Transcript OUR EXPERIENCE OF SECONDARY IOLS

“OUR EXPERIENCE OF
SECONDARY IOLS SCLERAL FIXATION v/sAC IOL
DR. RUPAM DESAI
ROTARY EYE INSTITUTE
NAVSARI
INDIA
(Author has no financial
interest)
INTRODUCTION
• When we think about aphakic eyes, it is a
complication – comes to our mind immediately.
•
Scleral fixation IOL is really boon to aphakic
patients who have no posterior capsule.
• So, patient can really enjoy a good pseudophakic
vision without any corneal complications as which
may be induced by AC IOLs.
Materials & Methods
• It was a prospective study of 40 eyes.
• Group A -22 eyes, underwent Scleral fixation
IOL procedure. Group B includes 18 eyes,
underwent AC IOL implantation.
• Patients demographic data shows mean age
of 62 with M:F ratio is 32:8.
• Systemic ailments were ruled out.
Materials & Methods
• Primary cause of surgery was senile cataract
in 34 patients, subluxated cataract in 4
patients, traumatic cataract in 2 patients.
• The duration between primary and secondary
surgery was between 3 months to 2 years.
• Preoperative vision, IOP, corneal thickness,
specular microscopy, gonioscopy, SLE and
fundus examination was done in all patients.
Surgical Procedure
• P/B anesthesia was given.
• Complete aseptic precaution was taken.
• Conjunctival peritomy done. Cauterization
done.
• Scleral tunnel made for IOL insertion. 2
scleral pockets made 180 º apart (avoiding 3
and 9 o’clock).
• Vitrectomy was done if required.
Surgical Procedure
• Scleral fixation suture (10-0 prolene with
straight needle) passed from 1 scleral pocket
to opposite scleral pocket.
• Suture was pulled out through superior
tunnel and suture was cut. Cut ends were
tied with holes of haptics of IOL.
• Other end of suture was pulled and IOL was
inserted in posterior chamber. Straight
needle of suture was then passed through
sclera and tied.
Surgical Procedure
• Scleral pockets were sutured with 10-0 nylon.
Conjunctival sutures taken.
• S/C antibiotics and steroids given.
Postoperatively oral antibiotics, topical
antibiotics, steroids and cyclopegics were
given.
• All patients were followed up on 1st day,
week, 1 month, 3month, 6month and year. At
each follow up patients were evaluated in
detail.
Results
Group – A
Group – B
Visual improvement
51.54 %
33.33 %
Visual deterioration
18.18%
44.44%
Hypotony
_
2.22%
CME
9%
22.22%
IOL decentration
_
11.11%
AC reaction
27%
33.33%
Stitch granuloma
0.1%
_
Mean astigmatism
2.35D
1.25D
Discussion
• Our prospective study shows that visual outcome
and complications were comparable and few in both
groups.
• Hill et all showed that 44.4 % had improved BCVA as
compared to 54.54% of our study.
• Lee et all (1993) revealed that Scleral fixation may
cause greater degree of tilt as compared to routine
PC IOL, the tilt has little effect on post operative
astigmatism. In our study mean astigmatism is 2.5 D
which may be due to large incision and sutures and
none of the patient show tilt of IOL.
Discussion
• AC reaction and CME may be due to vitrectomy.
• Suture erosion was reported by Solomon, Heilskov,
Othoff. Endophthalmitis was reported in cases with
exposed sutures. In our study there is no
endophthalmitis and only 1 case shows suture
exposure.
• Ab externo approach reduces the chances of
vitreous hemorrhage as compared to Ab interno
approach practiced by Uthoff.
Conclusion
• What ever is the cause of aphakia, proper
preoperative evaluation, good intra operative
vitrectomy followed by SF IOL implantation
give good postoperative comfort and better
alternative to AC IOL.
THANKS