Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, West Bengal, India.
Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, West Bengal, India.
Am J Ophthalmol. 2020 Oct;218:314-319. doi: 10.1016/j.ajo.2020.03.021. Epub 2020 Mar 25.
To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL).
Retrospective interventional case series.
A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3 mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt.
Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P < 0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt.
This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.
评估改良的自密封巩膜口袋技术用于巩膜固定人工晶状体（IOL）的效果和存活率。
回顾性介入性病例系列。
回顾性介入性病例系列，在过去的 4 年中，81 只眼睛接受了这种改良技术。病例包括脱位的 IOL 和缺失的后囊或半脱位的白内障。在距角膜缘 3 毫米处，在两个对角的缘旁，制作两个弯曲的自密封巩膜袋，同时进行玻璃体切割术。使用多件式 IOL，将襻固定在巩膜袋下的线性巩膜隧道下，位于浅层巩膜瓣下。使用电烙术使结膜对合。术后行眼前节光学相干断层扫描（AS-OCT），以检测巩膜内襻和光学倾斜的高反射横截面。使用超声生物显微镜（UBM）重新评估光学位置。主要结果是平均术前和术后最佳矫正视力（BCVA）、术后散光。术后 AS-OCT 用于检测襻和光学的位置。UBM 用于重新检查任何光学倾斜。
平均术前和术后 BCVA 分别为 LogMAR 1.2 ± 0.59 和 LogMAR 0.47 ± 0.3（P < 0.001）。平均术后散光为 1.27 ± 1.02 Dcyl。在 AS-OCT 中，巩膜内高反射阴影表示稳定的襻，没有任何光学倾斜。UBM 也显示 IOL 光学的稳定位置，没有任何倾斜。
这种改良的、简单的 IOL 巩膜固定方法可以缩短手术时间，并发症最小。
