Native means of graft stabilization: Host descemetic scaffolding and wound scaffolding to decrease the risk for graft detachment in DMEK and PDEK.

The main postoperative complication of Descemet membrane endothelial keratoplasty and pre-Descemet endothelial keratoplasty (PDEK) is graft detachment. We report a technique in which the host Descemet membrane or the incision is used for graft scaffolding. The descemetorhexis is created 0.5 mm smaller than the graft from between 1 quadrant to 360 degrees, preferably in two opposite quadrants. Using the Jacob technique of pressurized air infusion (air pump-assisted PDEK), the host Descemet membrane is gently teased from under the graft with a reverse Sinskey hook and allowed to overlap the graft from the posterior aspect in a scaffolding manner. Wound scaffolding within the incision is attained by pulling any overlapping part of the graft into the inner part of the corneal incision instead of allowing it to lie posterior to the inferior lip. Both these scaffolding maneuvers give an extra degree of scaffolding or support that provides graft stability and thereby decreases the risk for graft detachment.

Recognizing and Managing Bullous Descemet Detachment Secondary to Accidental Hydroseparation During Phacoemulsification/Cataract Surgery by Relaxing Descemetotomy.

PURPOSE: To report a new technique called relaxing Descemetotomy for treatment of bullous Descemet detachment (BDD) secondary to accidental hydroseparation of Descemet membrane (DM) during stromal hydration in cataract surgery. METHODS: A clear corneal keratome entry was created close to the limbus extending inward to create a relaxing cut (ab externo relaxing Descemetotomy) on taut DM, thus creating an egress route for supra-Descemetic fluid (SDF). This was followed by pneumodescemetopexy to drain SDF internally. RESULTS: Three patients with a history of unsuccessful pneumodescemetopexy and with planar or mildly convex separation of DM without break on anterior segment optical coherence tomography (ASOCT) underwent this procedure. All had successful reapposition of DM clinically and on ASOCT. All showed resolution of stromal edema and improved uncorrected and best-corrected visual acuity postoperatively. CONCLUSIONS: Rarely stromal hydration performed with an irrigating cannula positioned too close to the posterior stroma can result in hydroseparation of DM creating BDD, seen intraoperatively as a fluid wave propagating across the posterior aspect of the cornea. Large folds, free mobility, and DM tear classically seen with rhegmatogenous Descemet detachment are not seen clinically or on ASOCT in BDD. Pneumodescemetopexy alone cannot resolve BDD because without a DM tear, SDF cannot evacuate. Combining relaxing Descemetotomy with pneumodescemetopexy allows SDF to drain internally and Descemet detachment to resolve. This technique has numerous advantages over classical venting incisions in terms of ease, preferable limbal location, larger incision size, absence of complications such as visual axis scars, irregular astigmatism, epithelial ingrowth, infectious keratitis, etc.

Combined interface tattooing and fibrin glue-assisted sutureless corneal resurfacing with donor lenticule obtained from small-incision lenticule extraction for limbal dermoid.

We describe a technique of small-incision lenticule extraction (SMILE)-assisted sutureless corneal resurfacing with interface tattooing for superficial limbal dermoids. After excision at a plane minimally below surrounding normal cornea and sclera, a corneal tattoo powder is carefully applied within an inked circular outline of the intended corneal margin. Circularity and cosmesis are assessed in natural light with the microscope light off. Fibrin glue-assisted corneal resurfacing is performed with the lenticule. The conjunctiva is closed with glue. The technique was performed in 3 patients, who had satisfactory cosmetic and refractive effects and decreased corneal astigmatism (follow-up 12 to 25 months). The technique is safe, effective, and fast with good cosmetic and refractive effects. It retains tectonic stability and decreases the risk for complications such as intraoperative perforation, postoperative limbal ectasia, and visible corneal scarring. A similar technique with a microkeratome-created thin flap on a donor cornea was alternatively performed by us in the absence of donor lenticules.

Air Pump-Assisted Graft Centration, Graft Edge Unfolding, and Graft Uncreasing in Young Donor Graft Pre-Descemet Endothelial Keratoplasty.

