Advanced IOL Fixation Techniques: Strategies for Compromised or Missing Capsular Support

David F. Chang, MD
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ISBN 13:
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Book Description

Abnormal or deficient capsular anatomy creates numerous surgical challenges and predisposes eyes to IOL complications. Literally dozens of different approaches have been devised to implant IOLs in the face of compromised capsular support. However, a comprehensive compendium of the most important surgical strategies has not existed, until now.

Advanced IOL Fixation Techniques:Strategies for Compromised or Missing Capsular Support provides this much-needed resource with more than 70 different chapters that cover the wide array of surgical approaches. Among the contributors are many of the original innovators of the most important technologies and methodologies. In addition to teaching a specific surgical technique, these authors cover its history, rationale, and clinical results.

Editor Dr. David F. Chang is well known and acclaimed for 2 best-selling cataract textbooks—Mastering Refractive IOLs and Phaco Chop and Advanced Phaco Techniques. Along with associate editors Drs. Bryan S. Lee and Amar Agarwal, Dr. Chang has now tackled this new major subject area—how to best fixate IOLs when capsular support is compromised or absent.
  • Part One covers capsular fixation with either zonulopathy or following posterior capsule rupture. Topics include using conventional and modified capsular tension rings, capsular tension segments or capsular anchors, standard and reverse optic capture with anterior capsulorrhexis, sulcus fixation, posterior capsulorrhexis, and capsular membrane suture fixation.  
  • Part Two covers noncapsular fixation. Topics include anterior chamber IOLs, iris claw IOLs, iris and transscleral suture fixation of posterior chamber IOLs, and intrascleral haptic fixation using the Yamane double-needle or glued IOL methods.
  • Part Three covers miscellaneous topics such as anterior vitrectomy, IOL power calculation for noncapsular IOLs, and sliding slip knots and suture pupilloplasty.

To facilitate skills transfer, most chapters present detailed, step-by-step descriptions of the different techniques. The maneuvers are illustrated by over 1,100 diagrams and high-resolution surgical images. Finally, nearly every chapter is accompanied by narrated instructional videos. Combining over 150 videos, schematic diagrams, surgical images, and detailed written descriptions, Advanced IOL Fixation Techniques provides the most effective way to learn advanced surgical techniques.
With its comprehensive and practical approach to covering the gamut of strategies and devices, Advanced IOL Fixation Techniques:Strategies for Compromised or Missing Capsular Support will be an indispensable resource for cataract surgeons at all levels of experience.

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About the Editor

About the Associate Editors

Contributing Authors


Foreword by Howard V. Gimbel, MD, MPH

Part One          Capsular Fixation

Section I          Zonulopathy With Intact Capsular Bag

Chapter 1          Phaco Strategies With Zonulopathy

David F. Chang, MD

Chapter 2          Capsular Tension Ring Implantation and Rationale

Lisa Brothers Arbisser, MD

Chapter 3          Suture-Guided Capsular Tension Ring Insertion

Timothy P. Page, MD

Chapter 4          Capsular Tension Ring Insertion—Pearls and Pitfalls

Brian Little, BSc, MA, FRCS, FRCOphth, FHEA

Chapter 5          Henderson Capsular Tension Ring

Brett P. Bielory, MD and Bonnie An Henderson, MD

Chapter 6          Cionni Modified Capsular Tension Ring

Robert J. Cionni, MD

Chapter 7          Malyugin Modified Capsular Tension Ring

Boris Malyugin, MD, PhD

Chapter 8          Capsular Tension Segments

Patrick Gooi, MD, FRCSC and Ike K. Ahmed, MD, FRCSC

Chapter 9          Capsular Tension Segment Technique for IOL Fixation and Centration

Seng-Ei Ti, FRCS(Ed), MMed(S’pore) and Soon-Phaik Chee, FRCOphth, FRCS(G), FRCS(Ed), MMed(S’pore)

