Twist-and-Out IOL Exchange Followed by Yamane Intrascleral Fixation

Altan A. Ozcan, MD

Eyetube

A 61-year-old functionally monocular patient who had undergone multiple retinal detachment surgeries presented with visual impairment secondary to IOL dislocation. Atlan A. Ozcan, MD, demonstrates an IOL exchange using the twist-and-out technique, followed by Yamane intrascleral fixation of a new IOL.

Genetically Predisposed to Capsular Bag Instability

Melanie R. Daulton, MD, Kevin M. Miller, MD

Cataract and Refractive Surgery Today

Fibrin Glue in Retina Surgery

This tried-and-true tool may be a valuable tamponade alternative.

Lawrence Chan, MD; Tanner Frediani, MD; and Gaurav K. Shah, MD

Retina Today

KEY TAKEAWAYS Vitreoretinal surgeons have used fibrin glue off-label as a localized hemostatic agent in the setting of trauma, iatrogenic retinal breaks, and diabetic neovascularization, and as a form of retinopexy/tamponade to treat rhegmatogenous retinal detachment. When using fibrin glue intraocularly, the retinal surface must be carefully dried under air. The thick component of the glue is applied first, followed by the thin component shortly after. Potential complications with the use of fibrin glue include displacement of the glue posteriorly, subretinal migration, and epiretinal membrane or proliferative vitreoretinopathy formation because fibrin can act as a scaffold. Fibrin glue, a biologic tissue adhesive that recreates the final step of the coagulation cascade, has been a common tool in ophthalmic surgery for decades. It consists of fibrinogen and thrombin, and when the two components are combined, they quickly polymerize into a fibrin clot. That clot forms a temporary scaffold that adheres tissues together.1 Fibrin glue is often used in anterior segment surgery, such as conjunctival closure in strabismus surgery, conjunctival autografts in pterygium surgery, sealing wounds and perforations in corneal surgery, and amniotic membrane transplantation for ocular surface disease.2-6 The use of fibrin glue in vitreoretinal surgery is more recent and still evolving. Surgeons have used it as a localized hemostatic agent in the setting of trauma, iatrogenic retinal breaks, and diabetic neovascularization, and as a form of retinopexy/tamponade to treat rhegmatogenous retinal detachment (RRD).7-13 Here, we share the surgical steps and considerations for using this tool in your retina OR (Video). Video. Fibrin Glue-Assisted RD Repair   THE PROBLEM WITH TRADITIONAL TAMPONADES Tamponade agents such as gas (eg, air, SF6, C3F8), silicone oil, and perfluoro-n-octane (PFO) are effective, but they come with several constraints and potential complications.