PURPOSE: To assess an air pump-assisted technique for graft centration, graft edge unfolding, and graft uncreasing while performing pre-Descemet endothelial keratoplasty (PDEK) using young donor grafts. METHODS: Continuous pressurized air infusion was used for graft centration, graft edge unfolding, and graft unwrinkling. RESULTS: Ten eyes of 10 patients underwent PDEK with donors aged below 40 years. In all eyes, the donor scrolled into tight scrolls. In all cases, the air pump-assisted technique was effective in positioning and centering the graft accurately and in straightening infolded graft edges and smoothing out graft creases and wrinkles. Endothelial cell loss was 38.6%. Postoperative best-corrected visual acuity at 6 months was 0.66 ± 0.25 in decimal equivalent. Continuous pressurized air infusion acted as a third hand providing a continuous pressure head that supported the graft and prevented graft dislocation as well as anterior chamber collapse during intraocular maneuvering. Adequate maneuvering space was available in all cases, and bleeding, if any, was tamponaded successfully in all cases. CONCLUSIONS: Although very young donor grafts may be used for PDEK, they are difficult to center and unroll completely before floating against host stroma. An air pump-assisted technique using continuous pressurized air infusion allows successful final graft positioning even with very young donor corneas. It thus makes surgery easier as several key steps are made easier to handle. It additionally helps in tamponading hemorrhage during peripheral iridectomy, increasing surgical space, preventing fluctuations in the anterior chamber depth, and promoting graft adherence.

Sequential segmental terminal lenticular side-cut dissection for safe and effective small-incision lenticule extraction in thin lenticules.

Small-incision lenticule extraction may be associated with complications such as partial lenticular dissection, torn lenticule, lenticular adherence to cap, torn cap, and sub-cap epithelial ingrowth, some of which are more likely to occur during low-myopia corrections. We describe sequential segmental terminal lenticular side-cut dissection to facilitate minimally traumatic and smooth lenticular extraction. Anterior lamellar dissection is followed by central posterior lamellar dissection, leaving a thin peripheral rim and avoiding the lenticular side cut. This is followed by sequential segmental dissection of the lenticular side cut in a manner that fixates the lenticule and provides sufficient resistance for smooth and complete dissection of the posterior lamellar cut without undesired movements of the lenticule. The technique is advantageous in thin lenticules, where the risk for complications is high, but can also be used in thick lenticular dissection using wider sweeps to separate the lenticular side cut sequentially.

Preliminary Evidence of Successful Near Vision Enhancement With a New Technique: PrEsbyopic Allogenic Refractive Lenticule (PEARL) Corneal Inlay Using a SMILE Lenticule.

PURPOSE: To describe a new technique (PrEsbyopic Allogenic Refractive Lenticule [PEARL] inlay) using an allogenic corneal inlay prepared from a small incision lenticule extraction (SMILE) lenticule. METHODS: A SMILE lenticule of specified thickness (mean: 61.5 ± 3.32 µm) was trephined at the center to 1-mm diameter and implanted in the cornea on the coaxially sighted light reflex under a femtosecond laser-created cap of 120 µm in the nondominant eye of presbyopic patients. RESULTS: Four emmetropic presbyopic patients underwent PEARL inlay implantation in the nondominant eye. In the operated eye, uncorrected near visual acuity at 33 cm improved from J8 to J2 in one and from J5, J6, and J7, respectively, to J2 in three operated eyes with improvement between three and five lines in all eyes. Uncorrected intermediate visual acuity ranged between J3 and J5 at 67 cm and uncorrected distance visual acuity remained 20/20 in the operated eye and binocularly. The patients were comfortable and reported independence from glasses for near, intermediate, and distance for all of their routine visual tasks for the 6-month follow-up period. There were no complaints of dysphotopsia or troublesome night glare/halos. All lenticules remained well centered during the follow-up and no lenticule-induced complications were seen. All patients reported satisfaction with the surgical procedure. Topography showed a central area of prolateness corresponding to the PEARL inlay. The inlay was not visible on naked eye examination. CONCLUSIONS: This preliminary study demonstrates the safety and efficacy of a PEARL corneal inlay for presbyopic correction. Further studies are recommended to determine long-term outcomes. [J Refract Surg. 2017;33(4):224-229.].

Supracapsular glued intraocular lens in progressive subluxated cataracts: Technique to retain an intact vitreous face.