Chapter 10        Capsular Anchor for Surgical Management of Subluxated Lenses

Ehud I. Assia, MD and Michael E. Snyder, MD

Chapter 11        Bean-Shaped Ring Segments and Bag-in-the-Lens IOL Implantation

Marie-José Tassignon, MD, PhD, FEBO, FEBOS-CR and Sorcha Ní Dhubhghaill, MD, PhD, FEBO, FEBOS-CR

Chapter 12        Jacob Paperclip Capsule Stabilizer (Glued Capsular Hook)

Soosan Jacob, MS, FRCS, DNB

Chapter 13        Stepwise IOL Fixation Strategies for Varying Severity of Zonulopathy

David F. Chang, MD

Chapter 14        Fixation for Delayed Bag-IOL Subluxation—When and How

Tyler Q. Kirk, MD; Michael J. Siegel, MD; and Garry P. Condon, MD

Chapter 15        Scleral Fixation for Delayed Bag-IOL Dislocation

Alan S. Crandall, MD

Section II         Posterior Capsule Rupture

Chapter 16        IOL Placement Following Anterior or Posterior Capsule Tears

David F. Chang, MD

Chapter 17        IOL Selection for Sulcus Fixation

Liliana Werner, MD, PhD and Nick Mamalis, MD

Chapter 18        Sulcus IOL Fixation—My Technique

Kevin M. Miller, MD

Chapter 19        Sulcoflex IOLs

Allon Barsam, MA, FRCOphth and Soyang Ella Kim, MBBS, MA (Oxon), PG Cert

Chapter 20        Posterior Capsulorrhexis to Prevent or Manage IOL Complications

Howard V. Gimbel, MD, MPH and Hala Marzouk, MD

Chapter 21        Advanced Posterior Capsulotomy Techniques

Lisa Brothers Arbisser, MD

Chapter 22        Reverse Optic Capture in Eyes With Posterior Capsule Rupture

Jason Jones, MD

Chapter 23        Haptic Tuck for Reverse Optic Capture

Howard V. Gimbel, MD, MPH and Hala Marzouk, MD

Chapter 24        Reverse Optic Capture

Thomas A. Oetting, MS, MD

Chapter 25        Capsular Membrane Suture Fixation of IOLs

Howard V. Gimbel, MD, MPH and Hala Marzouk, MD

Part Two          Noncapsular Fixation

Section I          Iris Suture Fixation

Chapter 26        Peripheral Iris IOL Fixation—Rationale and Results

Garry P. Condon, MD

Chapter 27        Iris Suture IOL Fixation

Nicole Fram, MD; Samuel Masket, MD; and Steven Naids, MD

Chapter 28        Double-Needle Iris Suture Fixation for Dislocated IOLs

John C. Hart Jr, MD

Chapter 29        Complications of Iris-Sutured IOLs

Brandon D. Ayres, MD

Section II         Transscleral Suture Fixation

Chapter 30        Corneoscleral Pocket Technique

Richard S. Hoffman, MD; I. Howard Fine, MD; Annette Chang Sims, MD; and Janet M. Lim, MD, MBA

Chapter 31        Transscleral Gore-Tex Fixation of Akreos AO60 IOL

Brandon D. Ayres, MD

Chapter 32        Transscleral Gore-Tex Fixation of enVista IOL

Matthew S. Ward, MD

Chapter 33        Gore-Tex Scleral Fixation—Vitreoretinal Perspective

Ehsan Rahimy, MD

Chapter 34        Modified Cow-Hitch Suture Fixation

Alison Fraenkel, BBiomedSc, MBBS, MScMed(OphthSc) and Lawrence Lee, MBBS, FRANZCO, FRACS

Chapter 35        No-Tilt, Four-Point Transscleral Fixation of PMMA Posterior Chamber IOLs

Michael E. Snyder, MD and Gregory S. H. Ogawa, MD

Chapter 36        Techniques for Sulcus Fixation of Single-Piece Acrylate IOLs

Kenneth J. Rosenthal, MD, FACS and Nandini Venkateswaran, MD

Chapter 37        Complications of Transscleral-Sutured Posterior Chamber IOLs

Andrew McAllister, FRANZCO and Peter Beckingsale, MBBS, FRANZCO

Section III        Intrascleral Haptic Fixation

Chapter 38        Sutureless Intrascleral Haptic Fixation

Gabor B. Scharioth, MD, PhD

Chapter 39        T-Fixation Intrascleral Haptic Fixation Technique

Toshihiko Ohta, MD, PhD

Chapter 40        Glued IOL—Rationale and Results

Dhivya Ashok Kumar, MD(AIIMS), FICO, FAICO, FRCS and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 41        Glued IOL—Our Technique

