Intraocular lens scaffold
Intraocular lens scaffold, or IOL scaffold technique, is a surgical procedure in ophthalmology. In cases where the posterior lens capsule is ruptured and the cataract is present, an intraocular lens can be inserted under the cataract. The IOL acts as a scaffold, and prevents the cataract pieces from falling to the back of the eye. The cataract can then be safely removed by emulsifying it with ultrasound and aspiration. This technique is called IOL scaffold, and was initiated by Amar Agarwal at Dr. Agarwal's Eye Hospital in Chennai, India.
The technique can be used to support and protect the posterior capsule membrane during a lens swap procedure.
Definition
The lens capsule may be damaged due to trauma, from birth, or by surgery. During cataract surgery, when half or more of the lens remains and the surgeon notices capsule damage; the IOL scaffold technique can be used to capture the lens and prevent further complications. In this technique, the artificial lens or IOL is placed in the sulcus and phacoemulsification surgery using ultrasound is performed over it. Once the entire lens is removed, the IOL is well positioned on the sulcus. As soon as the surgeon notices the capsular tear or sinking nucleus, anterior chamber infusion can be used to stabilize the chamber. Anterior vitrectomy is performed to remove the vitreous body in the pupil and anterior part of eye. Then the IOL is inserted under the nucleus on the remaining capsule bag. The nucleus is positioned on the IOL and the surgery is completed.Advantage
By this method, the risk of lens fragments falling into the vitreous body or back part of the eye is reduced. The IOL acts as a barrier or scaffold preventing the lens remnants from falling back. Since separation is present in the posterior eye from the anterior part, retinal risks are reduced. Moreover, neither special instruments nor additional training required once this method is learnt.History
The intraocular lens scaffold technique was introduced by Dr. Amar Agarwal in 2012. He used this technique in a case which had posterior capsular rupture during a phacoemulsification procedure.Indications
The technique can be used for intraoperative nucleus removal during cataract surgery, removal of lens dropped on the retina, Sommering ring removal, intraocular foreign body removal, and IOL explantation.Glued scaffold
In an eye with total loss of bag where no capsular bag remnant is present, glued IOL scaffold is used. In this a glued IOL is placed behind the cataract pieces. The glued IOL then works as a scaffold and the cataract pieces are removed with the phaco handpiece using ultrasound. Two partial thickness scleral flaps measuring 2.5 to 2.5 mm are made 180 degrees diagonally apart. Infusion is placed by anterior chamber maintainer and sclerotomies are made below the flaps with 20 gauge needle. The IOL is injected below the remaining lens particles and the remaining lens is positioned on the artificial lens or IOL. The haptics of the IOL are brought out under the flaps as in the glued IOL method and tucked into the scleral tunnel made with 26 gauge needle at the entry site. The phacoemulsification procedure is then continued on the IOL and the anterior chamber is formed by the end of the procedure. Scleral flaps and conjunctiva are then closed with fibrin glue.In the IOL scaffold, the IOL is placed above the iris or above some remnant of the capsule. Otherwise, a glued IOL then acts as a scaffold.