An Alternative Technique For Intraocular Lens Removal: Bimanual Cleavage In The Vitreous Chamber
Published 2024 - 42nd Congress of the ESCRS
Reference: PP04.10 | Type: Free paper | DOI: 10.82333/rrrg-m280
Authors: Matteo Mario Carla'* 1 , Carlos Mateo 2
1Ophthalmology Department,Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli,Rome,Italy, 2Ophthalmology Department,Instituto de Microcirugia Ocular, IMO, Barcelona,Barcelona,Spain
Purpose
We aimed to present a new technique for lens explantation, involving intraocular lens (IOL) cleavage in the vitreous chamber using two forceps and successive removal from the anterior chamber (AC).
Setting
In this retrospective mono-centric interventional analysis, we enrolled patients affected IOL subluxation or dislocation into the vitreous chamber at Instituto de Microcirugia Ocular, Barcelona, Spain, between January 2023 and January 2024.
The primary endpoint was to verify the effectiveness of the IOL cleavage technique in the vitreous chamber, for a safer and less traumatic lens explantation.
Methods
Analysis of 10 eyes affected by IOL subluxation/luxation who underwent IOL explantation and 23G vitrectomy. After separating the capsular bag rests from the IOL using the vitrectomy probe, serrated forceps were used to grab the IOL, while microscissors performed an “initiation” cut at the midpoint of the lens plate. A second pair of serrated forceps grabbed the IOL plate on the other side. Then, the two forceps were slowly pulled one apart from the other, exerting a separative force perpendicular to the initiation cut and causing the IOL to cleave in two pieces. In case of asymmetric cleavage, a second cleavage was performed. The pieces of the IOL were then moved to the AC and removed through a 2.4-mm corneal incision.
Results
Intraoperative mean IOL removal time was 14.1±6.5 minutes. The IOLs (seven 1-piece and three 3-pieces IOLs) were successfully explanted with this technique in all patients. Overall, 4 cases underwent exclusive IOL explantation and the eyes were left aphakic. Postoperatively, BCVA improved in all patients at 1 week follow-up and no intraoperative or postoperative adverse events were reported. Cornea was completely clear in every case since postoperative day 1.
Conclusions
In conclusion, we presented a novel technique for IOL removal which exploits two vitreal forceps, starting from an initiation cut made with microscissors. We think that this method ensures safer manipulation of the lens in the larger vitreous chamber and minimizes the procedures to be performed in the AC, benefiting the iris and the cornea.