Graefes Arch Clin Exp Ophthalmol DOI 10.1007/s00417-015-2973-7
LETTER TO THE EDITOR
Sutureless scleral fixation of intraocular lenses Remzi Karadag & Hüseyin Bayramlar & Ozgur Cakici
Received: 12 January 2015 / Accepted: 18 February 2015 # Springer-Verlag Berlin Heidelberg 2015
Dear Editor, In their article, Abbey et al. presented two sutureless scleral fixated intraocular lens methods they called BSutureless scleral fixation of intraocular lenses: outcomes of two approaches. The 2014 Yasuo Tano Memorial Lecture^ [1]. The authors stated that the trocar-assisted transconjunctival sutureless scleral fixation method had been described by Prasad [2]. In fact, we first described that method about 1 year earlier than Prasad [3]. In this technique, we enter into the eye with 25-gauge vitrectomy trocars without any opening in conjunctiva, performing two 3-mm-long scleral tunnels parallel to the limbus 180 degrees apart from each other, at an angle of 10 degrees to the scleral surface, and we leave the trocars there. Then we perform vitrectomy if necessary, and we grip and take the haptics out of the eye with retinal forceps through the trocars. The haptics are pushed to the end of the mouth of the tunnels, and then we put a 10/0 nylon suture encircling the haptics for security and take it out 1 week later [3]. The authors reported endophthalmitis in one case and hypotony in two cases [1]. In fact, we did not observe any cases of endophthalmitis or hypotony in our series. To us, the complications the authors encountered with their cannula technique are due to lack of the security suture at the end of the procedure. We think that, in our technique, by means of the
R. Karadag (*) : H. Bayramlar School of Medicine, Department of Ophthalmology, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey e-mail: [email protected] O. Cakici Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
10/0 nylon security sutures in the scleral tunnels containing the haptics transconjunctivally, we ensure that the haptics are stabilized in the early postoperative period while we prevent possible leakage of the wound. So we have provided against endophthalmitis and hypotony. We take these sutures out after 1 week [3–10]. In addition, Abbey et al. observed haptic dislocation in three patients [1]. We did not see any haptic dislocation in our series. To us, the reason for that is that the authors performed scleral tunnels at an angle of 30 to 40 degrees. It may not be possible to successfully achieve 3-mm-long scleral tunnels with this level of angulation. We maintain the trocars at an angle of 10 degrees to the scleral surface while we create scleral tunnels, and thus we were able to achieve tunnels about 3 mm long in which the haptics are placed. We also think that the security sutures help us to prevent this complication [3–10]. Conflicts of interest The authors have no financial interest in any of the products mentioned in the manuscript. None of the authors has any conflicts of interest in this study.
References 1. Abbey AM, Hussain RM, Shah AR, Faia LJ, Wolfe JD, Williams GA (2014) Sutureless scleral fixation of intraocular lenses: outcomes of two approaches. The 2014 Yasuo Tano Memorial Lecture. Graefes Arch Clin Exp Ophthalmol 253(1):1–5 2. Prasad S (2013) Transconjunctival sutureless haptic fixation of posterior chamber IOL: a minimally traumatic approach for IOL rescue or secondary implantation. Retina (Philadelphia) 33(3):657–660 3. Totan Y, Karadag R (2012) Trocar-assisted sutureless intrascleral posterior chamber foldable intra-ocular lens fixation. Eye (Lond) 26(6):788–791
Graefes Arch Clin Exp Ophthalmol 4. Totan Y, Karadag R (2013) Two techniques for sutureless intrascleral posterior chamber IOL fixation. J Refract Surg 29(2):90–94 5. Totan Y, Karadag R (2014) New approach: removal of silicone oil and trocar assisted sutureless scleral fixated intraocular lens implantation at the same session. Int J Ophthalmol 7(4):734–736 6. Karadag R, Bayramlar H, Cakici O (2014) To the editor. Retina 34(8):e18 7. Karadag R, Bayramlar H, Sari U (2014) Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 40(5):853–854
8. Karadag R, Bayramlar H, Sari U (2014) Is this really sutureless scleral intraocular lens fixation? J Cataract Refract Surg 40(5): 851 9. Karadag R, Esmer O, Totan Y (2013) Re: a novel approach for posterior chamber intraocular lens placement or rescue via a sutureless scleral fixation technique. Retina 33(2):456 10. Karadag R, Bayramlar H (2014) Re: Yamane et al.: sutureless 27gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection (Ophthalmology 2014;121:61–6). Ophthalmology 121(8):e42
