Curran Christian, Adam Murtaza K
Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Colorado Retina Associates, Denver, CO, USA.
J Vitreoretin Dis. 2023 Jun 5;7(5):404-411. doi: 10.1177/24741264231178377. eCollection 2023 Sep-Oct.
To report the clinical and anatomic outcomes of a single-stage rescue and sutureless 30-gauge needle-assisted transconjunctival intrascleral fixation of dislocated 3-piece rigid poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs). This retrospective noncomparative single-surgeon interventional study comprised eyes that had concurrent 23- or 25-gauge pars plana vitrectomy and IOL rescue with sutureless transconjunctival needle-assisted flanged haptic intrascleral fixation. Lamellar scleral dissection for haptic fixation was performed 3 mm posterior to the surgical limbus with 30-gauge needles. Primary endpoints included visual acuity (VA), IOL tilt measured with ultrasound biomicroscopy (UBM), and postoperative complications. The study evaluated 25 eyes of 24 patients. The IOL was successfully refixated in 24 of the 25 eyes. The mean preoperative logMAR VA of 1.21 ± 0.79 SD (median 1.3; Snellen equivalent 20/400) improved to 0.28 ± 0.35 (median 0.14; Snellen equivalent 20/30) postoperatively ( < .0001). The mean IOL tilt measured by UBM (n = 7) was 3.79 ± 3.60 degrees. The mean postoperative follow-up was 348 ± 284 days (range, 7-979 days). Postoperative complications included self-clearing vitreous hemorrhage (n = 9), retinal detachment (RD) (n = 1), cystoid macular edema (n = 3), and corneal edema (n = 3). Three eyes (13%) required additional surgery, 1 for RD and 2 for delayed haptic slippage and secondary IOL tilt causing irregular astigmatism. Intrascleral needle-assisted fixation of dislocated or mobile 3-piece PMMA IOLs is an effective, safe method to restore VA.
报告单阶段挽救性且无缝合的30号针辅助经结膜巩膜内固定脱位的三片式硬质聚甲基丙烯酸甲酯（PMMA）人工晶状体（IOL）的临床和解剖学结果。这项回顾性非对照单术者干预性研究纳入了同时行23号或25号睫状体平坦部玻璃体切除术以及采用无缝合经结膜针辅助带凸缘襻的巩膜内固定进行IOL挽救的眼睛。使用30号针在手术角膜缘后方3 mm处进行用于襻固定的板层巩膜切开。主要终点包括视力（VA）、用超声生物显微镜（UBM）测量的IOL倾斜度以及术后并发症。该研究评估了24例患者的25只眼。25只眼中有24只眼的IOL成功重新固定。术前平均logMAR VA为1.21±0.79标准差（中位数1.3；Snellen等效值20/400），术后改善至0.28±0.35（中位数0.14；Snellen等效值20/30）（P＜0.0001）。通过UBM测量的平均IOL倾斜度（n = 7）为3.79±3.60度。术后平均随访时间为348±284天（范围，7 - 979天）。术后并发症包括自行消退的玻璃体出血（n = 9）、视网膜脱离（RD）（n = 1）、黄斑囊样水肿（n = 3）和角膜水肿（n = 3）。三只眼（13%）需要额外手术，1只眼因RD，2只眼因延迟的襻滑脱和继发性IOL倾斜导致不规则散光。巩膜内针辅助固定脱位或可移动的三片式PMMA IOL是恢复视力的一种有效、安全的方法。