We describe a technique to prevent late intraocular lens (IOL) subluxation and dislocation that can be associated with progressive zonulopathy. Supracapsular glued IOL fixation is done to retain an intact anterior hyaloid face and avoid vitreous disturbance while providing stable long-term IOL fixation. Phacoemulsification is followed by glued IOL implantation above intact anterior and posterior capsules. Sclerotomies are created ab interno in a supracapsular plane under diametrically opposite lamellar scleral flaps without entering the vitreous cavity. Haptics are externalized in the supracapsular plane and tucked into intrascleral tunnels. Intraoperative or postoperative posterior capsulorhexis or capsulotomy and anterior capsule relaxing cuts can prevent capsule phimosis.

INTRAOCULAR LENS SCAFFOLD TO PREVENT INTRAOCULAR FOREIGN BODY SLIPPAGE.

PURPOSE: To report the application of intraocular lens (IOL) scaffold technique in intraocular foreign body (IOFB) removal. METHODS: Patient with IOFB in posterior segment is included. The IOFB is retrieved from the posterior segment (pars plana vitrectomy and exteriorization of the IOFB from the retinal surface using an intravitreal forceps via the posterior capsulotomy) and placed on the iris. A three-piece posterior chamber IOL is placed in the sulcus via the clear corneal incision. IOFB is then removed from the anterior chamber over the IOL by forceps. RESULTS: Metallic IOFB of 4 mm × 3 mm has been retrieved by IOL scaffold technique after rescuing it from the posterior segment. There has been no drop or slip of IOFB in the vitreous during removal. Posterior chamber IOL served as scaffold during IOFB removal from anterior chamber. CONCLUSION: The IOL scaffold maneuver has shown to prevent slippage by acting as a barrier between the IOFB and the vitreous.

Secondary Angle-Closure Glaucoma Due to Posterior Synechiae of Iris Following Combined Phacoemulsification and 23-Gauge Transconjunctival Vitrectomy.

PURPOSE: To describe the clinical characteristics of eyes with secondary angle-closure glaucoma following combined phacovitrectomy. METHODS: Retrospective case series. RESULTS: Nine eyes developed angle-closure glaucoma due to iris posterior synechiae with an incidence rate of 1.82% (95% CI: 0.64 - 3%) among 493 eyes following phacovitrectomy. PDR with TRD was the most common surgical indication. Single piece IOL insertion and silicone oil were present in all cases. Fibrin in the anterior chamber was found in six eyes postoperatively. Mean degree of iris bombe was 310±79.37° at 3.55±1.87 weeks with a mean IOP of 32.56±5.89 mm of Hg. Systemic diabetes and grade of cataract were the only significant risk factors (r2 =1; p= 0.016 and 0.049, respectively). Nd:YAG laser PI relieved the angle-closure attack in all cases. CONCLUSION: Systemic diabetes and advanced grade of cataract are significant risk factors for secondary angle-closure glaucoma following combined phacovitrectomy.

White ring sign for uneventful lenticule separation in small-incision lenticule extraction.

We describe the white ring sign, which differentiates the posterior and anterior lenticular planes in small-incision lenticule extraction. The sign identifies the plane of dissection by the anteroposterior relationship between the dissecting instrument and the circular white light reflected from the lenticular side cut. Differentiating the planes enables the surgeon to dissect the anterior plane before the posterior plane, which facilitates smooth lenticule extraction and prevents complications such as cap tears, partial lenticule dissection, and a torn lenticule. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Closed-chamber haptic reexternalization for posteriorly displaced sclerotomy and inadequate haptic tuck in glued posterior chamber intraocular lenses.

UNLABELLED: The glued posterior chamber intraocular lens (PC IOL) requires externalization of a sufficient length of both haptics to obtain an adequate intrascleral tuck, which is vital for stable IOL fixation. One cause of a decreased length of externalized haptic may be a sclerotomy that is inadvertently placed posteriorly. We describe a technique to handle this situation by creating a fresh sclerotomy anterior to the first one, followed by internalizing the haptic and reexternalizing it through the new sclerotomy. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Ocular manifestations in hyperornithinemia-hyperammonemia-homocitrullinuria syndrome: a rare association.

PURPOSE: To report ophthalmic features in hyperornithinemia-hyperammonemia-homocitrullinuria syndrome, an uncommon presentation. METHODS: Case report. RESULTS: An 18-year-old Indian boy presented with progressive diminution of vision, night blindness, lenticular opacities, and midperipheral chorioretinal atrophy. Spectral domain optical coherence tomography revealed myopic foveoschisis, and Humphrey visual fields 30-2 showed peripheral field constriction. He had no neurocognitive disabilities. Serum biochemical analysis revealed hyperornithinemia, hyperglycinemia, and raised ornithine/citrulline ratio suggestive of hyperornithinemia-hyperammonemia-homocitrullinuria syndrome. CONCLUSION: Ocular findings of midperipheral chorioretinal degeneration with myopic foveoschisis can be the initial presenting manifesation of hyperornithinemia-hyperammonemia-homocitrullinuria syndrome.

