This document discusses the history and evolution of iris clip intraocular lenses (IOLs). It describes generations of IOL designs from 1949 to present day. Key developments include Binkhorst's iris clip lens in 1965 and Worst's iris claw lens in 1978, which pioneered iris fixation without sutures. Modern iris clip IOLs are made of PMMA or foldable materials, have vaulted designs for clearance, and fixate to the iris periphery for unrestricted pupil function. They are indicated for lens implantation in cases of cataract or aphakia.
Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
Boris Malyugin, M.D., PhD.'s presentation about Malyugin Ring® pearls. The key learning points of the presentation include the step-wise approach in managing small pupils, the main drivers for the decision to use pupil expander device, and the Malyugin Ring® implantation and removal pearls.
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
IOL implantation in the absence of capsular bagcrisnemato
Manejo de la ectopia lentis y de los implantes secundarios en ausencia de soporte capsular.
Comparativa entre las diferentes opciones quirúrgicas y protocolo de actuación.
Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
Boris Malyugin, M.D., PhD.'s presentation about Malyugin Ring® pearls. The key learning points of the presentation include the step-wise approach in managing small pupils, the main drivers for the decision to use pupil expander device, and the Malyugin Ring® implantation and removal pearls.
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
IOL implantation in the absence of capsular bagcrisnemato
Manejo de la ectopia lentis y de los implantes secundarios en ausencia de soporte capsular.
Comparativa entre las diferentes opciones quirúrgicas y protocolo de actuación.
Guide to Gastrostomy Tubes, developed by a pediatric NICU nurse as an educational and take-home tool for patient families. (c) Rady Children\'s Hospital-San Diego, 2012
IRIS Recognition is Fast Developing to be a Fool Proof And Fast Identification Technique. It is a classic Biometrics Application that is in an Advanced stage of Research all Over the world.
Title Secondary posterior chamber IOL (PC IOL) Implantation-made simple
Author(s) Dr zia u Mazhry FRCS, FCPS
Abstract Objective:
1. To classify Indications and to discuss surgical planning for secondary PC IOL implantation
2. To elaborate variations of surgical procedure required to manage different situations encountered in secondary PC IOL implantation.
Synopsis:
Secondary PC IOL implantation in aphakics is an established procedure. Variation of surgical procedure are required to manage different situations. The status of posterior capsule may vary from intact to partially deficient or totally absent. Similarly the technique has to be varied from simple implantation to synechiolysis to anterior vitrectomy combined with single or double haptic trans-scleral fixation of PC IOL.This course will present simplified approach to manage secondary IOL implantation.
Presentation Instruction Course
Subspecialty ophthalmology,Cataract
Education Level advance
Course Format lecture
Target Audience general
Course Length 60 minutes
Program english
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
the IUA Administrative Board and General Assembly meeting
Step by step IRIS clip
1. Step by Step Iris Clip
Dr Rahul Achlerkar
Dr Vijay Shetty
2. HISTORY
Italian scientist Tadini in mid 18th century first considered
intraocular lens implantation.
In 1895, Casamata implanted glass IOL which sank
posteriorly.
English ophthalmologist Sir Nicholas Harold Lloyd Ridley
is credited for first successful IOL implantation on November
29th 1949, at St. Thomas’ hospital in London.
Sir Harold Ridley (1906-2001)
3. EVOLUTION AND DEVELOPMENT
Generation-I (1949-1954)
Biconvex PMMA PCIOL
Implanted behind iris after ECCE
Diameter – 8.32 mm; Power – 24 D
Complications:
•Inferior decentration
•Posterior dislocation
•Inflammation
•Secondary glaucoma
4. Generation-II (1952-1962)
Early Anterior Chamber IOLs
Fixation of lens in angle recess
Advantages:
Less decenteration
Decreased reaction
Complications:
•Corneal decompensation
•Pseudophakic Bullous keratopathy
•Uveitis
•Secondary glaucoma
•UGH syndrome
EVOLUTION AND DEVELOPMENT
5. Generation-III (1953 – 1975)
Iris supported or iris fixated IOLs
Advantages:
It is away from angle structures hence
rate of complications like secondary
glaucoma is less.
Rate of dislocation is less.
Less contact with corneal endothelium
hence lesser damage to it.
