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Session Title: Subluxed IOLs and Scleral Fixation
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 08:18
Venue: E102 (First Floor)
First Author: : R.Mukherjee INDIA
Co Author(s): :
Demonstrates a new and safe ,sutureless and easy surgical technique of secondary implant ,wherein the IOL( foldable or non-foldable) haptics are lassoed into the 4mm prefabricated scleral tunnels, using micro-silicone tubings.through the 23G vitrectomy trocar canula system, nasally and temporally, after completing vitrectomy. IOL implantation,is facilitated with the use of micro-silicone tubing ,27G specially designed forceps and self designed silicone tube holder.This procedure simplifies scleral fixation and allows implantation of even rigid pmma IOLs, thereby making the procedure less costlier and prevents haptic damage.
Private Practice at Oculus Dr.Mukherjee"s Eye Clinic 1/1,Nav Bharatiya Bhavan CHS, 371,Tenth Road, Chembur, Mumbai - 400071. INDIA.
Corneal centre, limbus marked at 3,9 O"clock,and adjoining conjunctiva recessed. Two ,2+2mm scleral tunnels,in anticlockwise direction , parallel to the limbus ,on either side, with 23G MVR blade, is fashioned. 23G trocar canula is inserted in the proximal part of the scleral tunnel - temporal port for vitrectomy and nasal port for infusion. 2 Micro silicone tubing (MST) 40mm each , is inserted on the leading and trailing haptics.The free ends are inserted into the AC through the 12O"clock incision and grasped with 27G forceps inserted into the AC through the temporal port first, to exteriorise MST attached to the leading haptic, and then through nasal port for trailing haptic MST . The trocar removed, and the exteriorised MST is pulled through the distal 2mm tunnel on both sides. The IOL is then folded with forceps/injector and inserted through 3.5mm corneal incision , or a 5.5/6 mm posterior limbal incision for non foldable pmma IOL with the leading haptic first and the trailing haptic tucked in later . The exteriorised MST are simultaneously pulled in opposite direction to railroad the lassoed haptics into the 4mm scleral tunnel and finally removed. Wound integrity checked,and conjunctiva apposed at limbus with cautery.
8 eyes of 8 patients, aged 56-72 years , 7 males and 1 female ,were operated by myself as a single surgeon between April 2012 - January 2013 , with followup ranging from 10 months - 1 month. 8 patients - uniocular aphakia , 7 patients , 1 female and 6 males achieved CDVA of 20/40 at 4 weeks post-operatively,comparable to their pre-operative vision , and maintained the same till the last followup visit in February 2013. 1 patient ,male , had a preoperative CDVA of 20/100 , due to epiretinal membrane. at 1 month post-operatively he attained 20/100, and maintained till the last followup in february 2013. The procedure performed in all the patients was free of any intraoperative or postoperative complications.
Sutureless , complication free , simplified procedure of secondary IOL ( foldable or non-foldable ) implantation ,with rigid and stable fixation of IOL haptics in 4mm half thickness scleral tunnels , preventing decentration , tilt . Cosmetically good , with gratifying visual results , not requiring any corrections of IOL dioptric power. The Micro Silicone Tubing (MST) from DowCorning has an inner diameter of 400 microns which snugly fits on the haptics of the IOL like a lasso, thereby eliminating the risk of IOL dislocation during insertion . The outer diameter being 600 microns easily glides through the 23G ports during exteriorisation .This allows even rigid non-foldable pmma lenses to be implanted,which has never been possible unless sutured , thus making the procedure more economical. With foldable IOLs the risk of haptic damage or breakage during exteriorisation is totally avoided. Use of 23G MVS allows an angled entry into the vitreous cavity to create better wound integrity , and also prevents inadvertent injuries to the vitreous base and uveal tissue during instrument exchange and haptic delivery,and eases performing posterior segment procedures simultaneously. Location of vitrectomy ports 2mm from the 3 & 9 O"clock limbus, avoids the major arterial circle, preventing bleeds.
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