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Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature.

ABSTRACT: Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned with an angled 20-guage microvitreoretinal blade 1.5 mm away from the limbus in line with pre-existing defective scleral flap underneath which the exposed haptic is tucked securely. Following this, conjunctival autograft (CAG) with fibrin glue application is undertaken to combat conjunctival fibrosis. In three patients, where this technique was performed, had well-tucked haptic and maintained visual acuity with no complications at 3-months follow-up. This technique is a useful method of tucking extruded haptic after SFIOL in eyes subjected to multiple previous surgeries.

SUBMITTER: Agarwal R

PROVIDER: S-EPMC7942097 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature.

Agarwal Rinky R Todi Vishnu V Bafna Rahul Kumar RK Asif Md Ibrahime MI Sharma Namrata N

Indian journal of ophthalmology 20210301 3

Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned ...[more]

PMID: 33595520

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Project description:PURPOSE:Carpal tunnel release (CTR) is a common surgical procedure, representing a financial burden to the health care system. The purpose of this study was to test whether the choice of CTR technique (open carpal tunnel release [OCTR] vs endoscopic carpal tunnel release [ECTR]), surgical setting (operating room vs procedure room [PR]), and anesthetic type (local, monitored anesthesia care [MAC], Bier block, general) affected costs or payments. METHODS:Consecutive adult patients undergoing isolated unilateral CTR between July 2014, and October 2017, at a single academic medical center were identified. Patients undergoing ECTR converted to OCTR, revision surgery, or additional procedures were excluded. Using our institution's information technology value tools, we calculated total direct costs (TDCs), total combined payment (TCP), hospital payment, surgeon payment, and anesthesia payment for each surgical encounter. Cost data were normalized using each participant's surgical encounter cost divided by the average cost in the data set and compared across 8 groups (defined by surgery type, operation location, and anesthesia type). RESULTS:Of 479 included patients, the mean age was 55.3 ± 16.1 years, and 68% were female. Payer mix included commercial (45%), Medicare (37%), Medicaid (13%), workers' compensation (2%), self-pay (1%), and other (3%) insurance types. The TDC and TCP both differed significantly between each CTR group, and OCTR in the PR under local anesthesia was the lowest. The OCTR/local/operating room, OCTR/MAC/operating room, and ECTR/operating room, were associated with 6.3-fold, 11.0-fold, and 12.4-16.6-fold greater TDC than OCTR/local/PR, respectively. CONCLUSIONS:Performing OCTR under local anesthetic in the PR setting significantly minimizes direct surgical encounter costs relative to other surgical methods (ECTR), anesthetic methods (Bier block, MAC, general), and surgical settings (operating room). CLINICAL RELEVANCE:This study identifies modifiable factors that may lead to cost reductions for CTR surgery.

Dataset Information

Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature.

Publications

Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature.

Similar Datasets

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