Two-step technique for posterior optic buttonholing of intraocular lens
Tushar Agarwal1, Vishal Jhanji, Digvijay Singh
1*MD Dr. Rajendra Prasad Centre for Ophthalmic Sciences (TA, DS, SK), All India Institute of Medical Sciences, New Delhi, India; and Department of Ophthalmology and Visual Sciences (VJ), The Chinese University of Hong Kong, Hong Kong, China.
Purpose:
This study aims to describe a two-step surgical technique for placement of a posterior chamber intraocular lens (IOL) in cases with crystalline lens subluxation resulting from non-progressive zonular dialysis.
Methods:
The first stage entails a phacoemulsification with creation of a 4-mm posterior capsular opening using an automated vitrector. The second stage performed 6 weeks later includes an anterior vitrectomy and injection of a foldable three-piece IOL in the sulcus. The haptics of IOL are positioned in the sulcus while the optic is pushed behind the posterior capsular opening therefore "buttonholing" the IOL.
Results:
Seven eyes of seven patients with posttraumatic zonular dialysis were operated using this technique. Follow-up of all cases revealed a well-centered IOL with good postoperative visual acuity (20/20 to 20/80).
Conclusions:
Our two-stage surgical technique precludes the insertion of capsular tension ring in cases with non-progressive zonular dialysis. The technique is recommended in the presence of less than or equal to 6 clock hours of zonular dialysis with preexisting posterior capsular tear or herniation of vitreous in the anterior chamber.