•Complications:
•Iris chaffing
•Pupillary distortion
•Chronic inflammation
•CME
•Distortion on pupillary dilatation
•Endothelial decompensation
EVOLUTION AND DEVELOPMENT
6. Why the Iris?
Iris is the ”toughest” tissue within the eye
The iris is a resilient tissue.
Pigmented tissue in nature is usually associated with being “tough”
7. Iris
Macroscopic appearance.
1. Ciliary zone.
It presents series of radial streaks
due to underlying radial blood
vessels
2. Pupillary zone.
Is relatively smooth and flat.
8. The Iris consists of
Pupil Border
The sphincter mechanism of the
pupil border is functioning due to a
smooth muscle with a great
constricting and dilating capacity.
9. Anatomy of the Iris
The stroma connects to a sphincter muscle (sphincter pupillae)
It contracts the pupil in a circular motion, and a set of dilator muscles
(dilator pupillae) which pull the iris radially to enlarge the pupil, pulling it
in folds.
10. Anatomy of the Iris
Sphicnter pupillae muscle Dilator pupillae muscle
11. Pupil Dilatation Mechanism (3 concentric
areas)
The central part is highly mobile dilatable and constrictable
The paracentral thickened area lies at two-third from the iris
base
The iris base is immobile.
12. Binkhorst’s (1965)-
Iridocapsular Lens
Posterior haptics in capsular bag with anterior
loops removed.
In 1970 Binkhorst and Worst employed a trans-
iridectomy suture for fixation mechanism-
MEDALLION lens.
EVOLUTION AND DEVELOPMENT
14. Discovery of the Iris Claw principle
Using an early model, the Slotted Medallion lens, Jan Worst
sometimes observed that some iris tissue was caught in the slot
of his lens.
This clasping of iris tissue proved to be a serendipitously
discovered new possibility for stable fixation of the IOL.
Once the efficacy of this additional fixation method had been
proven in a number of cases additional iris stitching seemed no
longer necessary.
15. Peripheral Iris Supported IOLs
The design was relatively
simple
One piece, one material,
without additional loops.
The fixation mechanism is
based on the enclavation of a
fold of iris tissue.
16. In 1997 an improved vaulted design of the ARTISAN®
Aphakia Lens was introduced with a number of new
characteristics.
The lens configuration was made vaulted to create distance to
the iris
Enclavation was made easier by using a lens with a larger and
oval aperture between optic and haptics than the original
circular shape.
18. Lens Design
“Iris Bridge” support
The fixation points of these
lenses are located in the
virtually immobile part of
the peripheral iris
The “iris bridges” form a
shield and protect the cornea
from touching the PMMA
haptics of the IOL.
The Iocare /ARTISAN® Aphakia IOL
19. Since the start of the original design of the Iris Claw lens
(1978), the fixation concept of this lens has remained
unchanged
Only the lens design has slightly changed in 1997 (vaulted
design and oval aperture).
21. Unrestricted dilatation
The haptics (fixation arms) attach to the midperipheral virtually
immobile iris stroma, thus allowing the pupil unrestricted
ability to dilate &constrict
Fluorescein angiographic studies by Strobel1 and Izak2 have
shown no leakage of the iris vessels at the enclavation sites.
Only a few cases of iris atrophy in the area of the fixation have
been reported in the literature
23. Lens Manufacturing
Compression Molding Technology
During the compression molding process the molecular
structure of PMMA is enhanced by redistributing the molecules
into longer chains, resulting in a much stronger material.
25. Extreme flexibility of the haptics
Compression Molding Technology gives a high tensile
strength, combined with flexibility of the lens haptics.
The risk of fracture is minimal.
Proprietary Tumbling Process
The proprietary tumbling process gives a special surface
treatment to IOLs.
An ultra smoothness of the IOL is the result.
26. Technical Specifications
Lens type: AC/ PC Iris
Fixation (“ Iris Bridge”)
Lens material: Perspex-CQ
UV
Fixation: Mid-Peripheral,
Iris Stromal Support
Overall diameter: 8.5 mm
Body diameter: 5.4 mm
27. Technical Specifications
Optic diameter: 5.0 mm
Total height: 0.76 mm
Weight: 8mg in air (20D
lens)
Sterilisation: Ethylene
oxide
AC Depth: 3.3 mm
A-constant: 115.0
(Ultrasound)
115.7 (Optical)
28.
29.
30. Powers available: +2.0 D to
+30.0 D (1.0 D increments)
+14.5 D to +24.5 D (0.5 D
increments).
