|Year : 2020 | Volume
| Issue : 10 | Page : 2208
Commentary: Glued intraocular lens: A technique too many
Mahipal S Sachdev
Centre for Sight, New Delhi, India
|Date of Web Publication||23-Sep-2020|
Dr. Mahipal S Sachdev
Centre for Sight, B-5/24, Safdarjung Enclave, New Delhi - 110 023
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sachdev MS. Commentary: Glued intraocular lens: A technique too many. Indian J Ophthalmol 2020;68:2208
Scleral fixated intraocular lens with haptic externalisation (also commonly known as Glued IOL) technique is currently the standard of care for managing aphakia in the absence of posterior capsular support. Over the last decade, since Dr. Gabor Scharioth first described the technique of intrascleral IOL fixation, various modifications have come forth, each trying to make the Glued IOL technique A lot safer and surgically easier.
One of the technically most demanding steps, with a longest learning curve, is a careful externalisation of both the haptics of the intraocular lens. Dr. Agarwal et al. propagated the use of scleral flap under which the haptics were externalised using end grasping forceps and then fixing them in the Scharioth's tunnel. This technique makes the glued IOL technique A lot easier and also provides a flexibility to use a small incision with foldable lens. But the technique is also limited by a longer duration needed for surgery and warranted a need for an assistant, as a third arm, to hold the leading haptic while the lagging haptic is manipulated.
Baskaran et al. described their technique of extraocular needle guided haptic insertion technique of scleral fixation (X-NIT) in 2017, wherein a bent 26 gauge needle was used as a guide to externalise the haptic directly from the corneo scleral wound with excellent results. The haptics were also secured on a silicon stopper to circumvent the need of an assistant to hold the haptic. Further to this technique, Baskaran et al. have come up with a novel device described in this journal for safe externalisation of the haptic. The device consists of a set of disposable 26 gauge needles with a presecured silicon stoppers, making this technique easier for the users. Overall, it improves the logistics of doing X-NIT, but the basic problem of the X-NIT technique still exists: first, that of a need for a larger corneo scleral incision and second the strain on haptic optic junction during the threading of lagging haptic. Yamane et al. further modified this as a trans conjunctival technique with cauterisation of the haptic end to create a flange, which helps in holding the IOL in place without the use of fibrin glue.
All of these modifications in the Glued IOL technique are aimed at making the surgery simple and flatten the learning curve. In spite of many modifications described, a consistent postoperative astigmatism is seen that comes down with experience. The most common reason for this being a bend at the haptic optic junction due to overstretching or manipulation of the haptic. All of the newer modifications described by Baskaran et al., or Yamane et al. though reduce the surgical time but cause a significant strain on the haptic optic junction especially while threading the trailing haptic. Also, the postoperative results improve with increased surgical experience in any of the techniques. Therefore, it is imperative for any surgeon to choose his/her technique and then stick to it. The focus should be on perfecting the technique and achieving astigmatic neutrality consistently. In the current era of perfected cataract surgery outcomes, one should aim for a similar outcome with the glued IOL technique also.
| References|| |
Gabor SG, Pavlidis MM. Sutureless intrascleral posterior chamber intraocular lens fixation. J Cataract Refract Surg 2007;33:1851-4.
Agarwal A, Kumar DA, Jacob S, Baid C, Agarwal A, Srinivasan S. Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg 2008;34:1433-8.
Baskaran P, Ganne P, Bhandari S, Ramakrishnan S, Venkatesh R, Gireesh P. Extraocular needle- guided haptic insertion technique of scleral fixation intraocular lens surgeries (X-NIT). Indian J Ophthalmol 2017;65:747-50
Baskaran P, Venkatesh R, Ramakrishnan S, Sriram RD, Iyer G, Ramnath RK. A novel device for safe exteriorization of haptic in scleral fixation intraocular lens surgery. Indian J Ophthalmol 2020;68:2205-7. [Full text]
Yamane S, Sato S, Maruyama-Inoue M, Kadonosono K. Flanged intrascleral intraocular lens fixation with double-needle technique. Ophthalmology 2017;124:1136-42.