IOL Dislocation After Penetrating Keratoplasty

Surgeons discuss how to proceed after dislocation of the IOL–capsular bag complex is observed in a patient’s better-seeing eye.

Audrey R. Talley Rostov, MD; Ashvin Agarwal, MS; Ehud Assia, MD; and Samuel Masket, MD

Cataract and Refractive Surgery Today

CASE PRESENTATION A 76-year-old patient presents with diplopia and blurry vision in the right eye. This eye underwent penetrating keratoplasty for advanced keratoconus 20 years ago, cataract surgery with the implantation of a toric IOL 4 years ago, and sutured recentration of the IOL 1 year ago. On examination, the patient’s UCVA is 20/200 OD, and their BCVA is -2.50 + 4.00 x 150º = 20/50 OD. The corneal transplant is clear. Superior dislocation of the IOL–capsular bag complex is observed (Figure 1). Residual cortex and anterior tilt of the lens are evident, and iris sutures are present at the 11 and 12 clock positions. Multiple iris transillumination defects are visible. An OCT scan of the macula is normal. Tomography reveals 5.00 D of astigmatism at 140º.

Sutureless Scleral Fixation of IOLS

Evaluating real-world outcomes.

Zachary Zavodni, MD

Cataract and Refractive Surgery Today

Double-Flanged Polypropylene Technique: 5-Year Results Canabrava S, Carvalho MS1Industry support: None ABSTRACT SUMMARY A prospective observational case series evaluated the outcomes of patients who underwent the flanged polypropylene scleral fixation of capsular tension segments (CTSs) and IOLs. A total of 71 eyes were divided into three groups: double-flanged CTS (n = 25), four-flanged nonfoldable IOL (n = 18), and four-flanged foldable IOL (n = 28). The sutures made of 5-0 and 6-0 polypropylene were used in 60% and 40% of the cases, respectively. Partial-thickness scleral tunnels were created in all cases to facilitate burial of the flanges. Follow-up averaged 28.24 months (range, 6–60 months). Descriptive outcome measures included patients’ visual acuity, flange position (intrascleral vs sub-Tenon vs conjunctival erosion), and complications such as IOL dislocation and retinal detachment. Study in Brief A prospective observational case series assessed the long-term results and complications of the scleral fixation of capsular tension segments and IOLs with the double-flanged polypropylene technique. Overall, fixation remained stable throughout the 5-year study period. Flange exposure or erosion occurred in less than 3% of cases. WHY IT MATTERS The double-flanged polypropylene technique has become popular for the scleral fixation of IOLs owing to its efficiency and speed.

Practice Makes Progress

Marion Munk, MD, and Justis P. Ehlers, MD

Retina Today

It’s always fascinating when trendy technology seeps into health care. While working on this issue, our news feeds were overrun with stories of surgeons using Apple’s new Vision Pro in the OR.1 According to the press release, a nurse used the device to help with instrument selection, data visualization, and procedure monitoring.1 Cool stuff, and even if you aren’t an Apple aficionado, you have to admit this “spatial computer” is impressive.2 The news caught our eyes, but it didn’t surprise us because the field of retina was way ahead of the curve with this technology. The first ophthalmic exoscope—the Beyeonics One visualization system—that integrates augmented reality into a surgical headset was installed into an ophthalmic surgical suite years ago.3 Not only that, but the company recently announced the integration of intraoperative OCT into the headset, making it something of a spatial computer itself—for the surgeon.4 Retina has always been a field defined by technologic advancement, and our imaging tools are a great example. In an explosion of innovation in the early 2000s, we saw the advent of 3D visualization in the OR, intraoperative OCT, and OCT angiography (OCTA). Since then, it has been a slow march of improvement. For example, the January/February issue highlighted the addition of fluorescein angiography to surgical 3D heads-up displays. Other issues have touched on scanning laser ophthalmoscope-based multimodal fundus imaging and ultra-widefield technologies for the detection of diabetic eye disease. To catch up on these articles, see Further Reading. Some technology still in the pipeline may be poised to hit the clinic in the next few years; K. Bailey Freund, MD, and others have been lecturing on high-resolution OCT for a while now, with Retina Today following closely since its inaugural issue in 2006.5 While researchers work on fine-tuning the next generation, we asked experts to share their insights to help you perfect your skills with the imaging tools at your disposal.