32. Paediatric Aphakia IOL
Lens type: AC Iris Fixation
(“Iris bridge”);
Lens material: Perspex-CQ
UV;
Overall diameter: 6.5 mm;
Body diameter: 4.4 mm;
Optic diameter: 4.4 mm;
Total height: 0.56 mm;
Weight: 8mg in air (20D
lens);
- 6.5mm overall size
33. Benefits
The “iris bridge” protects the
endothelium from touching the
PMMA
Safe clearance from vital
structures (corneal endothelium);
Unrestricted pupil dilatation and
constriction (sphincter
independent)
Excellent centration; once fixated
the lens will not decenter
“vaulted” lens configuration
34. Iris clip Angle Supported
lens
Sclera sutured PC
IOL
Safety Excellent,
predictable
Angle related
complications
Sutures can erode
and
refraction unstable
Outcomes Excellent,
predictable
Angle related
complications
Refraction not
predictable,
lens tilt,
hemorrhage and
secondary glaucoma
Clinical History 30+ years Removed from
many
markets
30+ years
Toric option Yes No No
Suturing
required IOL
No No Yes
Fixation options Iris Angle Sclera, sulcus, iris
35. Next Generation of Iris Fixated IOLs
Foldable lens body thus
permitting a small incision.
Small incision, 3.2 mm
Controlled folding and
unfolding
Reversible treatment
Aspherical edge design
Large optical zone
39. Other Indications
Iris fixated Custom-made IOLs include lenses for the
treatment of unique ocular conditions like
Coloboma,
Diplopia
There are two categories of Custom-made lenses:
Iris Reconstruction IOLs (made of coloured & clear PMMA)
Pupil Occluder for Diplopia Correction (made of black
PMMA).
40. Iris fixated Reconstruction IOLs
IOLs with coloured haptics (blue, brown, green or black) are
ideal for anterior segment reconstruction when iris damage has
occurred or is already congenitally present.
Even large iris colobomata can be covered by the coloured
haptic of the IOL.
41.
42. Pupil Occluder for Correction of
Diplopia
Another application of the iris base Fixation Concept is Pupil
Occlusion in case of intolerable Diplopia due to ocular muscle
imbalance.
The Pupil Occluder functions as a cover over the pupil to
prevent double images.
Occluder is made of black polycarbonate and covers the pupil
completely
Due to the vaulted configuration it can be applied in both
phakic and aphakic eyes
44. The main features are:
Minimal risk surgery
The anatomy of the iris and its specific features allow surgery
with minimal risks. Fixation is performed to the iris periphery.
Pressure free iris fixation
No iris atrophy when the recommended surgical technique is
used
45. indications
Senile cataract with severe zonular dialysis
Traumatic cataract
Congenital or juvenile cataract with subluxation
Secondary implantation after aphakia.
46. Contraindications
Recurrent or chronic iritis
Rubella cataract
Retina and optic nerve defects;
Corneal distrophy (except in preparation for penetrating
keratoplasty)
Acute inflammation
Severe iris atrophy
Uncontrolled chronic glaucoma
57. Peripheral iridectomy or iridotomy
Although all Aphakia IOLs are vaulted ,it is highly
recommended to perform an iridectomy or iridotomy.
The pigment layer needs to be perforated completely
An iridectomy or iridotomy has to be made to avoid a postop
pupil block
It can also be used to manage an unwanted iris prolapse.
58. Retropupillary Fixation Technique
As recommended by A. Mohr, M.D.
A technique is recommended with a 12 o’clock frown incision
(corneo-scleral 5.5mm)
Authors from Bursa-Turkey use a scleral tunnel incision to
avoid the formation of postoperative astigmatism.
The width of the incision should be 5.5 mm.
59. Do not constrict the pupil
Leave the pupil at a minimum size of approximately 3mm to
allow the lens to reach the retropupillary position through the
pupil.
use of high viscosity viscoelastic
Inject a small amount of viscoelastic from the periphery of the
eye, but never directly into the pupillary area
60. Implantation of the iol
The IOL will be inserted into the anterior chamber with the
convex side downwards (upside down) holding it in the
forceps.
With a manipulator, the IOL will be brought into the horizontal
position from 3 o’clock to 9 o’clock.
