Intraocular lens scaffold

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Intraocular lens scaffold
Other namesIntraocular lens scaffold
Specialty ophthalmology

Intraocular lens scaffold, [1] or IOL scaffold technique, is a surgical procedure in ophthalmology. In cases where the posterior lens capsule is ruptured and the cataract is present, an intraocular lens (IOL) can be inserted under the cataract. The IOL acts as a scaffold, and prevents the cataract pieces from falling to the back of the eye. The cataract can then be safely removed by emulsifying it with ultrasound and aspiration. This technique is called IOL scaffold, and was initiated by Amar Agarwal at Dr. Agarwal's Eye Hospital in Chennai, India.

Contents

The technique can be used to support and protect the posterior capsule membrane during a lens swap procedure. [1]

Definition

The lens capsule may be damaged due to trauma, from birth, or by surgery. [2] [3] During cataract surgery, when half or more of the lens remains and the surgeon notices capsule damage; the IOL scaffold technique can be used to capture the lens and prevent further complications. In this technique, the artificial lens or IOL is placed in the sulcus (remaining part of the lens bag) and phacoemulsification surgery using ultrasound is performed over it. Once the entire lens is removed, the IOL is well positioned on the sulcus. As soon as the surgeon notices the capsular tear or sinking nucleus, anterior chamber infusion can be used to stabilize the chamber. Anterior vitrectomy is performed to remove the vitreous body in the pupil and anterior part of eye. Then the IOL (already planned to be placed in the lens bag) is inserted under the nucleus on the remaining capsule bag. The nucleus is positioned on the IOL and the surgery is completed.[ citation needed ]

Advantage

By this method, the risk of lens fragments falling into the vitreous body or back part of the eye is reduced. The IOL acts as a barrier or scaffold preventing the lens remnants from falling back. Since separation is present in the posterior (vitreous) eye from the anterior (aqueous) part, retinal risks are reduced. Moreover, neither special instruments nor additional training required once this method is learnt.[ citation needed ]

History

The intraocular lens scaffold technique was introduced by Dr. Amar Agarwal in 2012. He used this technique in a case which had posterior capsular rupture during a phacoemulsification procedure. [4]

Indications

The technique can be used for intraoperative nucleus removal during cataract surgery (phacoemulsification), removal of lens dropped on the retina, Sommering ring removal, intraocular foreign body removal, and IOL explantation. [4] [5] [6] [1] [7] [8]

Glued scaffold

Fig 2 : GLUED IOL SCAFFOLD A- Cataract piece lying inside the eye (creamy white color). The Intraocular lens (IOL) is injected inside the eye. B- Handshake technique done to externalize the haptics of the IOL. C- Handshake technique completed. D- Both haptics of the IOL are externalized. The IOL is under the cataract piece and acts as a scaffold preventing the cataract pieces from falling down. E- The phaco handpiece emulsifies the cataract pieces using ultrasound. The glued IOl is acting as a scaffold so the technique is called glued IOL scaffold F- Cataract pieces removed. GLUED IOL SCAFFOLD.jpg
Fig 2 : GLUED IOL SCAFFOLD A- Cataract piece lying inside the eye (creamy white color). The Intraocular lens (IOL) is injected inside the eye. B- Handshake technique done to externalize the haptics of the IOL. C- Handshake technique completed. D- Both haptics of the IOL are externalized. The IOL is under the cataract piece and acts as a scaffold preventing the cataract pieces from falling down. E- The phaco handpiece emulsifies the cataract pieces using ultrasound. The glued IOl is acting as a scaffold so the technique is called glued IOL scaffold F- Cataract pieces removed.

In an eye with total loss of bag where no capsular bag remnant is present, glued IOL scaffold is used. [5] In this a glued IOL is placed behind the cataract pieces. The glued IOL then works as a scaffold and the cataract pieces are removed with the phaco handpiece using ultrasound. Two partial thickness scleral flaps measuring 2.5 to 2.5 mm are made 180 degrees diagonally apart. Infusion is placed by anterior chamber maintainer and sclerotomies are made below the flaps with 20 gauge needle. The IOL is injected below the remaining lens particles and the remaining lens is positioned on the artificial lens or IOL (Fig 2). The haptics of the IOL are brought out under the flaps as in the glued IOL method and tucked into the scleral tunnel made with 26 gauge needle at the entry site. The phacoemulsification procedure is then continued on the IOL and the anterior chamber is formed by the end of the procedure. Scleral flaps and conjunctiva are then closed with fibrin glue.