Soosan Jacob, MS, FRCS, DNB and Amar Agarwal, MS, FRCS, FRCOphth

Chapter 42        Glued Intrascleral Haptic Fixation IOL—My Technique

George H. H. Beiko, BM, BCh (Oxon), FRCSC

Chapter 43        Supracapsular Glued IOL Technique for Progressive Zonulopathy

Soosan Jacob, MS, FRCS, DNB

Chapter 44        Complications of Glued IOL

Ashvin Agarwal, MD and Priya Narang, MS

Chapter 45        Yamane Double-Needle Technique—Rationale and Results

Shin Yamane, MD, PhD

Chapter 46        Yamane Double-Needle Intrascleral Haptic Fixation—My Technique

Melina I. Morkin, MD and Naveen K. Rao, MD

Chapter 47        Yamane Double-Needle Intrascleral Haptic Fixation—My Technique

Steven G. Safran, MD

Chapter 48        Yamane Double-Needle Technique—Kim Modification

D. Brian Kim, MD

Chapter 49        Learning the Yamane Technique—Pearls and Pitfalls

Kourtney Houser, MD; Joshua Duncan, DO; Mitchell P. Weikert, MD; and Zaina Al-Mohtaseb, MD

Chapter 50        Complications of Double-Needle Flanged Intrascleral Haptic Fixation

Jason Jones, MD

Chapter 51        New Techniques for Gore-Tex Suture Fixation of IOLs

Yuri McKee, MD, MS

Chapter 52        Case Selection for Intrascleral Haptic Fixation

Priya Narang, MS and Ashvin Agarwal, MD

Section IV        Anterior Chamber IOL

Chapter 53        Anterior Chamber IOL—Rationale and Results

Neel Dave Pasricha, MD and Ayman Naseri, MD

Chapter 54        Anterior Chamber IOL—My Technique

Bryan S. Lee, MD, JD

Chapter 55        Anterior Chamber IOL Complications and Management

Marjan Farid, MD and Allison R. Jarstad, DO

Section V         Iris Claw IOL Fixation

Chapter 56        Iris Claw IOL Fixation—Rationale and Results

Jose L. Güell, MD, PhD; Paula Verdaguer, MD, PhD; Daniel Elies, MD; Felicidad Manero, MD;
Oscar Gris, MD, PhD; and Merce Morral, MD, PhD

Chapter 57        The Artisan Iris Claw Lens for Anterior Iris Fixation

Kenneth J. Rosenthal, MD, FACS and Nandini Venkateswaran, MD 

Chapter 58        Iris Claw IOL Following Subluxated IOL Exchange

Thomas Kohnen, MD, PhD, FEBO

Chapter 59        Iris Claw IOL Fixation—Our Technique

Ravijit Singh, MS; Kiranjit Singh, MS; Harmit Kaur, MS; Indu Singh, MS; and Daljit Singh, MS, DSc

Part Three        Miscellaneous

Chapter 60        IOL Power Calculation With Sulcus or Noncapsular Fixation

Warren E. Hill, MD, FACS

Chapter 61        Corneal Considerations for Noncapsular IOL Fixation

Sadeer B. Hannush, MD

Chapter 62        Strategies for Managing Posterior Capsule Rupture

David F. Chang, MD

Chapter 63        Pars Plana Anterior Vitrectomy for the Anterior Segment Surgeon

Lisa Brothers Arbisser, MD

Chapter 64        Anterior Vitrectomy Pearls

D. Brian Kim, MD

Chapter 65        Anterior Vitrectomy Concepts

Steve Charles, MD

Chapter 66        Trocar Anterior Chamber Maintainer

Dhivya Ashok Kumar, MD(AIIMS), FICO, FAICO, FRCS; Athiya Agarwal, MD, DO; and
Amar Agarwal, MS, FRCS, FRCOphth

