Eyeworld

EW CATARACT 29 September 2014 cases. Dislocation was corrected in 101 cases: 1) repositioning using SFIOL (48 cases), iris suturing (1 case); 2) IOL exchange ACIOL (29 cases) or ICIOL (20 cases); 3) IOL removal (1 case); 4) capsulotomy (2 cases). Mean CDVA improved sig- nifi cantly after surgery (p=0.0001). There was no signifi cant difference in postoperative CDVA between SFIOL, ACIOL, and ICIOL (p=0.753) or between the group with or without CTR. IOL repositioning was performed in 50% of case s with CTR vs. 46.9% of cases without CTR. Conclusion: Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation. A CTR within the bag did not prevent dislocation but facilitated IOL repositioning. Satis- factory results were achieved with a low rate of complications using different surgical alternatives to correct IOL position. Dr. MacDonald: The study is the largest series of in-the-bag IOL dislocation reported to date. Its retrospective design, which has inherent limitations, indicat- ed that earlier dislocation of IOL with CTR risk factor had 74% pseudoexfoli- ation accompanying disease and 55% glaucoma. One fi fth of dislocated lenses had CTR. CTR makes the repositioning easier. I suspect the CTR eyes had more extensive zonular dehiscence since they had CTRs placed and still dislocated. Because we don't have the denomina- tor of CTR cases in general, we can't comment on the rate of dislocation of CTR cases. Retrospective study of visual outcomes and complications after sutureless, fl apless, and glueless intrascleral fi xation of posterior chamber IOL in cases with inadequate capsule support Prabhu Vijayaraghavan, MS, FICO, and colleagues Purpose: To evaluate the visual outcomes and complications among cases of sutureless, fl apless and glue- less intrascleral fi xation of posterior chamber IOL in cases of inadequate capsular support. Methods: A retrospective study of 106 patients with mean follow-up of 8 months after intrascleral fi xation of the haptics of a standard 3-piece PCIOL without sutures or glue in cases of inadequate capsular support. The main outcome measures were improvement in visual acuity, early and late postoperative complications including scleral thinning. Results: Mean logMAR visual acuity change from uncorrected preoperative to best corrected post- operative was 1.63 (0.38 SD) to 0.21 (0.18 SD), p<0.001. Early postopera- tive complications (within 1 month) include corneal edema (21%), raised IOP (2%), vitreous hemorrhage (18%), and hyphema (2%). Late postoperative complications includ- ed raised IOP (9%), cystoid macular edema (6%), and retinal detachment (1%). No cases showed scleral thinning/haptic erosion. Conclusion: Technique of fl apless, glueless, sutureless scleral fi xation of 3-piece IOL showed signifi cant improvement in visual acuity. Early and late postoperative complications were managed conservatively. Dr. MacDonald: This paper presented 106 eyes of scleral fi xated PMMA lens with no suture, no glue. Good outcomes were reported but it's still early yet to tell if there will be long-term stability. There were good visual outcomes in 73% of cases, at 6/9 better and 20% at 6/18 and 6/12. Early postop com- plications included mild corneal edema (21%), vitreous hemorrhage (18%), and hyphema (2%). At 1 month or later, there were no complications in 84% of cases, with CME reported in 6% and retinal detachment in 1%. This looks surgically challenging with (I am guessing) a steep learning curve. EW Editors' note: Dr. MacDonald has no fi nancial interests related to her comments. Contact information MacDonald: Susan.M.MacDonald@lahey.org Best in cataract September 2014 View Dr. MacDonald's presentation at Clinical.EWrePlay.org.

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