Unstable IOL: tips and tricks - Needles can help
First Author: B.Oliveira Lopes PORTUGAL
Co Author(s): M. Brízido V. Lemos S. Cruz L. Gomes J. Nascimento
The surgical management of dislocated IOL and aphakia without capsular support is often complex. Surgery is planned after a comprehensive case evaluation that includes the retina-vitreous status, type of luxated or subluxated IOL and evaluation of the iris and remaining capsular bag support. We report tips and tricks using needles in three surgical techniques that can help in these circumstances: Aphakic retropupilar IOL Artisan implantation with 27 or 30 G needle, sutureless sclera IOL fixation with 25 G needle and unstable IOL levitation with simple impaling technique of a 30G into a 25G needle in vitrectomized eye.
Ophthalmology Department, Beatriz Ângelo Hospital
We report in video tips and tricks using needles in several clinical cases of aphakic eyes undergoing retropupillary iris-claw IOLs enclavation (Artisan®) and sutureless scleral IOL fixation. Special instruments for the implantation and fixation of these IOLs are available to optimize the operative procedure. However, the presented surgical techniques are costless, simple and unprovided of other instruments unless a 27G or a 30G needle. We also report a simple impaling technique of a 30G into a 25G needle that can be used in cases of unstable IOLs that needs explantation and replacement in vitrectomized eyes.
Iris-claw IOLs and sutureless scleral IOLs fixation have been shown to be a safe choice for secondary IOL implantation in eyes with extended zonulolysis or without enough capsular support. IOLs were properly retropupillary positioned and maintained centered and stable in our case series. In relation to unstable IOLs explantation or replacement, the IOL levitation with an impaling technique of a 30G into a 25G needle, showed good anatomic and functional results. There was no intra or postoperative complications in all reported cases.
The iris-claw fixation with 27G or 30G needle and the scleral IOLs fixation techniques with a 25G needle allow a safe retropupillar IOL implantation in cases of extended zonulolysis or without capsular support, reducing the risk of posterior IOL dislocation. The IOL levitation with an impaling technique of a 30G into a 25G needle can be very helpful in recover a subluxated IOL. These surgical techniques are costless, simple and may be very useful in these complex situations, by combining the advantages of short operation time and minimal manipulation of the conjunctiva and trauma to the corneal endothelium.