61. iol fixation on the iris
After the IOL has been brought behind the iris and the pupil is
constricted, the IOL will be lifted and tilted slightly in order to
show the contour of the“claws” through the iris stroma.
A fine spatula is inserted and exerts gentle pressure on the
slotted centre of the lens haptic, the “claw”.
The same manoeuvre is now repeated on the other side.
The IOL is now retropupillary fixated.
63. Peripheral iridectomy
It is not absolutely essential and strictly recommended to
perform an iridectomy
removal of all viscoelastic
Carefully remove all of the viscoelastic to avoid a high pressure.
Suturing
Close the incision with sutures.
65. INTRA operative problems
Macular burns
The light of the surgical
microscope may cause
damage to the macula during
surgery
Prevention
Use a protecting filter on the
microscope or cover the
pupil with a surgical sponge
.
66. Iris Prolapse
An iris prolapse occurs more
often when making a
corneoscleral incision, than
making a tunnel incision
Prevention
Place one or two sutures
after the insertion of the lens
and before the enclavation.
Solution
Make an iridectomy as soon
as possible.
67. Lens not centered properly
A decentered IOL may cause
glare or halos
Prevention
Check the centration of the
IOL on the pupil after
removal of the viscoelastic.
Solution
It can be corrected by re-
enclavation
68. Insufficient Iris Enclavation
Insufficient Iris Enclavation
can lead to postoperative
dislocation
Prevention
Use the specific instruments
developed for the Aphakia
IOL implantation
Solution
Re-enclavate a dislocated
IOL
69. Subluxation
After ocular trauma or spontaneously, luxation of one of the
claws can occur, leading to subluxation of the IOL
when a too small amount of iris tissue is enclavated, The IOL
has to be reenclavated
immediately to minimize endothelial damage.
70. Secondary surgical interventions
Lens repositioning
Is necessary after lens decentration and in cases in which a
preventive repositioning was performed
in subjects with too small amounts of enclavated iris tissue.
Lens replacement
An IOL can be removed and replaced by a new Aphakia IOL.
71. Articles of Interest
Long-term follow-up of the corneal endothelium after
artisan lens implantation for unilateral traumatic and
unilateral congenital cataract in children: two case
series.
Odenthal MT, Sminia ML, Prick LJ, Gortzak-Moorstein N, Volker -Dieben HJ. Cornea 2006;
25(10):1173-7.
RESULTS: Endothelial cell loss 10.5 yrs after iris fixated IOL
implantation for traumatic cataract was substantial & related to the
length corneal scar of original trauma . In children operated for
congenital cataract , no difference was found in CECD in operated &
unoperated eyes after 9.5 yrs after artisan iols
73. Dr Vijay Shetty
Dr Suhas Haldipurkar
Dr Shweta Rao
Dr Maninder Singh Setia
A RETROSPECTIVE ANALYSIS OF IOL POWER
CALCULATION AND POSTOPERATIVE RESULTS OF
IRIS CLIP IOL
WOC 2011
Abu Dhabi
74. AIM
• To study the post operative visual outcome in retrofixed
iris clip IOLs with respect to uncorrected visual acuity and
best corrected visual acuity
• To study the refractive outcome in iris clip IOLs using IOL
master and various formulae
• To study the prevalance of PXF, Trauma, Marfan’s
syndrome, retinal tears, cystoids macular oedema and
retinal detachment in patients who underwent iris clip
IOL
75. CONCLUSION
Retrofixed iris clip IOL is a relatively a safe procedure in
eyes with no capsular support. Trauma, PXF and Marfan’s
syndrome were associated in 41%, 14% and 14%
respectively .IOL was required in 5/26 (19%). Similar IOL
refixation was noted in both horizontal and vertical
fixation.CME: 2/26, Uveitis: 1/27, Retinal Hole: 1/27 in our
population,
Hoffer Q formula predicted the IOL power most
accurately for iris clip IOLs consistently in eyes with
varied axial length followed by Holladay and SRK T.
76. Books
1. Cataract and IOL
Daljit Singh, Jan Worst, Ravijit Singh, Indu R. Singh. 1993
Chapter 20: Iris Claw Lens, page 82-97
2. A Colour Atlas of Lens Implantation
Chapter 13: Iris-fixated lenses, evolution and application – Jan
Worst, page 79-87
3. Iris Claw Lens or Lobster Claw Lens of Worst
Alpar JJ / Fechner PV, 1986