Purpose:
To develop a novel, sutureless, single-piece, nonfoldable intraocular lens (IOL) intrascleral fixation technique based on the existing Malbran IOL scleral fixation and Yamane double-needle techniques.
Methods:
The novel method uses a 5.0 polypropylene suture and a bipolar cautery to create 2 flanges in the eyelets of the IOL and 2 flanges outside to insert inside the scleral tunnel and thus fixate the IOL.
Results:
This technique had been applied in 4 patients with aphakia after phacoemulsification complications. The mean preoperative and postoperative corrected distance visual acuities were 0.45 ± 0.17 and 0.67 ± 0.27 (Snellen decimal units), respectively.
Conclusions:
The 4-flanged technique improves and simplifies the existing single-piece, nonfoldable IOL intrascleral fixation techniques.
A new technique for fixating the capsular bag in patients with ectopia lentis is presented. In this technique, the capsulorhexis is performed using a femtosecond laser, followed by the insertion of a standard capsular tension ring to redistribute capsular forces. The nucleus is hydroprolapsed into the anterior chamber and nuclear disassembly is performed above the iris plane to reduce zonular stress. Finally, a 5-0 polypropylene monofilament is used to fixate a capsular tension segment and subluxated capsular bag. This novel double-flanged method, achieved with cautery, does not require direct suturing of the monofilament on the sclera. This article describes the use of this new technique in 3 eyes, 2 in patients with Marfan syndrome and 1 in a patient with microspherophakia.
A 29-gauge model test fine needle is used to create a beveled intrascleral tunnel; with microforceps, a 6-0 polypropylene suture is placed in the bore of the needle, which is used as a guide to pass and externalize the monofilament through the sclera. This maneuver is repeated by passing the suture ends through the intraocular lens (IOL) eyelets. The folded IOL is inserted and centered, the sutures are cut, and the flanges are created by thermocautery and inserted into the scleral tunnel. This technique was performed on 7 patients and visual acuity was recorded. The 4-flanged technique for scleral fixation using a 4-eyelet IOL was an effective and a safe treatment in the setting of aphakia.
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