In the IOL scaffold, the IOL is placed above the iris or above some remnant of the capsule. Otherwise, a glued IOL then acts as a scaffold.[ citation needed ]

Soemmering ring

Fig 3 : GLUED IOL SCAFFOLD FOR SOMMERING RING A: Two scleral flaps are made diagonally apart.B: IOL injected below the Sommering ring (thick white portion) and IOL haptics externalized similar to glued IOL.C: Sommering ring dislodged and positioned on the IOL. D: Sommering ring removed by phaco handpiece. GLUED IOL SCAFFOLD FOR SOMMERING RING.jpg
Fig 3 : GLUED IOL SCAFFOLD FOR SOMMERING RING A: Two scleral flaps are made diagonally apart.B: IOL injected below the Sommering ring (thick white portion) and IOL haptics externalized similar to glued IOL.C: Sommering ring dislodged and positioned on the IOL. D: Sommering ring removed by phaco handpiece.

The Soemmering ring is the ring-shaped growth of lens cells after surgical removal of cataractous lens in childhood. This is seen as a peripheral ring after pupil dilatation. Patients who undergo artificial lens implantation in an eye that had earlier cataract surgery use this technique to remove the ring remnant. [6] Here the IOL is placed with the glued IOL scaffold method, the Sommering ring is dislodged on the IOL, and is removed (Fig 3).

Refractive surprise

Refractive surprise can happen after IOL implantation; incorrect lens or power is the probable cause for this. In that situation, the IOL is removed and an IOL of correct power is placed. IOL scaffold is used where the new IOL is placed into the lens bag below the old IOL. The new IOL acts as scaffold or barrier and helps as a platform for the removal of the old lens. [1]

Foreign body removal

Fig 4 : IOL SCAFFOLD FOR INTRAOCULAR FOREIGN BODY (IOFB) REMOVAL. A: IOFB retrieved from the posterior part of eye and placed on the iris.B: IOL injected on the remaining lens bag.C: IOFB removed via the corneal wound over the IOL. IOL SCAFFOLD FOR IOFB REMOVAL.jpg
Fig 4 : IOL SCAFFOLD FOR INTRAOCULAR FOREIGN BODY (IOFB) REMOVAL. A: IOFB retrieved from the posterior part of eye and placed on the iris.B: IOL injected on the remaining lens bag.C: IOFB removed via the corneal wound over the IOL.

External foreign bodies can enter the eye and become lodged on the retina or vitreous. This is often removed through the open method of opening through the sclera (white coat of the eye). While removing intraocular foreign bodies (IOFB), it may drop or slip onto the back of the eye (Fig 4). This will prevent the accidental slippage of IOFB into the eye.[ citation needed ]

Outcomes

No increased risk of postoperative complications such as endothelial decompensation or post-operative uveitis has been reported. [7] [8] Good visual outcomes are obtained. IOL has been reported to be stable without de-centering in both eyes.[ citation needed ]

Related Research Articles

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A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause 51% of all cases of blindness and 33% of visual impairment worldwide.

<span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

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<span class="mw-page-title-main">Phacoemulsification</span> Method of cataract surgery

Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery induced astigmatism.

<span class="mw-page-title-main">Intraocular lens</span> Lens implanted in the eye to treat cataracts or myopia

An Intraocular lens (IOL) is a lens implanted in the eye usually as part of a treatment for cataracts or for correcting other vision problems such as short sightedness and long sightedness, a form of refractive surgery. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic lens. Both kinds of IOLs are designed to provide the same light-focusing function as the natural crystalline lens. This can be an alternative to LASIK, but LASIK is not an alternative to an IOL for treatment of cataracts.

<span class="mw-page-title-main">Phakic intraocular lens</span> Lens implanted in eye in addition to the natural lens

A phakic intraocular lens (PIOL) is a special kind of intraocular lens that is implanted surgically into the eye to correct myopia (nearsightedness). It is called "phakic" because the eye's natural lens is left untouched. Intraocular lenses that are implanted into eyes after the eye's natural lens has been removed during cataract surgery are known as pseudophakic.

<span class="mw-page-title-main">Cataract surgery</span> Removal of opacified lens from the eye

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL) implant.

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Howard V. Gimbel FRCSC, AOE, FACS, CABES, is a Canadian ophthalmologist, university professor, senior editor, and amateur musician. He is better known for his invention, along with Thomas Neuhann, of the continuous curvilinear capsulorhexis (CCC), a technique employed in modern cataract surgery.

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<span class="mw-page-title-main">Glued intraocular lens</span> Surgical treatment for eyes lacking functional lens capsules

In ophthalmology, glued intraocular lens or glued IOL is a surgical technique for implantation, with the use of biological glue, of a posterior chamber IOL in eyes with deficient or absent posterior capsules. A quick-acting surgical fibrin sealant derived from human blood plasma, with both hemostatic and adhesive properties, is used.

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<span class="mw-page-title-main">History of cataract surgery</span> Development of the procedure for removing an opacified lens from the eye

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References

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