Implantation of glued intraocular lenses in eyes with microcornea.

PURPOSE: To evaluate the intraoperative modifications for and vision outcomes after implantation of glued intraocular lenses (IOLs) in eyes with microcornea. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective case series. METHODS: Eyes with a horizontal cornea of 10.0 mm or less were evaluated for intraoperative modifications and postoperative vision after implantation of a glued IOL. The type of surgery, type of IOL, incision and optic sizes, haptic length modifications, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and postoperative complications were analyzed. RESULTS: A glued IOL was implanted in 15 eyes to treat subluxated cataract (9 eyes), aphakia (5), and intraoperative capsule loss (1). In cases involving a subluxated cataract, implantation of the glued IOL was followed by lensectomy (7 eyes) or intracapsular cataract extraction (2 eyes). The mean follow-up was 22.4 months ± 17.2 (SD). The mean horizontal corneal diameter and axial length were 8.0 ± 0.6 mm and 21.0 ± 2.4 mm, respectively. The mean amount of IOL haptic trimmed intraoperatively was 1.54 ± 0.33 mm. There was significant correlation between the horizontal corneal diameter and the amount of haptic trimmed (P = .000). The mean size of the main incision was 3.70 ± 0.98 mm. Three-piece foldable IOLs with a 6.0 mm optic were used. There were no cases of haptic extrusion or subconjunctival haptic placement. There was statistically significant improvement in CDVA (P = .032) and UDVA (P = .012) after surgery. CONCLUSION: Glued IOLs were safely implanted in eyes with microcornea using modifications such as custom haptic trimming and 6.0 mm optic foldable IOLs. FINANCIAL DISCLOSURE: Dr. Amar Agarwal is a paid consultant to Staar Surgical Co. No other author has a financial or proprietary interest in any material or method mentioned.

Long-term assessment of tilt of glued intraocular lenses: an optical coherence tomography analysis 5 years after surgery.

PURPOSE: Long-term assessment of the optic position of glued transscleral fixated intraocular lens (IOL) with optical coherence tomography (OCT). DESIGN: Prospective observational case series. PARTICIPANTS: Patients with a minimum 5 years' follow-up after glued IOL surgery were included. METHODS: Postoperatively, IOL position was examined by anterior segment OCT (Carl Zeiss Meditec) and the scans were analyzed in 2 axes (180°-0° and 270°-90°) using MatLab (Mathworks). Best-corrected visual acuity (BCVA; Snellen's charts), Orbscan, retinoscopy, refraction, and slit-lamp biomicroscopy were performed. MAIN OUTCOME MEASURES: The distance between the iris margin and the anterior IOL optic (D1, D2), slope of the line across the iris and IOL, the slope ratio between the IOL and iris, IOL tilt, and optic surface changes were determined and correlated with the astigmatism and vision. RESULTS: A total of 60 eyes (mean follow-up of 5.9±0.2 years; range, 5-6 years) were evaluated. There was a significant correlation (P = 0.000) between the slope of iris and the IOL in horizontal and vertical axes. The mean D1 and D2 were 0.94 ± 0.36 and 0.95 ± 0.36 mm, respectively. Nine of 60 eyes (15%) had pigment dispersed on the IOL surface. Twenty-one eyes (35%) had optic tilt detected on OCT and 65% of eyes had no optic tilt. The mean angle between the IOL and the iris was noted to be 3.2 ± 2.7° and 2.9 ± 2.6° in horizontal and vertical axes, respectively. The mean ocular residual astigmatism (ORA) was 0.53 ± 0.5 diopters. There was no difference in the ORA between the eyes with and without tilt (P = 0.762). There was no correlation (P = 0.348) between the ORA and BCVA. Position of the IOL was not dependent on the type of lens, age of the patient, or the preoperative surgical indication. CONCLUSIONS: Long-term analysis with OCT demonstrated good IOL positioning without any significant optic tilt in patients with glued IOL fixation.

