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      Iris-claw intraocular lens implantation: Anterior chamber versus retropupillary implantation

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          Abstract

          Purpose:

          To compare the outcomes of anterior chamber and retropupillary implantation of iris-claw Artisan intraocular lenses (IOL).

          Design:

          Prospective, randomized, single-blinded study.

          Patients and Methods:

          Forty eyes of forty aphakic patients were enrolled. Patients were randomized into two groups. Each group includes twenty patients. Group 1 received anterior chamber Artisan IOL implantation. Group 2 received retropupillary Artisan IOL implantation. Preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and all complications were noted and compared at 6 months follow-up.

          Results:

          Each two groups obtained a significant improvement in CDVA ( P < 0.05). Four patients in Group 1 and five patients in Group 2 had significant but nonpermanent increase at IOP values. There were one and two pupillary irregularity in Group 1 and Group 2, respectively. In one patient, a shallow and inferior located retinal detachment were encountered in anterior chamber group.

          Conclusions:

          The results were not significantly different between the two fixation techniques for iris-claw lens. The surgery procedure is dependent to surgeon experience and eye's conditions.

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          Most cited references18

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          Simplified and safe method of sutureless intrascleral posterior chamber intraocular lens fixation: Y-fixation technique.

          We report a new surgical technique that allows intrascleral fixation of a posterior chamber intraocular lens (IOL) without sutures. The Y-fixation technique does not involve complicated intraocular manipulation and achieves safe sutureless fixation. A Y-shaped incision is made in the sclera and a 24-gauge microvitreoretinal (MVR) knife is used to create the sclerotomy instead of a needle. The Y-shaped incision eliminates the need to raise a large lamellar scleral flap and to use fibrin glue because the haptic can be fixed both inside the tunnel and in the groove, and performing the sclerotomy with the 24-gauge MVR knife simplifies extraction of the haptic and improves wound closure. There is no risk of infection from exposure of the haptic on the sclera and no use of fibrin glue. There was significantly less IOL decentration and tilt than with suture fixation.
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            Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lens.

            We describe a technique for easy externalization of the haptics for glued intrascleral fixation of a posterior chamber intraocular lens (IOL). The "handshake" technique is a modification of the glued-IOL procedure in which the IOL haptic is bimanually transferred from one glued IOL forceps to another under direct visualization in the pupillary plane. The modification provides better intraocular maneuverability throughout the surgery and extends applicability of the technique to challenging cases that require haptic manipulation, such as IOL drop and haptic slippage. It also provides the intraoperative advantage of a well-formed globe throughout the surgery.
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              Lens implant selection with absence of capsular support.

              If contact lens or spectacle correction is not viable, little debate exists that the secondary placement of an intra-ocular lens (IOL) is the method of choice in the absence of capsular support. The choice of IOL mainly depends on the preoperative status of the eye (eg, aphakia in children) and the selected location for the implant. Theoretically, there are several IOL implantation approaches in cases without capsular support: an angle-supported anterior chamber (AC) IOL, an iris-fixated ACIOL, an iris-sutured or iris-fixated posterior chamber (PC) IOL and a transsclerally sutured PCIOL. No consensus exists, however, on the indications as well as on the relative safety and efficacy of these different options. Implantation of modern ACIOLs, like the refined open-loop or iris-fixated claw (toric) ACIOLs, have regained popularity and provide a valuable alternative to sutured PCIOLs. However, in the absence of capsular support, the transsclerally sutured PCIOLs offer numerous advantages for certain eyes. Because of its anatomic location, the sutured PCIOL is more appropriate for eyes with compromised cornea, peripheral anterior synechiae, shallow anterior chamber, or glaucoma. Moreover, sutured PCIOLs are appropriate if the patient with aphakia is young or has a life expectancy of 10 years or more. Recent technological advances, including PCIOL with iris diaphragm for aniridia, toric ACIOLs, and small-incision surgery with foldable, transsclerally sutured IOLs, seem to further improve clinical outcomes.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                January 2016
                : 64
                : 1
                : 45-49
                Affiliations
                [1]Department of Ophthalmology, Adana Numune Training and Research Hospital, Adana, Turkey
                Author notes
                Correspondence to: Dr. Sezer Helvacı, Elbistan Devlet Hastanesi, Kahramanmaraş - 46100, Turkey. E-mail: sezerhelvaci1985@ 123456hotmail.com
                Article
                IJO-64-45
                10.4103/0301-4738.178139
                4821121
                26953023
                0f456e50-5e87-4948-befb-29e38e79ac8a
                Copyright: © 2016 Indian Journal of Ophthalmology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 10 June 2015
                : 17 November 2015
                Categories
                Original Article

                Ophthalmology & Optometry
                aphakia,artisan lens,retropupillary implantation
                Ophthalmology & Optometry
                aphakia, artisan lens, retropupillary implantation

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