LETTER TO THE EDITOR
Sutureless scleral fixation of intraocular lenses Remzi Karadag & Hüseyin Bayramlar & Ozgur Cakici
Received: 12 January 2015 / Accepted: 18 February 2015 # Springer-Verlag Berlin Heidelberg 2015
Dear Editor, In their article, Abbey et al. presented two sutureless scleral fixated intraocular lens methods they called BSutureless scleral fixation of intraocular lenses: outcomes of two approaches. The 2014 Yasuo Tano Memorial Lecture^ [1]. The authors stated that the trocar-assisted transconjunctival sutureless scleral fixation method had been described by Prasad [2]. In fact, we first described that method about 1 year earlier than Prasad [3]. In this technique, we enter into the eye with 25-gauge vitrectomy trocars without any opening in conjunctiva, performing two 3-mm-long scleral tunnels parallel to the limbus 180 degrees apart from each other, at an angle of 10 degrees to the scleral surface, and we leave the trocars there. Then we perform vitrectomy if necessary, and we grip and take the haptics out of the eye with retinal forceps through the trocars. The haptics are pushed to the end of the mouth of the tunnels, and then we put a 10/0 nylon suture encircling the haptics for security and take it out 1 week later [3]. The authors reported endophthalmitis in one case and hypotony in two cases [1]. In fact, we did not observe any cases of endophthalmitis or hypotony in our series. To us, the complications the authors encountered with their cannula technique are due to lack of the security suture at the end of the procedure. We think that, in our technique, by means of the
R. Karadag (*) : H. Bayramlar School of Medicine, Department of Ophthalmology, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey e-mail: [email protected] O. Cakici Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Goztepe, Istanbul, Turkey
10/0 nylon security sutures in the scleral tunnels containing the haptics transconjunctivally, we ensure that the haptics are stabilized in the early postoperative period while we prevent possible leakage of the wound. So we have provided against endophthalmitis and hypotony. We take these sutures out after 1 week [3–10]. In addition, Abbey et al. observed haptic dislocation in three patients [1]. We did not see any haptic dislocation in our series. To us, the reason for that is that the authors performed scleral tunnels at an angle of 30 to 40 degrees. It may not be possible to successfully achieve 3-mm-long scleral tunnels with this level of angulation. We maintain the trocars at an angle of 10 degrees to the scleral surface while we create scleral tunnels, and thus we were able to achieve tunnels about 3 mm long in which the haptics are placed. We also think that the security sutures help us to prevent this complication [3–10]. Conflicts of interest The authors have no financial interest in any of the products mentioned in the manuscript. None of the authors has any conflicts of interest in this study.
References 1. Abbey AM, Hussain RM, Shah AR, Faia LJ, Wolfe JD, Williams GA (2014) Sutureless scleral fixation of intraocular lenses: outcomes of two approaches. The 2014 Yasuo Tano Memorial Lecture. Graefes Arch Clin Exp Ophthalmol 253(1):1–5 2. Prasad S (2013) Transconjunctival sutureless haptic fixation of posterior chamber IOL: a minimally traumatic approach for IOL rescue or secondary implantation. Retina (Philadelphia) 33(3):657–660 3. Totan Y, Karadag R (2012) Trocar-assisted sutureless intrascleral posterior chamber foldable intra-ocular lens fixation. Eye (Lond) 26(6):788–791
Graefes Arch Clin Exp Ophthalmol 4. Totan Y, Karadag R (2013) Two techniques for sutureless intrascleral posterior chamber IOL fixation. J Refract Surg 29(2):90–94 5. Totan Y, Karadag R (2014) New approach: removal of silicone oil and trocar assisted sutureless scleral fixated intraocular lens implantation at the same session. Int J Ophthalmol 7(4):734–736 6. Karadag R, Bayramlar H, Cakici O (2014) To the editor. Retina 34(8):e18 7. Karadag R, Bayramlar H, Sari U (2014) Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 40(5):853–854
8. Karadag R, Bayramlar H, Sari U (2014) Is this really sutureless scleral intraocular lens fixation? J Cataract Refract Surg 40(5): 851 9. Karadag R, Esmer O, Totan Y (2013) Re: a novel approach for posterior chamber intraocular lens placement or rescue via a sutureless scleral fixation technique. Retina 33(2):456 10. Karadag R, Bayramlar H (2014) Re: Yamane et al.: sutureless 27gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection (Ophthalmology 2014;121:61–6). Ophthalmology 121(8):e42
