OBJECTIVE: To evaluate and compare the clinical outcomes of three different methods of intraocular lens (IOL) implantation in the surgery of subluxated cataracts.
METHODS: In this retrospective, comparative, clinical interventional study, the medical records of patients who underwent IOL implantation with sutureless 27-gauge needle-assisted transconjunctival intrascleral (Group 1), Z-suture knotless transscleral (Group 2), and Cionni capsular tension ring (Cionni-CTR) assisted (Group 3) simultaneously with subluxated cataract extraction between June 2010 and June 2022 were evaluated. Demographic characteristics, follow-up times, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical refractive values, and spherical equivalent (SE) values of three groups were compared. Intraoperative and postoperative complications were recorded.
RESULTS: There were 20 eyes in Group 1, 35 eyes in Group 2, and 40 eyes in Group 3. In all groups, statistically significant improvement was observed in postoperative UDVA and CDVA compared to preoperative values (each p < 0.05). There was no statistical difference between the groups in postoperative UDVA and CDVA values. (p = 0.130, p = 0.167 respectively). No significant difference was observed between the groups in terms of postoperative spherical, cylindrical, and SE values (each p > 0.05).
CONCLUSIONS: The study suggests that three different IOL implantation techniques for simultaneous IOL implantation in subluxated cataract surgery have similar effects on visual and refractive outcomes.

BACKGROUND: To describe a novel surgical approach in the management of subluxated cataracts.
METHODS: A 70-year-old Caucasian male with a subluxated cataract in the left eye was referred to our clinic at the Azienda Ospedaliero-Universitaria di Bologna- Ophthalmology Unit. The ophthalmic examination revealed a best-corrected visual acuity (BCVA) of 20/200 in the left eye with monocular diplopia and a severely subluxated NO6/NC6 cataract and the fundus examination did not reveal any vitreoretinal abnormalities. The right eye had 20/20 BCVA and was pseudophakic. After a 300° conjunctival peritomy, a single 25-gauge valved trocar 4 mm was inserted from the limbus in the inferotemporal quadrant, where the cataract was mainly dislocated and a corneal paracentesis to reduce the anterior chamber intraocular pressure was performed. Subsequently cohesive viscoelastic was progressively injected in the retrolental space through the trocar, to recenter and elevate the subluxated cataract. Thereafter, a complete centered capsulorhexis was performed, four capsular hooks were inserted to stabilize the bag, and complete phacoemulsification was performed with intact posterior capsular support. In the end, given the lack of capsular support elements such as the Cionni ring or Ahmed segment, a sutureless scleral fixated intraocular lens was implanted.
RESULTS: One week after surgery, the BCVA was 20/25, and the final BCVA at 6 months was 20/20, without any complications.
CONCLUSIONS: Retrolental cohesive ophthalmic viscoelastic injection could represent a novel effective surgical approach in recentering and elevating subluxated cataracts, facilitating the capsulorhexis, and reducing the risk of a pars plana approach.

UNASSIGNED: Primary congenital glaucoma is potentially blinding condition characterized by elevated intraocular pressure and optic disc cupping. It is typically bilateral and usually manifest in the first year of life. Spontaneously arrested primary congenital glaucoma can occur, but it is very rare.
UNASSIGNED: A 32-year-old male patient from North Shewa presented to the department of ophthalmology, Menelik II Hospital with deterioration of vision. On examination he had large corneas with horizontal diameter of 14 mm, increased axial length, faint corneal stromal opacity and Haab\'s striae of both eyes. Anterior chamber angles were wide open. His intraocular pressure, optic nerve head appearance and visual field in both eyes were normal. He had subluxated dense cataract of the right eye.
UNASSIGNED: Late presentation with sequelae of primary congenital glaucoma without optic neuropathy is possible. Regular follow-up of spontaneously arrested congenital glaucoma and scleral fixation of intraocular lens is recommended.

We propose a technique for combined femto laser-assisted cataract surgery (FLACS) and limited vitrectomy from the pars-plana site for optimization of surgical results in subluxated cataracts. FLACS creates a free-floating, customised capsulotomy, minimizes stress on compromised zonules, and prechops the nucleus, effectively reducing the ultrasonic power as well as the forces required to chop the nucleus. The area of zonular dehiscence creates a direct communication between the irrigation fluid and the anterior vitreous, leading to its hydration. Trans-limbal vitrectomy creates a continuum between the liquefied vitreous and the main wound, leading to further vitreous loss, and exaggeration of the zonular weakness, while pars-plana vitrectomy avoids this by cutting the liquefied vitreous, near its attachment, thereby preventing further hydration and causing lesser stress to the zonules. A combination of these procedures, along with a capsule support device, gives favorable surgical outcomes in moderate to severe subluxations.

Polytetrafluoroethylene (Gore-Tex) suture is preferred for scleral fixation of intraocular lenses or capsular tension devices as it is more resilient to breakage than polypropylene 10-0. However, manipulation of the thick calibre and overcurved configuration of the Gore-Tex needle within the eye poses a risk of damage to the intraocular structures. Existing techniques that overcome the problem of needles within the anterior chamber involve special instruments to retrieve the suture. We describe a technique that creates a suture snare from a short segment of the Gore-Tex suture borne on a 26-gauge needle, which is used to retrieve the Gore-Tex suture safely at the scleral fixation site. The suture is threaded into the bore of the needle leaving a short length extending from the hub which is secured by inserting a 1 cc syringe acting as a handle. The needle is inserted at the scleral fixation site, and the suture trailing from the needle tip forms a loop which is externalised at the main incision. This suture snare is used to retrieve the end of the Gore-Tex suture bearing the device to the scleral fixation site when the needle and the loop of the suture are withdrawn from the eye. This technique eliminates the inappropriate needle and the need for a large sclerostomy, and is cost-effective and can also be used in combination with the conjunctival-sparing Hoffman corneoscleral pocket.

OBJECTIVE: This paper introduces a surgical technique for the sutureless management of zonular dialysis greater than 120° using a capsular tension segment (CTS) or a modified capsular tension ring (m-CTR; CTR with suturing eyelets) and a haptic removed from a 3-piece polypropylene IOL.
METHODS: A CTR is used as normal. Cataract removal is followed by connection of the CTS or m-CTR to the single haptic and created using heat to make a flange in one haptic\'s extremity. The other extremity is placed in the CTS or m-CTR\'s central hole. The CTS or m-CTR/flanged-haptic complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 30-gauge needle guides the externalization of the free haptic extremity through the adjacent pars plana and creates a flange on the second haptic tip permitting intrascleral fixation of the CTS or m-CTR.
RESULTS: The result is a successful IOL implantation with a sutureless technique.
CONCLUSIONS: This double-flanged m-CTR/CTS technique allows suture-free option for managing zonular weakness or dialysis while performing cataract surgery.