VJCRGS Introduction: Volume 40, Issue 1

Robert H. Osher, MD

Eyetube

Mastering Posterior Chamber IOL Fixation

Innovative strategies for eyes lacking capsular support.

Lisa Brothers Arbisser, MD; Brandon D. Ayres, MD; Sara Bozorg, MD; Megan Haghnegahdar, MD; Beeran Meghpara, MD; and Shin Yamane, MD, PhD

Cataract and Refractive Surgery Today

.fluid-width-video-wrapper{ margin-bottom: -75px !important; } Glued Scleral IOL Fixation Without Capsular Support By Lisa Brothers Arbisser, MD When faced with subluxated or secondary IOLs in eyes lacking capsular support, I recommend first considering all forms of optic capture. A simple lasso technique can be a strong choice for a subluxated capsular bag–IOL complex when a vitrectomy is otherwise unnecessary. If optic capture is not feasible, various options for IOL fixation may be considered. I’ve been asked to focus this article on glued scleral fixation. TECHNICAL EVOLUTION My approach to managing a subluxated IOL-capsular bag complex in an eye without capsular support has evolved over time. Initially, I performed anterior chamber IOL implantation with a large scleral tunnel incision. This approach shifted to the two-point iris fixation of a three-piece IOL. I employed iris fixation only briefly, however, because I abhorred touching uveal tissue. I then briefly performed sutured scleral fixation of a one-piece PMMA lens, followed by a short period of four-point suture fixation of a hydrophilic acrylic IOL. The risk of calcification in certain eyes led me to settle on glue-assisted sutureless scleral tunnel fixation as my preferred method before the development of the flanged intrascleral haptic fixation (ISHF) technique popularized by Yamane and colleagues.1 Whatever form of IOL fixation is employed, the surgeon’s attention to detail is paramount to achieving excellent outcomes.

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.