Fibrin glue an option when capsular support is lacking

April 18, 2015

Fixating a posterior chamber IOL using fibrin glue is a “viable option in patients with deficient capsular support,” said Mahipal S. Sachdev, MBBS, MD.

San Diego-Fixating a posterior chamber IOL using fibrin glue is a “viable option in patients with deficient capsular support,” said Mahipal S. Sachdev, MBBS, MD.

His group performed an interventional case series of 250 eyes (238 patients) that underwent glued IOL implantation for various indications, including traumatic subluxated cataracts, subluxated/ dislocated IOLs, and aphakia with absent posterior capsule. Follow-up was anywhere from 3 months to 3 years.

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In this series, the majority of eyes (n = 95) presented with a subluxated IOL, and an additional 57 eyes presented with a subluxated lens, said Dr. Sachdev, of New Delhi, India.

An IOL was placed in the eye and the haptics brought out through a sclerotomy created under scleral flaps made 180° away from each other and about 1 mm apart, he said.

The IOL haptics were tucked into a scleral pocket “to prevent any sideward or up-down movement,” he said.

This was reinforced with fibrin glue, and the scleral flaps were then repositioned and the conjunctiva closed with the same glue.

In addition, at the time of surgery, associated complications, such as secondary glaucoma, corneal decompensation, corneal scars were treated with trabaeculectomy or valve implantation and penetrating keratoplasty or Descemet’s stripping endothelial keratoplasty (DSEK) as required.

Next: Results

 

Best-corrected visual acuity at 6 weeks postoperatively was better than 6/12 in 180 of the 250 eyes, he said.

The surgical time “was greatly reduced” by 15 to 20 minutes, and the need for sutures completely eliminated.

“There was no significant IOL tilt or corneal edema, and no significant inflammation at 1 week,” Dr. Sachdev said.

There were complications, however, which Dr. Sachdev attributed to learning curves for the most part.

Macular edema was the leading complication, and the leading cause of visual outcomes less than 20/40 at 6 weeks. Vitreous hemorrhage (n = 26) was the second-leading cause of poor outcomes. Transient hypotony (with a duration of less than 1 week) occurred in 15 patients.

“There was also haptic exposure in two eyes, and one expulsive hemorrhage,” he said.

The two cases of haptic exposure that were noted were replaced in an alternative scleral tunnel under the scleral flap. The expulsive hemorrhage was surgically drained.

“We have found excellent results after the initial learning curve, with substantially reduced complications,” he said.

He attributed the higher levels of macular edema to improperly positioned lenses during the early learning phase.

During a question-and-answer period, he said the technique might be expanded into multifocal lenses, but he has not yet begun that study.

Further, “you don’t need a specially designed lens with eyelets for this procedure,” he said, noting his group uses either the MA60 or the Tecnis 3.

Next: Conclusion

 

“Finally, the glue lasts for about a week or two and by then fibrosis has occurred to create the additional stability,” he said.