Glued capsular hook: technique for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses.

We describe a technique that uses a capsular hook to obtain sutureless fibrin glue-assisted transscleral fixation of the capsular bag. The hook passes through a sclerotomy created under a scleral flap and engages the capsulorhexis rim, providing scleral fixation intraoperatively and postoperatively. A standard capsular tension ring expands the capsular fornix. The haptic of the hook is tucked into a scleral tunnel for postoperative fixation. The scleral flap is closed with fibrin glue. The glued capsular hook is used for subluxated cataracts and IOLs. It anchors the capsular bag to the sclera, providing vertical and horizontal stability, and stabilizes the bag intraoperatively and postoperatively. The technique was used in 7 patients, who were followed for more than 4 months.

Clinical outcomes of glued transscleral fixated intraocular lens in functionally one-eyed patients.

PURPOSE: To analyze the indications, visual outcome, mental status, and quality of life after glued transscleral fixated intraocular lens (IOL) in functionally one-eyed individuals. SETTING: Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective observational comparative case series. METHODS: Patients with one functioning eye with surgical indications (aphakia, luxated IOL, or dislocated lens) and the fellow eye with no perception of light were included. Indications, uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), mental status (Amsterdam Preoperative Anxiety and Information Scale) and quality of life (visual function scoring VF-14) were assessed. Outcomes of nonsurgical and surgical management were evaluated and compared. RESULTS: Of 22 patients, 10 (45.4%) patients underwent glued IOL (group A) and 12 (54.5%) wore spectacles (group B). There was a strong association between the initial clinical presentation and management (χ, P=0.000). Subluxated cataract and dislocated lens (or IOL) required surgical treatment. Postoperative aphakia with adequate spectacle correction were conservatively treated. There was change (P=0.005) in UDVA and CDVA after glued IOL surgery. There was no loss of CDVA. There was difference between the 2 groups in reading small prints (P=0.021), sporting activities (P=0.000), and night driving (P=0.000). Surgical anxiety was higher in group B (P=0.014). Females were more anxious than the males (P=0.014). There was an association of increasing age and the decision for nonsurgical management (χ, P=0.005). CONCLUSION: Glued transscleral fixated IOL can be safely performed in one-eyed patients for specific indications to provide good functional results.

Modified technique for combining DMEK with glued intrascleral haptic fixation of a posterior chamber IOL as a single-stage procedure.

PURPOSE: To describe changes in the surgical technique required for combining Descemet membrane endothelial keratoplasty with glued intrascleral haptic fixation of a posterior chamber intraocular lens ([IOL] glued IOL) as a single-stage surgery in patients diagnosed as having aphakic or pseudophakic bullous keratopathy. METHODS: Six patients with corneal decompensation and inadequate capsular support requiring implantation/exchange of an IOL underwent a single staged glued IOL with Descemet membrane endothelial keratoplasty at a tertiary care center. Stability of the anterior chamber and structure of iris diaphragm-IOL complex were assessed intraoperatively by injecting air and, when required, iridoplasty was performed. Patients were observed postoperatively. RESULTS: One patient had partial graft detachment requiring re-bubbling and 1 patient had a small peripheral detachment with spontaneous resolution. The graft remained attached in all patients. An iridoplasty was required for 2 patients. Visual acuity improved in all patients. The mean preoperative and postoperative corrected distance visual acuity were 0.11 ± 0.07 and 0.7 ± 0.17, respectively. There was significant change in the corrected distance visual acuity after surgery (P = .028). The mean postoperative endothelial cell density at 6 months was 1,710.3 ± 205.8 cells/mm(2). CONCLUSIONS: Descemet membrane endothelial keratoplasty with glued IOL provides stable IOL with decreased pseudophacodonesis for better graft fixation. Iris diaphragm covering IOL optic all around is essential to restore bicamerality, allows sufficiently sized, non-migrating air bubbles, and decreases graft detachment and dislocation both intraoperatively and postoperatively. A need for iridoplasty must be confirmed intra-operatively.

Pre-Descemet's endothelial keratoplasty (PDEK).

A new surgical technique for endothelial keratoplasty is described, in which the composite of pre-Descemet's layer (Dua's layer) with Descemet's membrane and endothelium is transplanted subsequent to the removal of the recipient's Descemet's membrane. The technique was performed in five eyes of five patients, with successful attachment of the graft and good postoperative visual recovery in all cases. Postoperative optical coherence tomography showed good graft attachment without interface abnormalities and a mean graft thickness was 28±5.6 µm. This study demonstrates the practicality of the technique, termed pre-Descemet's endothelial keratoplasty (PDEK), which can be a viable option in endothelial keratoplasty with some potential advantages.

