Eyeworld

20 | EYEWORLD | JULY 2021 Contact Mukhtar: mukhtars@upmc.edu Waxman: waxmane@upmc.edu ASCRS NEWS technique, it would be helpful to use a lens with stronger haptics such as the CT Lucia 602 (Carl Zeiss Meditec), as there can be a lot of manip- ulation and torquing of the haptics earlier on. The surgeon should be mindful that the change in direction from the vertical sclerotomy to the horizontal scleral tunnel is a difficult angle and requires targeted manipulation of the haptics. Lastly, having an able assistant to hold the leading haptic during the handshake technique is important and should be considered during surgical planning. In conclusion, the authors presented long- term results of the glued IOL technique that overall had good anatomical and functional outcomes showing stability in these complex pa- tients. While there can be a steep learning curve associated with the technique, it is an important skill for a surgeon to have in their armamentari- um for eyes with deficient capsules. axis and 0.4±1.2 degrees in the 0 to 180 axis versus mean 2.4 degrees in the Yamane tech- nique). 11,14 This is likely due to the fact that the scleral passage with the Yamane technique is more difficult, and the glued IOL technique uses bigger openings and allows for more consistent scleral passages, therefore, a surgeon may have more tilt with the Yamane technique when first learning it. Lens availability can also determine which technique to use; if the correct lens is unavailable to perform the Yamane technique, the glued IOL technique becomes a better op- tion. Regardless, it is important to understand that both techniques have a role and surgeons should be skilled in both. More long-term out- comes data is needed comparing both sutureless transscleral fixated IOL techniques. A few pearls mentioned by the panelists in the ASCRS Journal Club included performing a pars plana vitrectomy as there is a lot of posteri- or manipulation, especially at the vitreous base. Additionally, when a novice surgeon learns the Glued intraocular lens in eyes with deficient capsules: A retrospective analysis of long-term effects Dhivya Ashok Kumar, MD, FRCS, Amar Agarwal, MS, FRCS, Atul Dhawan, MBBS, MS, Vijayanand Thambusamy, MBBS, DO, Soundari Sivangnanam, DO, DNB, Triveni Venktesh, MBBS, MS, Radhika Chandrasekar, BSc J Cataract Refract Surg. 2021;47(4):496–503. n Purpose: To assess the long-term (6–12 years) results and complications of glued transscleral fixated intraocular lens (IOL). n Setting: Dr. Agarwal's Eye Hospital, Chennai, India. n Design: Retrospective case series. n Methods: Eyes with glued IOL with more than 5 years of follow-up were evaluated. Visual acuity (logMAR), IOL tilt, corneal topography, corneal endothelial cell density, intraocular pressure, central corneal thickness (CCT), central foveal thickness (CFT), and ocular residual astigmatism (ORA) were evaluated. n Results: Overall, 91 eyes (63 patients) with mean postoperative 8.2±2.3 years were analyzed. The durations were 10–12 years in 31 (34%) eyes, 9 years in 14 eyes (15.3%) and 6–9 years in 46 eyes (50.5%), respectively. No subscleral haptic was visible in 50% of eyes. Mild, moderate, and severe grade of haptic visibility was noted in 33.5%, 9.4%, and 7%, respectively. The BCVA was 0.50±0.50 logMAR. Clinically no tilt was seen in 87 eyes (95.6%), while detectable tilt was seen in 4 eyes (4.3%). The OCT microtilt was 0.8±1.70 and 0.4±1.20 degrees in 90- and 180-degree axes, respectively. The mean iris vault was 0.45 mm, and the mean ORA was 1.1±1 D. Complications were glaucoma (7.6%), IOL luxation (4.4%), retinal detachment (3.2%), macular edema (4.3%), corneal decompensation (3.2%), uveitis (2.1%) and uveitis-glaucoma-hyphema syndrome (1%). Haptic reposition (3.2%), retinal detachment surgery (3.2%), keratoplasty (1%), pupilloplasty (2.1%), and IOL explantation (1%) were the second surgeries. n Conclusion: Glued IOL has shown good anatomical and functional stability with minimal incidence of vision-threatening complications on long term. continued from page 19 References continued 9. Kumar DA, Agarwal A. Glued intraocular lens: a major review on surgical technique and results. Curr Opin Ophthalmol. 2013;24:21–29. 10. Kumar DA, et al. Compli- cations and visual outcomes after glued foldable intraocular lens implantation in eyes with inadequate capsules. J Cataract Refract Surg. 2013;39:1211–1218. 11. Kumar DA, et al. Glued intra- ocular lens in eyes with deficient capsules: retrospective analysis of long-term effects. J Cataract Refract Surg. 2021;47:496–503. 12. Wagoner MD, et al. Intraoc- ular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmol- ogy. 2003;110:840–859. 13. Kumar DA, et al. Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reacti- vation of inflammation. Indian J Ophthalmol. 2019;67:1610–1616. 14. Yamane S, et al. Suture- less 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scler- al dissection. Ophthalmology. 2014;121:61–66.

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