Results in comparison between 30 gauge ultrathin wall and 27 gauge needle in sutureless intraocular lens flanged techniq
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ORIGINAL ARTICLE
Results in comparison between 30 gauge ultrathin wall and 27 gauge needle in sutureless intraocular lens flanged technique in diabetic patients: 24‑month follow‑up study Matias Iglicki1 · Dinah Zur2 · Hermino Pablo Negri3 · Joaquin Esteves3 · Romina Arias3 · Emanuel Holsman3 · Anat Loewenstein2 · Catharina Busch4 Received: 31 January 2020 / Accepted: 27 March 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Abstract Aims Intraoperative complications in cataract surgery are more common in diabetic patients. Solving aphakia in these circumstances remains a challenge, as the scleral structure has been shown to be different in diabetes. This study aims to analyze the role of a secondary sutureless scleral intraocular lens (IOL) flanged fixation in diabetic patients without capsular support and to compare the anatomical and functional outcomes using a 30 gauge (G) ultrathin wall needle vs. a 27G needle. Methods Retrospective, observational cohort study. 105 eyes (105 patients) who underwent PPV with secondary IOL fixation using a sutureless 27G (n = 51) or a 30G ultrathin wall (UTW) needle technique (n = 54) and had a 24 months postoperative follow up. Consecutive patients’ records were reviewed for lens stability and centration parameters, intra- and postoperative complications at 7 days, 1, 3, 6, 12, and 24 months after surgery. Correlations between outcome measures and needle size (27G vs. 30G UTW) were analyzed. Results IOL displacement occurred in 30 patients (41.2%) in the 27G group and did not occur in the 30G UTW needle group (p 10°, respectively (Table 1).
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This is the first study to compare IOL fixation sutureless flanged technique using 27G versus 30G ultrathin needle in diabetic patients. Our study demonstrated that 30G UTW needle has statistically significant less IOL decentration and dislocation, as well as intra- and postoperative complications. Previous studies showed the feasibility and safety of intrascleral IOL sutureless fixation techniques. With time, there was a trend to decrease the cannula size for haptic externalization because of higher rates of complications with the use of 24G [3] and 25G [4] needles. A major concern with these techniques was wound leak and postoperative hypotony due to the leakage caused by a mismatch between the diameters of the sclerotomy and IOL haptic. With the introduction of a new sutureless intrascleral fixation technique by Yamane et al. using a 27G needle, there was no wound leak [5]. Still, haptic stability remained an important concern in the long-term follow-up. Using a 30G ultrathin needle and flange technique prevents haptic dislocation. Yamane et al. reported no case of IOL dislocation using this new technique [6]. The results of our current study support these findings in a diabetic population.
Acta Diabetologica Table 1 Patients characteristics and study outcomes Entire cohort, n = 105 Age, years, mean (SD) Male, n (%) Time until surgery, days, mean (SD) Axial length, mm (SD) IOP at baseline, mmHg (SD) BCVA, lo
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