Cataract Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Indian J Ophthalmol. 2022 Jul;70(7):2777. doi: 10.4103/ijo.IJO_1429_22.
Even though rare, posterior chamber intraocular lens (IOL)-bag complex dislocation is a serious complication following cataract surgery. Preoperative trauma or zonular weakness, capsule contraction syndrome, and surgical or postoperative trauma to the zonules have been proposed as the causative mechanism. Various risk factors have been described such as pseudoexfoliation (PXF), aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, and connective tissue disorders, among which PXF is the most common risk factor. The management of late IOL-bag complex dislocation poses a challenge even for an experienced surgeon.
To demonstrate the "stay back technique" of scleral fixation of decentered IOL-bag complex.
We demonstrate three cases of scleral fixation of anteriorly dislocated IOL-bag complex. The first two cases are traumatic subluxation of IOL-bag complex and the third case is late decentration of both the haptics in a case of PXF. A scleral flap/groove is made along the area of haptic dislocation. Dislocated haptic is allowed to stay in the same position and one arm of 9-0 prolene suture is passed between the optic-haptic junction and docked in a 26-gauge needle passed beneath the scleral flap, 2 mm from the limbus. Haptic is then repositioned beneath the iris and the second arm of prolene suture is passed above the haptic. Sutures are pulled underneath the scleral flap and secured with 5 to 6 knots.
This is a simplified approach of scleral fixation of anteriorly dislocated IOL-bag complex. This novel technique gives better visualization of the optic-haptic junction during the passage of prolene suture.
尽管罕见，但后房型人工晶状体（IOL）-囊袋复合体脱位是白内障手术后的一种严重并发症。术前创伤或悬韧带薄弱、囊袋收缩综合征以及手术或术后对悬韧带的创伤被认为是致病机制。已经描述了各种危险因素，例如假性剥脱（PXF）、衰老、高度近视、葡萄膜炎、外伤、先前的玻璃体视网膜手术、色素性视网膜炎、糖尿病和结缔组织疾病，其中 PXF 是最常见的危险因素。即使对于经验丰富的外科医生来说，晚期 IOL-囊袋复合体脱位的处理也具有挑战性。
展示偏位 IOL-囊袋复合体巩膜固定的“后退技术”。
我们展示了 3 例前脱位 IOL-囊袋复合体的巩膜固定病例。前两例是 IOL-囊袋复合体的外伤性半脱位，第三例是 PXF 病例中两个襻的晚期偏心。在襻脱位区域制作巩膜瓣/槽。允许脱位的襻保持在同一位置，将 9-0 prolene 缝线的一条臂穿过光学-襻交界处并扣入在巩膜瓣下方 26 号针，距角膜缘 2 毫米。然后将襻重新定位在虹膜下方，将 prolene 缝线的第二条臂穿过襻上方。缝线被拉到巩膜瓣下方，并通过 5 到 6 个结固定。
这是一种简化的前脱位 IOL-囊袋复合体巩膜固定方法。这种新技术在穿过 prolene 缝线时提供了更好的光学-襻交界处可视化。
