eyes which were operated and completed follow-up of 6 weeks were included in the study. The most common indications for scleral-fixated intraocular lens (SFIOL) were subluxated lens - 55 eyes (59%), and surgical aphakia - 31 eyes (34%). Sixty-nine eyes (75.7%) had a postoperative vision of uncorrected visual acuity of 6/18 on day 1. There was an improvement in mean logMAR BCVA (0.086±0.18) at 6 weeks as compared to preoperative visual acuity (<0.05). BCVA of 6/12 or better was attained in 94% of the cases at 6 weeks. Special mentions need to be made for 6 (7%) of our cases. Three of the patients were cases of fully treated postoperative endophthalmitis who lacked capsular support. Two of the other cases had undergone pars plana vitrectomy for retinal detachment. Both had silicon oil removal done 1 month before the SFIOL procedure. One of the patients had Marfan's syndrome.
Our procedure is safe, easy, less traumatic, and less resource-demanding with good visual outcomes and can be performed even in low-resource settings of developing countries. It may also be considered in patients who have had posterior segment surgeries previously.
报告一种使用前段手术器械进行后房型人工晶状体无缝线巩膜内固定的改良技术及其效果。
前瞻性、非对比性、干预性病例系列。
对92例接受手术的无晶状体和晶状体半脱位患者的92只眼进行评估。
经巩膜插入27号针，并在粘弹套管引导下经主切口引出。将人工晶状体襻装入管腔并从进针点引出。然后将襻固定在由27号针制作的巩膜隧道内。测定最佳矫正视力（BCVA）和并发症。
92只接受手术并完成6周随访的眼纳入研究。巩膜固定人工晶状体（SFIOL）最常见的适应证是晶状体半脱位——55只眼（59%），以及手术性无晶状体——31只眼（34%）。69只眼（75.7%）术后第1天的裸眼视力为6/18。与术前视力相比，6周时平均logMAR BCVA有所改善（0.086±0.18）（P<0.05）。6周时94%的病例达到6/12或更好的BCVA。我们的6例（7%）病例需要特别提及。其中3例患者是术后眼内炎得到充分治疗但缺乏囊膜支持的病例。另外2例因视网膜脱离接受了玻璃体切除术。均在SFIOL手术前1个月取出硅油。其中1例患者患有马凡综合征。
我们的手术安全、简便、创伤小、资源需求少，视觉效果良好，甚至可以在发展中国家资源匮乏的环境中进行。对于之前接受过后段手术的患者也可考虑采用。
