Intraocular Suture Looping Technique for Flapless Four-Point Refixation of Dislocated Intraocular Lenses

Abstract

Purpose. To describe a flapless/grooveless technique for four-point refixation of a dislocated intraocular lens (IOL) with four fenestrated haptics. Methods. An intraocular suture looping technique was performed with the assistance of two 27-gauge needles. A looping needle was passed into the eye through paracentesis and was used to loop both fenestrated haptics on the same side with an 8–0 polypropylene thread. A guiding needle was used to guide the looping needle out of the eye at the scleral fixation sites. After looping each pair of fenestrated haptics on nasal/temporal sides with 8–0 polypropylene sutures, the IOL was refixated by definitive knotting. The exterior suture ends were buried into the sclera without the creation of scleral flaps/grooves. Results. The technique was employed in four eyes (three patients). The mean postoperative follow-up period was 13.8 ± 2.2 months. Postoperatively, the IOLs of all the eyes remained well positioned and stable. The postoperative visual acuities of all the eyes were improved. No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. Conclusion. The present technique provides minimal surgical invasion for the transscleral refixation of a dislocated IOL with four fenestrated haptics.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks

“…Recently, 4-point scleral fixation has been applied for IOL implantation in the absence of capsular support. 6,7 It dramatically increases stability and reduces the possibility to tilt of IOL around to points at which it is sutured, which has been documented more than 10 degrees in 11.4% to 16.7% of cases using traditional 2-point scleral IOL fixation. 8 To the best of our knowledge, this is the first study reporting 4-point scleral fixation of complete dislocated IOL-capsular bag complex, which combines the advantages of both capsular hook and 4-point scleral fixation in vitrectomized eye with IOL-capsular bag complex dropping onto the retina.…”

“…Recently, 4-point scleral fixation has been applied for IOL implantation in the absence of capsular support 6,7 . It dramatically increases stability and reduces the possibility to tilt of IOL around to points at which it is sutured, which has been documented more than 10 degrees in 11.4% to 16.7% of cases using traditional 2-point scleral IOL fixation 8 .…”

“…6 Ophthalmologists remain in ongoing dilemma for the treatment of patients with COVID-19 infection that have ocular conditions requiring immunosuppression. 7 In terms of management, there is no evidence for prophylactic treatment of patients with preexisting disease, such as uveitis or herpes zoster ophthalmicus, who will be planning to have COVID-19 vaccination or have active infection.…”