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Xavier Campos, Ike K. Ahmed MD, Manjool Shah
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In this video, Iqbal Ike K. Ahmed; Manjool Shah; and Xavier Campos; demonstrate removal of a single piece acrylic IOL in a bag-sulcus position in a patient with symptomatic Uveitis-Glaucoma-Hyphema (UGH) Syndrome. A posterior continuous capsulorhexis is performed, and a 3-piece IOL is subsequently implanted in the sulcus and double optic captured posteriorly through the anterior and posterior capsulotomies.
Posted: 2/24/2015
Xavier Campos, Ike K. Ahmed MD, Manjool Shah
In this video, Iqbal Ike K. Ahmed; Manjool Shah; and Xavier Campos; demonstrate removal of a single piece acrylic IOL in a bag-sulcus position in a patient with symptomatic Uveitis-Glaucoma-Hyphema (UGH) Syndrome. A posterior continuous capsulorhexis is performed, and a 3-piece IOL is subsequently implanted in the sulcus and double optic captured posteriorly through the anterior and posterior capsulotomies.
Posted: 2/24/2015
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Xavier Campos-Möller
10 years ago
@KMbharucha @zanglei @zarali : Thanks for your comments! This is Xavier Campos, M.D. on behalf of Dr. Ahmed. Three-piece IOLs like the one implanted (Alcon MA60 lens) are in fact more compatible with the ciliary sulcus due to the haptic design, which is round and rigid . The rounded haptics are less likely to cause uveal chaffing than square-edge haptics which have sharper borders and are non-sulcus compatible. The increased haptic rigidity of 3 piece lenses usually grants them more stability in the sulcus. Having said that, three-piece IOLs in the ciliary sulcus may sometimes cause UGH (although much less frequently than single-piece IOLs) but this is usually due to IOL mobility, tilt or instability (the movements of the IOL chaffe uveal tissue). Optic capture usually ensures that the lens will be less mobile. In this patient, the anterior and posterior capsules were fused superiorly so the IOL could not be repositioned in the bag (the IOL was found with one haptic in the bag and the other in the sulcus- this position very frequently causes uveal chaffing and can lead to UGH syndrome). Traditional optic capture requires that the anterior capsule leaflet and the posterior capsule are separate and in this case they were fused, so we decided to do posterior-optic-capture, which 1) Greatly reduces the possibility of the IOL being mobile and 2) brings the square-edged optic further away from uveal tissue than when left in the sulcus without optic-capture, thus reducing the risk of iris chaffing by the optic itself. I hope this answers your questions!
Lei Zang
10 years ago
Hi Zarali, to your second question, I would guess Dr. Ahmed was concerned if the anterior cpasule was still intact or strong enough after removing the original IOL. But yes, I would want to hear Dr. Ahmed's answer as well. Thanks.
KM Bharucha
10 years ago
What's the rationale of putting a 3 piece IOL in the sulcus in a case of UGH syndrome? Wouldn't it aggravate the situation? Was a PCCC required to stabilize the lens? thanks
LADAN ESPANDAR
10 years ago
two questions: 1. What type of 3-piece IOL did you use? 2. why did you decide to do double capture? why posterior capsulotomy was performed? thanks