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Nikoloz Labauri MD
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Nikoloz Labauri, MD, presents a 65-year-old patient with traumatic subluxation of crystalline lens. He performs pars plana vitrectomy with lensectomy and sutureless intrascleral IOL fixation to correct an aphakia in the same setting.
Posted: 8/24/2012
Nikoloz Labauri MD
Nikoloz Labauri, MD, presents a 65-year-old patient with traumatic subluxation of crystalline lens. He performs pars plana vitrectomy with lensectomy and sutureless intrascleral IOL fixation to correct an aphakia in the same setting.
Posted: 8/24/2012
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anil verma
12 years ago
superb surgery learnt a lot
Grigor Kamushadze
12 years ago
This is a wonderful Surgery Doctor Nicholas., I very much liked your technique and I am going to use it. Thank you
Nikoloz Labauri
12 years ago
Thanks for comment. This is Scharioth IOL Scleral fixation forceps manufactured by DORC company. plz go through this link : http://www.dorc.nl/whatsnew.php?whatsnew=23
sharon fekrat
12 years ago
hello! terrific technique! where did you purchase the straight forceps that you use to externalize the haptics and to pull the haptics through the scleral tunnel? thanks!
SHALABH SINHA
12 years ago
Nice surgery. I would have been cursing myself if saw as much blood on my hands, not to mention NOT having checked the infusion cannula inside the vitreous cavity before switching on the BSS. I try to do it EVERY single time. Hand shake technique can be done even with your technique. The problem I have faced as do too is that these three piece IOL come with an injector with screwing action, so both hands are busy. Ask your assistant to screw the plugger while you hold the injector, and have a forceps in the eye to hold the leading haptic as soon as it is delivered into the eye, don't pull till entire IOL is unfolded, then you can pull the haptic out.
SHALABH SINHA
12 years ago
Nice surgery. I would have been cursing myself if saw as much blood on my hands, not to mention NOT having checked the infusion cannula inside the vitreous cavity before switching on the BSS. I try to do it EVERY single time. Hand shake technique can be done even with your technique. The problem I have faced as do too is that these three piece IOL come with an injector with screwing action, so both hands are busy. Ask your assistant to screw the plugger while you hold the injector, and have a forceps in the eye to hold the leading haptic as soon as it is delivered into the eye, don't pull till entire IOL is unfolded, then you can pull the haptic out.
SHALABH SINHA
12 years ago
Nice surgery. I would have been cursing myself if saw as much blood on my hands, not to mention NOT having checked the infusion cannula inside the vitreous cavity before switching on the BSS. I try to do it EVERY single time. Hand shake technique can be done even with your technique. The problem I have faced as do too is that these three piece IOL come with an injector with screwing action, so both hands are busy. Ask your assistant to screw the plugger while you hold the injector, and have a forceps in the eye to hold the leading haptic as soon as it is delivered into the eye, don't pull till entire IOL is unfolded, then you can pull the haptic out.
Nikoloz Labauri
12 years ago
I absolutely agree with you in both points. Infusion has been checked before turning on, but sometimes we miss a tiny layer which can partially cover it, until we push the cannula and towards the pupil and visualize through the microscope, which was not done in this case, because LC was hanging and could course its early luxation, With an IOL insertion you are right, I do the same thing to get help from assistent while injecting an IOL. The plan was here to put it in the AC first and then using regrasping techniques to externalize it out of the sulcus, but it inadvertently went down and thats why another haptic I deliver directly through the sulcus using 25G forceps. Thanking you for valuable comments. Nikoloz
Paulo Bueno
12 years ago
Dr. Nikoloz, first congrats for your surgery. But do you think that the haptics without any tunnel can increase the risk of endophthalmitis, due to the direct path into the eye? Thanks for sharing
Nikoloz Labauri
12 years ago
Theoretically Endopthalmitis can occur with this technique, but leaking bleb formation at this particular zone, where the haptic comes out through the sclera is not seen by us so far, and hypotony as well. Sometimes we get the leaking bleb in case of sutured IOLs as it was already published in few journals. Of course conjuctival closure plays a major role here to avoid early postoperative infection until the sclera seals around the haptic. Thanks for discussion
Stanislav Zhuk
12 years ago
why PFO? there was no RD as I could tell why chandeliers?
Nikoloz Labauri
12 years ago
Of course you can perform these surgeries without Chandeliers, but I use it in many cases now, because it makes the steps related to scleral indentation much quicker and safer. Those are: 1)Peripheral vitreous shaving, 2) Peripheral retinal assessment for breaks and 3) Peripheral laser with indentation under BSS. You need not your assistants help while do all these. With regard of PFO it is also optional, but I use it because of while working on anterior segment and my infusion is ON, it can detach the macula if you have a retinal break and you still are not aware about its existence. Apart of that, I would reply to our colleague with previous comment that IOL even if it dislocates posteriorly it can’t damage the macula, because it is protected by PFO. Thanks for discussion, Nikoloz
matias iglicki
12 years ago
thank you very much indeed for answering me
aziz çil
13 years ago
I think ,in this case free ?OL haptics in posterior chamber may cause retinal damage. During implantation , holding haptic tip with another instrument may be more safe.
aziz çil
13 years ago
Hand shake technic described by Agarwal may be more convenient to implant intraocular lens in such cases.
Nikoloz Labauri
13 years ago
That is interesting to hear your argumentation. I don't think that Hand Shake technique would be better at any case, because as it has been described by original author it requires following things : 1)you need to rise up the flaps instead of just tunnels, 2) you need to use 20G sulcus incisions, instead of 25G, 3) you need to use Glue, instead of nothing, because it is not required at all. In my opinion I dont see any advantage of Glued IOL over Scharioth's technique.
ari weitzner
13 years ago
i agreee with azizcil. agarwal's technique looks much simpler. the flaps are no big deal and can be closed with 10-0 nylon if one does not want to use glue.
Nikoloz Labauri
13 years ago
Dear Dr. Matias Thank you for discussion The surgery was performed on 5th of July this year. Last time he was reviewed by me 2 weeks ago and the structural and functional outcomes remained the same. The fast recovery of this patient is related to minimally invasive surgery and its sutureless nature. As you note on video, there was performed 11 consecutive incisions through the eyewall and all were left unsutured. The TA at the end of the surgery avoids from early postop inflammation, which I always use when I end up the surgery with the gas or air (exception is the Macular Hole case). Nikoloz
matias iglicki
13 years ago
???????
matias iglicki
13 years ago
i was surprise about the vitrectomy technique and IOL fixation but what was more outstanding was the postqx...Pictures and visual acuity.... could you tell me when the surgery was performed and if the result remains the same dr matias iglicki
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