OCT 2012

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

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October 2012 lene suture on a curved needle was passed through the 9:30 paracentesis and pupil, through the fibrotic CCC rim, behind the iris, and then through the superior scleral pocket incision. The other needle of the double-armed suture was then passed in a similar fashion, but this time over the fibrotic CCC. The previous stabilizing suture was removed. Next, the two ends of the suture were looped out of the Hoffman pocket and temporarily tied with a slip knot. Because laxness of the inferior zonules was then evident, the same technique except using the routine Hoffman tunnel was used to anchor the CCC rim to the sclera inferiorly using the 2:30 paracentesis. OcuCoat was injected as needed to keep the anterior chamber formed throughout the procedure. The ends of the superior and inferior incision sutures were adjusted for proper tension, tied in a square knot, cut close to the knot, and reposited into the scleral pock- ets. This effectively anchored the fi- brotic CCC rim to the sclera at both 6 and 12 o'clock. Further bimanual anterior vitrectomy was performed to be sure that no more vitreous had presented, and at this point the lens was deemed well centered and stable with this two-point fixation. The su- perior scleral flap was closed with a single interrupted 10-0 nylon suture, and overlying conjunctiva was closed with two wing 9-0 vicryl su- tures. A small bolus of vancomycin (1.0 mg in 0.1 ml of balanced salt solution) was instilled in the ante- rior chamber and vitreous, and both paracenteses were hydrated. A drop of Iopidine 0.5% (apraclonidine, Alcon, Fort Worth, Texas) and Tobradex 0.3% (tobramycin/dexam- ethasone, Alcon) were instilled. The eye was covered with a shield, and the patient was taken to the recov- ery room in good condition. On 10 months post-op, the patient continued to enjoy good quality of vision in the left eye. Her BCVA was 20/30 with a manifest refraction of +0.25 –1.00 x 089. The IOP was 12 mm Hg. Slit lamp exami- nation revealed residual Elschnig pearls in the capsular bag that could be seen near the visual axis. The IOL remained stable and well centered throughout her post-op course of 10 months to date. EW References 1. Gimbel H, Condon G, Kohnen T, et al. Late in-the-bag intraocular lens dislocation: incidence, prevention, and management. J Cataract Refract Surg 2005;31(11):2193- 204. 2. Por Y, Lavin M. Techniques of intraocular lens suspension in the absence of capsu- lar/zonular support. Surv Ophthalmol 2005;50(5):429-62. 3. Michaeli A, Assia E. Scleral and iris fixation of posterior chamber lenses in the absence of capsular support. Curr Opin Ophthalmol 2005;16(1):57-60. 4. Wagoner M, Cox T, Ariyasu R, et al. Intraoc- ular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology 2003;10(4):840-59. 5. Szurman P, Petermeier K, Aisenbrey S, et al. Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants. Br J Ophthalmol 2010;94(2):167- 9. 6. Kulkarni K, Zarbin M, Priore LD, Tezel T. Ab externo technique for accurate haptic placement of transscleral sutured posterior chamber intraocular lenses. Ophthalmic Surg Lasers Imaging 2007;38(1):72-5. 7. Kjeka O, Bohnstedt J, Meberg K, Seland J. Implantation of scleral-fixated posterior chamber intraocular lenses in adults. Acta Ophthalmol 2008;86(5):537-42. 8. Hoffman R, Fine I, Packer M. Scleral fixation without conjunctival dissection. J Cataract Refract Surg 2006;32(11):1907-12. 9. Hannush S. Sutured posterior chamber in- traocular lenses: indications and procedure. Curr Opin Ophthalmol 2000;11(4):233-40. 10.Rodriguez-Agirretxe I, Acera-Osa A, Ubeda- Erviti M. Needle-guided intrascleral fixation of posterior chamber intraocular lens for aphakia correction. J Cataract Refract Surg 2009;35(12):2051-3. 11.Ton Y, Michaeli A, Assia E. Repositioning and scleral fixation of the subluxated lens cap- sule using an intraocular anchoring device in experimental models. J Cataract Refract Surg 2007;33(4):692-6. 12.Gimbel H, Shah C, Venkataraman A, Rattray K. Capsular Membrane Suture Fixation of Sulcus IOLs. Clin Surg Ophthalmol 2008;26(2):42-7. Editors' note: Dr. Gimbel has no finan- cial interests related to this article. Contact information Gimbel: hvgimbel@gimbel.com Come See Us At AAO, Booth 1904 s&AX 3360 Scherer Drive, Suite B. 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