Sutureless Scleral Fixation of Dislocated Rayner Type C-flex Broad Haptic Intra-Ocular Lenses Using Fibrin Glue-Possibility & Limitations


ABSTRACT

Advantages:

Rayner type C-flex broad haptic Intra-Ocular Lens is a commonly used lens in cataract surgery. Posterior dislocation of this Intra Ocular lens is an uncommon but serious complication of cataract surgery. This may occur intra-operatively or postoperatively due to large posterior capsular defects, weak zonules or trauma. In case of inadequate capsular support these lenses are removed and replaced by an anterior chamber IOL or a scleral fixated IOL. The exchange procedure results in making a larger corneo-scleral tunnel and removal of lens through it. Scleral fixation of the IOL using fibrin glue is a simple technique which avoids all the above complications besides giving better post operative visual results. The advantages of repositioning of IOL by this technique I that it avoids intraoperative fluctuation in intra-ocular pressure during removal of lens. Also, it does not cause endothelial damage due to removal and insertion of a new lens.

Methods:

Retrospective review of 6 eyes that underwent repositioning of the dislocated Rayner type C-flex broad haptic IOL using glue assisted sclera fixation. None of the above eyes had any capsular support. Standard 3 port pars plan Vitrectomy was performed in all eyes. PVD was induced when needed and IOL was separated of all vitreous adhesions. Vitreous was also removed from anterior chamber and the pars plana region. Partial thickness sclera flaps were made 180 degrees apart at the limbus. Small sclera pockets were dissected at the edge of the flaps. A sclerotomy was done under the flap 1.5 mm behind the limbus on both sides. Vitreous was removed at the sclerotomy site using vitrectomy cutter. Using a 23G forceps the haptics of the IOL were brought out on both sides. The IOL was adjusted on both sides to make it central. The inner arm of the haptic of the IOL was cut and replaced inside whereas the outer arm was buried in the previously made scleral pockets. Glue was applied in the flap region to close the pockets, sclerotomy and the flap.

Results:

The follow up was done at 1 day, 1 week, 2 weeks, 6 weeks and 3 months post-operatively. All IOLs were adequately positioned. None of the patients had intra-operative/post-operative surgical complications.

Conclusions:

Glue assisted sclera fixation of Rayner type C-flex Broad haptic Lens is a safe and effective way of repositioning of dislocated IOLs. This technique is combined with sutureless vitrectomies for faster rehabilitation of patients


CONTACT DETAILS

 

Sangeet Mittal
Jalandhar, India
Email : sangeetmittal@rediffmail.com
Cell Phone: +919988998844
Work Phone: +911812272607