AUG 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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August 2013 EW RESIDENTS 53 outcomes after glued foldable inadequate capsules" Left to right: Richard Hwang, MD, William Watkins, MD, Samantha Williamson, MD (chief resident), Yuna Rapoport, MD, and Sumeer Thinda, MD Source: Laura I. Wayman, MD postoperative IOP recorded in eyes that received glued foldable intrascleral lenses in better context. Different patient populations, ranges of follow-up, and diagnosis threshold for ocular hypertension make comparing rates of postoperative ocular hypertension difficult between this and previous studies. The authors reported no postoperative retinal detachments with a mean follow-up of 16.7 months, and drew contrast to reported rates of retinal detachment following scleralsutured IOLs of 2.4–10%. The studies cited in the present paper that examined postoperative complications of scleral-fixated lenses had a mean follow-up of 1–83.3 months,410 and this variation of postoperative follow-up may undermine direct comparison. In addition, the present study excluded individuals with a dislocated nucleus that required a pars plana vitrectomy (PPV). In contrast, a comparison study cited by the authors included patients who had undergone intracapsular cataract extraction and subsequent PPV.8 No mention is made of the learning curve for this procedure. The authors reported that IOL decentration occurred due to surgical imprecision, secondary to either unequal haptic tuck or non-diagonal scleral flaps. Outcomes for glued intrascleral IOL implantation may be different than those reported in the hands of a novice surgeon. Nonetheless, the present study suggests that glued foldable IOL implantation results in satisfactory visual outcomes without serious complications. This technique may reduce the incidence of postoperative inflammation and glaucoma compared to sutured IOLs. Suturerelated complications (i.e., suture breakage, suture exposure) would also be avoided. An added benefit to glued IOL implantation is the ability to use currently available IOLs, in contrast to other non-endocapsular procedures that require special lenses. In addition to avoiding the cost of special IOL designs, this technique may prove to be cost effective if associated with fewer complications and secondary procedures. Glued intrascleral IOL implantation represents a promising option for eyes with inadequate capsular support. We look forward to a prospec- tive, randomized, controlled trial with longer follow-up to further evaluate its outcomes. EW References 1. Kumar D, Agarwal A, Packiyalakshmi S, Jacob S, Agarwal A. Complications and visual outcomes after glued foldable intraocular lens implantation in eyes with inadequate capsules. J Cataract Refract Surgery 2013; 39:1211-1218. 2. Kumar D, Agarwal A. Glued intraocular lenses: a major review on surgical tech- niques and results. Curr Opin Ophthalmol 2013; 24:21-29. 3. Ganekal S, Venkataratnam S, Dorairaj S, Jhanji V. Comparative evaluation of sutureassisted and fibrin glue-assisted scleral fixated intraocular lens implantation. J Refract Surg 2012; 28:249-252. 4. McAllister AS, Hirst LW. Visual outcomes and complications of scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg 2011; 37:1263-1269. 5. Kwong YY, Yuen HK, Lam RF, et al. Comparison of outcomes of primary scleral-fixated versus primary anterior chamber intraocular lens implantation in complicated cataract surgeries. Ophthalmology 2007; 114:80-85. 6. Yang YF, Bunce C, Dart JK, et al. Scleral-fixated posterior chamber intraocular lenses in non-vitrectomized eyes. Eye (Lond) 2006; 20:64-70. 7. Chang JH, Lee JH. Long-term results of implantation of posterior chamber intraocular lens by suture fixation. Korean J Ophthalmol 1991; 5:42-46. 8. Kjeka O, Bohnstedt J, Meberg K, Seland JH. Implantation of scleral-fixated posterior chamber intraocular lenses in adults. Acta Ophthalmol 2008; 86:537-542. 9. Helal M, el Sayyad F, Elsherif Z, et al. Transscleral fixation of posterior chamber intraocular lenses in the absence of capsular support. J Cataract Refract Surg 1996; 22:347-351. 10.Mittelviefhaus H, Witschel H. Transscleral suture fixation of posterior-chamber lenses after cataract extraction associated with vitreous loss. Ger J Ophthalmol 1995; 4:80-85. Contact information Wayman: laura.l.wayman@vanderbilt.edu

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