Glued trans-scleral intraocular lens exchange for anterior chamber lenses in complicated eyes: analysis of indications and results.

PURPOSE: To determine the clinical outcomes after glued trans-scleral posterior chamber intraocular lens (IOL) exchange for anterior chamber (AC) IOL. DESIGN: Retrospective case series. METHODS: Eyes with AC IOL explantation with glued IOL implantation in a single setting at the Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, India, from 2008 through 2012 were included. Data were collected from the patient records. MAIN OUTCOME MEASURES: Corrected distance visual acuity (CDVA) in logarithm of the minimal angle of resolution units, intraocular pressure, AC reaction, AC depth, central corneal thickness, central macular thickness, endothelial cell density, and endothelial cell loss (percentage) were determined before and after IOL exchange. RESULTS: Thirty-eight eyes with mean follow-up of 24.1 ± 15.4 months (range, 8 to 60 months) were analyzed. The indications were corneal decompensation (39.4%), malpositioned AC IOL (28.9%), uveitis (15.7%), glaucoma (13.1%), and broken haptic (2.6%). There was significant improvement in the postoperative CDVA (P = .000) and central corneal thickness (P = .000) after AC IOL removal. CDVA better than 20/60 was obtained in 65.7% eyes. Thirty-four (86.8%) eyes showed an increase in the CDVA after IOL exchange. The mean endothelial cell loss was 3.4 ± 2.4% (range, 0.13% to 10.5%). There was significant correlation between the CDVA and the central corneal thickness (P = .000). There was significant change in the AC depth (P = .000), the intraocular pressure (P = .005), and the AC inflammation (P = .000) after IOL exchange. The preoperative macular edema in 3 eyes resolved after surgery (mean central macular thickness, 205.6 ± 7.2 µm). CONCLUSIONS: Glued trans-scleral fixated posterior chamber IOL exchange for AC IOL can be an excellent alternative in eyes with ocular complications related to AC IOL.

Clinical outcomes of intraocular lens scaffold surgery: a one-year study.

PURPOSE: To evaluate the safety and 1-year outcome of the intraocular lens (IOL) scaffold technique in eyes with soft to moderate nuclear remnants after intraoperative posterior capsule rupture (PCR). DESIGN: Single-center, retrospective, interventional, noncomparative, consecutive case series. PARTICIPANTS: A total of 20 eyes of 20 patients who had intraoperative PCR underwent IOL scaffold surgery in a tertiary clinic. METHODS: A retrospective analysis of medical records of a consecutive series of patients who underwent IOL scaffold surgery from August 2011 to February 2013 was reviewed. All surgeries were performed by a single surgeon, and a 3-piece, 6.0-mm optic, acrylic, foldable IOL with a modified C-loop haptic configuration was implanted in all eyes. MAIN OUTCOME MEASURES: The preoperative and postoperative parameters evaluated were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), specular microscopy, gonioscopy, ultrasound biomicroscopy, central macular thickness, intraocular pressure (IOP), and anterior and posterior segment inflammation. The final visual outcome at 1 year was evaluated. RESULTS: At 1-year follow-up, the mean postoperative UDVA and CDVA in Snellen's decimal equivalent was 0.58 ± 0.15 and 0.90 ± 0.17, respectively. The IOL was placed in the sulcus for 14 eyes and in the capsular bag for 3 eyes, and glued intrascleral fixation of IOL was performed in 3 eyes. The mean postoperative refractive error at the final examination was -0.4 ± 0.05 diopter (standard error of mean). Postoperative CDVA of 20/20 and 20/30 was achieved in 75% (15 eyes) and 25% (5 eyes), respectively. There was no correlation between preoperative specular count and percentage loss of cells (P = 0.602; r(2)=0.015). The mean central macular thickness at 1 year was 182.5 ± 11.79 µm. Clinical macular edema was observed in 1 of 20 eyes (5%). CONCLUSIONS: The IOL scaffold provided an effective, relatively noninvasive means of emulsifying moderate to soft nuclear remnants in eyes with intraoperative PCR, with a good visual outcome and a favorable complication rate.