Chapter 67        Siepser Sliding Slip Knot

Steven B. Siepser, MD, FACS

Chapter 68        Single-Pass Four-Throw Pupilloplasty

Priya Narang, MS; Ashar Agarwal, MS, FRCS; Ashvin Agarwal, MD; and
Amar Agarwal, MS, FRCS, FRCOphth

Chapter 69        Ultrasound Biomicroscopy Evaluation of Optimal Ciliary Sulcus IOL Suture Fixation Site

Takeshi Sugiura, MD

Chapter 70        New Guide Needles for Yamane Intrascleral Haptic Fixation Technique

Brandon D. Ayres, MD

Chapter 71        Yamane Double-Needle Stabilizer

Shin Yamane, MD, PhD

Financial Disclosures


About the Editors

David F. Chang, MD is a summa cum laude graduate of Harvard College and Harvard Medical School. He completed his ophthalmology residency at the University of California, San Francisco (UCSF), where he is now a clinical professor. Having chaired the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee, Dr. Chang has been on the ASCRS Board and Executive Committee since 2009 and served as the 2012-2013 president. He is past chair of the American Academy of Ophthalmology (AAO) Cataract Preferred Practice Pattern Panel and in 2009 completed his 5-year term as chair of the AAO Annual Meeting Program Committee. Dr. Chang co-chairs the joint ASCRS-ASRS (American Society of Retina Specialists) task force on hemorrhagic occlusive retinal vasculitis and the joint ASCRS-AAO-OOSS (Ophthalmic Outpatient Surgery Society) task force on ophthalmic instrument cleaning and sterilization. He also co-chairs the ASCRS Foundation and serves on the medical advisory boards of the Himalayan Cataract Project and Project Vision.

Dr. Chang is one of only 3 ophthalmologists to ever receive the Charlotte Baer Award, which annually honors the most outstanding clinical faculty member at the UCSF Medical School. In addition to the Standard, Senior, and Lifetime AAO Achievement awards, Dr. Chang was the first 4-time AAO Secretariat Award recipient (2003, 2006, 2007, and 2009). He has been honored by the following international ophthalmology organizations: ASCRS (Binkhorst Medal), AAO (Kelman Lecture), Asia-Pacific Association of Cataract & Refractive Surgeons (Lim Medal), United Kingdom & Ireland Society of Cataract & Refractive Surgeons (Rayner Medal), Canadian Society of Cataract and Refractive Surgery (Award of Excellence/Stein Lecture), Canadian Ophthalmology Society (Sally Letson Lecture), All India Ophthalmology Society (President’s Lecture), Indian Intraocular Implant & Refractive Society (Gold Medal), Italian Ophthalmological Society (Strampelli Medal), International Intraocular Implant Club (IIIC Medal), American-European Congress of Ophthalmic Surgery (Visionary Award), International Society of Refractive Surgery (Presidential Recognition Award), Chinese American Ophthalmology Society (Pioneer Award), DOC-German Ophthalmic Surgeons (DOC Innovator Lecture), Royal Australia and New Zealand College of Ophthalmologists (Gregg Medal), and the Asia-Pacific Academy of Ophthalmology (Jose Rizal International Medal). Including these, Dr. Chang has delivered a total of 40 named lectures. He has twice been voted the fifth most influential ophthalmologist in the world by the international readership of The Ophthalmologist.

Dr. Chang served as chief medical editor of EyeWorld and Cataract & Refractive Surgery Today. He is the author or coauthor of more than 120 peer-reviewed papers. Dr. Chang was the textbook editor of Cataract Surgery Today and SLACK Incorporated’s Curbside Consultation in Cataract Surgery and Mastering Refractive IOLs: The Art and Science. Dr. Chang was also the series editor for the Curbside Consultation Ophthalmology textbook series and the principal author of two editions of Phaco Chop and Advanced Phaco Techniques: Strategies for Complicated Cataracts, all published by SLACK Incorporated.