Case Reports

Folow-up of 21 vitrectomized patients using the four flanged technique with scleral tunnel for IOL implatation

Case Report Details

First Author: T.Caldeira BRAZIL

Co Author(s):    K. Andrade   B. Carvalho   N. Rabelo   C. Caldeira   A. Canedo        

Abstract Details

Purpose:

'- Report 21 cases of patients who underwent posterior vitrectomy and IOL implantation using the Four Flanged technique with scleral tunnel. - Analyze the clinical evolution and describe the postoperative results. - Assess the reduction of the risk of IOL decentralization and inclination using the Four Flanged technique with scleral tunnel in vitrectomized patients.

Setting:

Longitudinal clinical trial in which 21 patients underwent posterior vitrectomy surgery, associated with 360° peripheral endolaser and IOL implantation using the Four Flanged technique with scleral tunnel. Surgeries were performed from February to December 2019. All patients had nuclear fragments displaced into the vitreous cavity. No patient presented glaucoma.

Report of Case:

The Four Flanged scleral fixation technique, proposed by Canabrava, et al., consists of a 6 mm main scleral tunnel incision or a corneal incision, followed by the transsclerally implantation of two 26 G needles at 2 mm distance from the limbus. The procedure is done at 6 o’clock and 12 noon. One end of 5-0 prolene thread is placed in the lumen of each needle using retinal forceps. The other end is fixed on the IOL haptics orifices. The threads are cauterized to melt their end and create a conic tip. They serve as support for the lens haptics and for the scleral fixations, which will be inserted into the sclera space without the need of sutures. In this way, the haptics are free in an anatomical position, reducing the chances of complications derived from the decentralization and inclination of the IOL. The 21 patients in the study had various proportions of lens nucleus dropped into the vitreous cavity. Posterior vitrectomy associated with peripheral endolaser 360 conducted on the patients, as well as IOL fixation using the Four Flanged technique with scleral tunnel. After surgery, the patients are observed for eighteen months. Reassessments ake place after the 1st, 5th and 15th days, as well as after the 1st, 3rd, 9th, 12th and 18th month. The research is ongoing and the complete reassessment of all patients in the mentioned period is to be finished on 2021. All patients have evolved to the present date with satisfactory postoperative visual acuity with correction, ranging from 20/20 to 20/40. They presented a well-centered IOL biomicroscopy exam, stable flangeds without extrusion, absence of angled pigment with no anterior chamber reaction. All patients were with a 360° applied retina maintained intraocular pressure within the typical limits.

Conclusion/Take Home Message:

So far, the patients showed a positive result after the surgery. All of them had an substantial improved in visual acuity. The results are optimistic but the number of cases of vitrectomized patients undergoing IOL fixation using the Four Flanged technique with scleral tunnel is still limited due the newness of the technique- More detailed studies is suggested, as well as a greater number of patients to be evaluated, with a longer term follow-up

Financial Disclosure:

None