Dislocation of a Scleral-Fixated, Hydrophobic, Single-Piece Acrylic Intraocular Lens Secondary to Eyelet Fracture From Gore-Tex Suture

Abstract

Purpose: This article reports a case of the dislocation of a scleral-fixated enVista MX60 (Bausch + Lomb) intraocular lens (IOL) secondary to eyelet fracture at the point of contact with a Gore-Tex (W.L. Gore & Associates) suture. Methods: A case report is discussed. Results: An 81-year-old woman presented with decreased vision secondary to a dislocated Gore-Tex scleral-sutured enVista MX60 IOL in the left eye 14 months after surgery. The patient returned to the operating room for IOL exchange, and intraoperatively it was confirmed that the eyelet of the lens had fractured secondary to tension from the Gore-Tex suture. Conclusions: To the best of the authors’ knowledge, this is the first report of eyelet fracture in an enVista MX60 scleral-sutured IOL secondary to tension from a Gore-Tex suture.

Gore-Tex Scleral-Sutured Envista Intraocular Lens Dislocation: Three Cases and an Assessment of Eyelet Tensile Strength, Fracture Characteristics, and Risk Factors

“…13 Lens fracture at the haptic arm has been reported after fixation by the tying suture around the haptic itself, and there is a recent report of a lens dislocation because of EnVista eyelet fracture. 10,11 We report our own experience with three fractures that occurred using the SOH method with Gore-Tex suture fixation to the sclera. One of the dislocations occurred intraoperatively inside the eye from overtightening the suture with an MX60E lens, which has demonstrated lower tensile strength than the MX60 lens in vitro.…”

“…8,10 The Gore-Tex suture has been used off-label to fixate this lens to the sclera, usually 2–3 mm from the limbus. 11…”

“…EnVista eyelet fracture and concomitant intraocular lens (IOL) dislocation has recently been reported, 11 but the tensile strength of the eyelets, fracture characteristics, and its risk factors have not been assessed. Here, we present three such cases, which all occurred using the Gore-Tex CV-8 suture tied with SOH.…”

Complications of Secondary Scleral-fixated Intraocular Lens Placement

“…There have been numerous reports of eyelet breakage from MX60 occurring after Gore-Tex scleral fixation. 13,14 One tension study showed that the MX60E is particularly susceptible to eyelet breakage. 15 In comparison, the CZ70BD is a rigid IOL that must utilized a 7 mm scleral tunnel incision for insertion.…”

Management of Subluxated Lens and Spherophakia

“…A foldable one-piece hydrophobic acrylic lens with an eyelet at each optic haptic junction (enVista MX60, Bausch and Lomb, Bridgewater, NJ) has been used for this purpose [47]. However, this lens has thick square haptics, not suitable for sulcus placement, and there is a recent report of eyelet fracture leading to lens dislocation following Gore-Tex fixation of enVista lens [51].…”